This bidirectional exchange of clinical information between a health plan and its providers is a first, according to Availity. But it won't be the last. EHR vendors Athenahealth, Allscripts, eClinicalWorks, and GE Centricity are all integrated with Availity, and Greenway says it intends to make similar arrangements with other health plans this year. Among the plans that own Availity besides Florida Blue, and that could potentially participate with Greenway or other vendors, are Humana, Minnesota Blue Cross and Blue Shield, WellPoint, and Health Care Services Corp. (HCSC), which includes Blues plans in Illinois, New Mexico, Oklahoma and Texas.
Availity, which enables Web-based administrative transactions between providers and insurers, has long offered health plan care summaries, based on claims and other data, to physician practices on its Web portal. But until a year or two ago, relatively few providers were accessing those care profiles, which include alerts about patients' care gaps. Not only did providers have to go to a portal to obtain the information, but they also had no financial incentive to look at this data, noted Availity CEO Russ Thomas in an interview with InformationWeek Healthcare.
[ Multiple efforts are afoot to enable electronic health record systems to work together. Read EHR Interoperability A Hot Topic At HIMSS. ]
But, with the advent of healthcare reform, financial incentives have started to change, making health plan data more valuable to providers. "As payment reform models evolve, whether they're accountable care organizations or other risk-based models, there's a demand for new information types," Thomas pointed out.
The workflow barrier must still be overcome, however, and that's where the Greenway arrangement comes in.
Under the arrangement with Florida Blue, Greenway customers will be able to see care summaries containing up to two years of patient care history within their EHR. According to Justin Barnes, VP of marketing and government affairs for Greenway, these summaries will be in the form of continuity of care documents (CCDs), which many providers use to exchange clinical summaries. When these CCDs arrive, they will flow into the patient history area of the EHR for easy viewing by clinicians, he said.
Integrating this information, along with care alerts, into the clinical workflow is crucial to Florida Blue and other plans, Thomas said. "This is increasingly important to plans as they work to more effectively manage the cost of care."
Florida Blue will also be able to obtain from Greenway EHRs the data it needs to improve care management, Thomas said. Although this information will be packaged in the CCD format, it will serve a variety of purposes, including quality data collection for pay-for-performance programs and for Healthcare Effectiveness Data and Information Set (HEDIS) reporting to the National Committee on Quality Assurance (NCQA). Among the types of data that can be pulled from the EHR, he added, are demographic information, health problems, medications, allergies and progress notes.
As Greenway strikes deals with other plans, Barnes said, it will customize these functions to each insurer's needs. "We do that proactively today," he said. "We enable our customers to submit data to all of these pay-for-performance programs that are available to them. Every plan has a different kind of program."
In addition, practices will be able to attach documents, such as surgical notes, to claims and send them to Florida Blue through Availity. But as the integration between Greenway and Florida Blue's system deepens, Barnes added, that will become unnecessary, as payers will be able to simply request certain information and have it immediately transmitted to them from the EHR. The same system can be used for prior authorizations and notifications of hospital discharges and transfers.
Availity announced last June that it was expanding its clinical documentation abilities, including real-time exchange of in-patient information between hospitals and health plan case managers, medical attachments to claims, automated extracts from physician EHRs for HEDIS reporting, and EMR integration with health plan care summaries. The deal with Greenway and Florida Blue is an outgrowth of that initiative.