Windfall and Humana have teamed as much as launch a new information trade program to enhance value-based care. Their venture, introduced on Monday, seeks to allow safe and standardized medical information sharing, streamline member attribution, lower administrative burdens and shut care gaps.
Healthcare’s poor information infrastructure is a well-documented concern. The trade’s present information administration programs are fragmented and troublesome to entry, which makes it difficult for suppliers and payers to coordinate care and monitor sufferers’ outcomes. By leveraging nationwide requirements like FHIR, the brand new program rolled out by Windfall and Humana goals to create a extra interoperable ecosystem that ensures extra well timed and correct information.
The venture additionally seeks to create a scalable framework that may be replicated throughout different payers and suppliers, mentioned Michael Westover, Windfall’s vp of inhabitants well being informatics.
Humana is an acceptable accomplice for this venture as a result of it’s a giant nationwide payer, he mentioned.
“If Windfall and a small Northwest payer did one thing, folks would say, ‘That’s nice, however how’s that going to impression the world?’ However after we begin shifting over to Humana, which has a number of attain and will impression distributors and suppliers throughout the nation, I believe we’re actually speaking about altering the way in which we do information trade as a nation,” Westover acknowledged.
He famous that value-based care solely works if information flows freely and bidirectionally between payers and suppliers. But, Windfall presently receives data in tons of of inconsistent codecs, which he mentioned creates large inefficiencies.
To assist repair this, Westover famous that the brand new program will use standardized APIs to permit for the real-time trade of rosters, claims, gaps in care and monetary information — decreasing clinicians’ guide work and sufferers’ delays.
He identified that this effort is a part of Windfall’s broader technique to scale value-based care throughout its roughly 150 threat preparations.
In Westover’s eyes, Windfall is enhancing its efficiency and high quality metrics with out requiring habits modifications from clinicians. He mentioned standardized information trade might reduce implementation timelines from 18 months to days — in addition to make this method replicable with different payers.
On the affected person facet, Westover famous that information standardization can enhance affected person matching and care coordination, making certain the fitting individual receives the fitting care on the proper time.
He linked the trouble to CMS and ONC’s push for interoperability, saying Windfall is fulfilling commitments beneath TEFCA and different federal initiatives selling open information trade.
Finally, Westover mentioned this work is about liberating healthcare from “walled gardens.”
The aim, he added, is to switch right this moment’s costly, guide data-cleaning processes with a extra standards-based trade. This manner, supplier organizations can dedicate extra of their deal with affected person care and innovation.
Picture: da-kuk, Getty Photographs
