Allscripts Enables EHR Customers To Send Data To Payers

Deal with analytics firm Inovalon designed to relieve burden on providers while enabling online feedback from health plans.
-- Risk adjustment. Public and private payers increasingly pay providers under risk-adjusted models that require documentation of risk scores.

-- Shared risk arrangements. Many plans and providers are entering these deals, which require the exchange of clinical and claims data to succeed.

With automatic data extraction from EHRs, Dunleavy said, most of the burden on providers to supply the requisite data for these purposes disappears, "because it's all done in the background."

Allscripts struck the deal with Inovalon to provide value to its customers, said Faisal Mushtaq, GM of the company's payer and life sciences division, in an interview. Through the partnership, he said, Allscripts customers can offer payers the "depth and breadth of clinical data that is essential to payers doing a good job. At the same time, the payers can provide insights back to providers so they can do their job more effectively around their payer contracts. So under this agreement, we were able to add tremendous value to providers and make their lives easier."

The insights that providers can receive are related to issues such as risk score management (essential to risk adjustment) and patient care gaps, which should be addressed to improve outcomes, he said. Although health plans send physician practices profiles of their cost and quality performance now, he noted, they're usually outdated because they're based primarily on claims. The back-end interface between Allscripts and the payer systems, he said, will speed up the feedback while supplying more detailed data for the health plans to work with.

In fact, Dunleavy said, the partners are aiming to provide near-real-time feedback to physicians when plan members visit. Triggered by, say, an eligibility check at the front desk, the data analyses could flow back to the practice within minutes, he said.

The use of the patient data is authorized by the health plans and covered under HIPAA's provision for health plan operations, he added. Inovalon also has a business associate agreement with Allscripts, as required by HIPAA.

Faisal noted that this is not the first arrangement that Allscripts has made that involves its customers sending clinical data to health plans. It has several direct payer relationships and most of them include interfaces with those plans' back-end systems, he said. These agreements help providers and payers interact beneficially in areas like prior authorization, pharmacy benefit management, and quality improvement.

Editor's Choice
Samuel Greengard, Contributing Reporter
Cynthia Harvey, Freelance Journalist, InformationWeek
Carrie Pallardy, Contributing Reporter
John Edwards, Technology Journalist & Author
Astrid Gobardhan, Data Privacy Officer, VFS Global
Sara Peters, Editor-in-Chief, InformationWeek / Network Computing