Epic-Humana partnership 1 year later: Key accomplishments, projects in the works

In June 2019, Epic and Humana created an innovative partnership to improve patient and provider communication and health information access.

A first-of-its-kind endeavor for both parties, the partnership aimed to advance interoperability and transparency between patients and providers. At the time, Humana said it would integrate its tool to check benefits, IntelligentRx, into Epic's electronic prescribing workflow and speed up information exchange. Since then, Humana also has become the first national health plan to use Epic's Payer platform, which automates data-sharing and collaboration between payers and healthcare organizations.

One major health system has seen the manual work required to send information from its EHR to Humana cut in half, Epic and Humana say. And Humana members have seen an average $30 in out-of-pocket savings per prescription since the partnership began.

"Patients know how much they can expect to pay for medications before they go to the pharmacy because the estimated cost is included on their visit summary," said Scott Greenwell PharmD, president of Humana Pharmacy Solutions. "When providers order medications, they can see safety warnings, for example, drug interactions, low-cost alternatives and prior authorization messages."

Humana also worked with Epic on a function that will send prior authorization requests when physicians place orders. Payers then receive the clinical information needed to address the requests and send decisions back electronically. The feature is expected to be released later this year with the goal of helping patients access the care they need sooner and reduce administrative burden for clinicians.

"We are also working with Humana on a feature that could help reduce out-of-pocket costs for patients by helping clinicians understand which specialists are in network based on a patient's coverage," said Kevin Worrall, an Epic implementation executive.

"Our goal is to help healthcare organizations and payers succeed as they continue to transition from fee-for-service to value-based care," said Mr. Worrall. "For value-based care to work well, it's essential that all participants — providers, payers, and patients — have up-to-date information. In our work together, we see opportunities to continue to improve sharing among all parties to facilitate new ways to collaborate and drive better outcomes at a lower cost. We will also continue to work to reduce administrative work for healthcare providers and help patients get the care they need sooner."

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