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Highmark Health and Epic to Improve Payer-Provider Collaboration with Insights from Google Cloud

Highmark Health announced its collaboration with Epic and Google Cloud to support coordination across payers and providers, and to identify insights that personalize the consumer experience and improve health outcomes.

Epic’s Payer Platform improves collaboration between health insurers and health providers. Now, by connecting to Google Cloud, the insights shared with payers and providers can be used to inform consumers of the next best actions in their care journeys. Epic’s Payer Platform enables a new level of payer-provider collaboration by driving automation, faster decision-making, and better care—while reducing burden and fragmentation at every touchpoint.

“Epic’s Payer Platform is a powerful resource that enables payers and providers to work more effectively together. Pairing that resource with Google Cloud’s technology gives Highmark Health the ability to change the paradigm,” said Tony Farah, MD, executive vice president, chief medical and clinical transformation officer, Highmark Health. “It’s another step forward in achieving better experiences for both consumers and clinicians, while improving health outcomes and lowering cost of care.”

Google Cloud data analytics technologies, like BigQuery and Healthcare Data Engine, will facilitate  insights shared with provider partner organizations that use Epic, Highmark health plan staff, and Highmark members through other integrated digital channels such as the My Highmark member portal.

“Google strives to help billions of people live healthier lives. For Google Cloud, this means helping healthcare organizations accelerate their digital transformations to support personalized health journeys,” said Amy Waldron, director, healthcare and life sciences strategy and solutions, Google Cloud. “Highmark Health’s use of Google Cloud will enable the organization to create an intelligence system equipped with AI to deliver valuable analytics and insights to healthcare workers, patients, and members. Highmark Health’s investment in cloud technology is delivering real-time value and simplifying communications; it’s redefining the provider and consumer experience.”

From a clinician’s perspective, payer-derived insights delivered to existing provider workflows in Epic give a more complete view of a patient’s health. These insights can include a patient’s conditions, history of in- and out-of-network visits, health plan benefits and programs available, insurance claims, alerts for acute events, decision support, and care management.

These insights also help providers identify high-quality care covered by their patients’ health plans. When providers have accurate information about coverage during referral selection and at scheduling, surprise out‐of‐pocket costs can be avoided, and service authorizations can be expedited.

Further, automated information sharing can trigger actions to improve health outcomes, such as creating a case for authorization, prompting acute care concurrent review, or initiating transitional care. Using enhanced analytics to improve population health performance, health systems working with Highmark can leverage health plan-calculated care gap statuses to initiate actions that achieve gap closure, to avoid unnecessary outreach, and to understand quality performance outcomes from the health plan’s perspective.

In tandem, health systems can automate the process of notifying a health plan about current or upcoming patient encounters. Notification can occur when a patient has an event, such as an arrival to the emergency department, an admission, a patient class change, or a discharge. Health plans often request to be notified when a member has been admitted to or discharged from a hospital. Without technology such as Epic’s Payer Platform, health systems administrators typically engage in time-consuming points of connection, like making phone calls or sending faxes.

“Leveraging automation for responsible data sharing is a game-changer, especially when it comes to reducing the administrative burden of relaying clinical information in various directions—to payers, providers and customers,” said Richard Clarke, PhD, senior vice president, chief analytics officer, Highmark Health. “It facilitates informed decisions without the need for manual back‐and‐forth, all within the confines of Highmark’s secure Google Cloud infrastructure.”

More than half of Highmark’s 7 million members are currently attributed to an Epic provider. For every attributed member, Highmark anticipates closing approximately 2.5 care gaps automatically, with upwards of 300 percent potential increase in care gaps closed.

Highmark Health’s 14-hospital provider system, Allegheny Health Network, estimates this shared claims data will amount to $2.7 million in annual savings, which can be reinvested into quality clinical care and patient experience.  

In addition to Epic’s Payer Platform, Highmark Health is deploying a suite of tools to improve digital enablement of provider partners, including a new provider resource center and provider portal powered by Availity.