Providence and Humana have teamed up to launch a new data exchange program to improve value-based care. Their project, announced on Monday, seeks to enable secure and standardized clinical data sharing, streamline member attribution, decrease administrative burdens and close care gaps.
Healthcare’s poor data infrastructure is a well-documented issue. The industry’s current data management systems are fragmented and difficult to access, which makes it challenging for providers and payers to coordinate care and track patients’ outcomes. By leveraging national standards like FHIR, the new program rolled out by Providence and Humana aims to create a more interoperable ecosystem that ensures more timely and accurate data.
The project also seeks to create a scalable framework that can be replicated across other payers and providers, said Michael Westover, Providence’s vice president of population health informatics.
Humana is a suitable partner for this project because it is a large national payer, he said.
“If Providence and a small Northwest payer did something, people would say, ‘That’s great, but how’s that going to impact the world?’ But when we start moving over to Humana, which has a lot of reach and could impact vendors and providers across the country, I think we’re really talking about changing the way we do data exchange as a nation,” Westover stated.
He noted that value-based care only works if data flows freely and bidirectionally between payers and providers. Yet, Providence currently receives information in hundreds of inconsistent formats, which he said creates massive inefficiencies.
To help fix this, Westover noted that the new program will use standardized APIs to allow for the real-time exchange of rosters, claims, gaps in care and financial data — reducing clinicians’ manual work and patients’ delays.
He pointed out that this effort is part of Providence’s broader strategy to scale value-based care across its roughly 150 risk arrangements.
In Westover’s eyes, Providence is improving its performance and quality metrics without requiring behavior changes from clinicians. He said standardized data exchange could cut implementation timelines from 18 months to days — as well as make this system replicable with other payers.
On the patient side, Westover noted that data standardization can improve patient matching and care coordination, ensuring the right person receives the right care at the right time.
He linked the effort to CMS and ONC’s push for interoperability, saying Providence is fulfilling commitments under TEFCA and other federal initiatives promoting open data exchange.
Ultimately, Westover said this work is about freeing healthcare from “walled gardens.”
The goal, he added, is to replace today’s expensive, manual data-cleaning processes with a more standards-based exchange. This way, provider organizations can dedicate more of their focus on patient care and innovation.
Photo: da-kuk, Getty Images
