Allscripts has struck a deal with a health plan industry vendor under which users of its ambulatory EMR will be able to send data to payers, reports InformationWeek. Under the terms of the deal, vendor Inovalon will funnel data to payers, and providers will receive patient-level analyses of the data in return.
Inovalon aggregates claims, lab, pharmacy, durable medical equipment, functional status and patient demographic for payers, according to InformationWeek. For 10 years, Inovalon has also been collecting clinical data from providers for its health plan customers. In recent times the vendor has been collecting data from EMRs using export and “screen scraping” methods.
Allscripts customers who choose to take advantage of the Inovalon deal will be able to integrate with Inovalon’s system simply by giving permission. “When a provider or provider group authorizes the integration, they don’t have to do any more work on site,” CEO Keith Dunleavy told IW. “The back end [of Inovalon] handles the rest, coordinating the data exchanges for the providers.”
Going out of the gate, Inovalon wasn’t able to say which payers would be receiving Allscripts data. However, Inovalon already serves hundreds of health plans which collectively cover about half of the insured population, Dunleavy told IW.
So why should providers want to send data to health plans in the first place?, asks IW editor Ken Terry. Inovalon CEO Dunleavy had several suggestions, including the following:
* Regulatory compliance. Providers must submit clinical data regularly for varied reasons, including processes related to claims audits, and quality assessment.
* HEDIS chart reviews. Health plans need providers to supply HEDIS data, which is required by many state insurance departments as well as CMS.
* Shared risk arrangements. As providers increasingly get into shared risk agreements with managed care plans sharing clinical and claims data effortlessly becomes critical.
I was particularly interested in the point Dunleavy made about the need for providers and insurers to share data smoothly as risk sharing arrangements mature, something that will have to happen if accountable care is to become a reality. Perhaps solutions like these will offer a more realistic approach to meeting ACOs’ data needs then the big money efforts deep pocketed industry leaders are trying out today.