Platform makes interoperability, payment easier

To make value-based reimbursement work, the nation must achieve interoperability at scale across payer, provider and vendor lines, says Amy Larsson, vice president of clinical claims management at payer vendor McKesson Health Solutions.

In a new initiative, the company has launched an interoperability and payment management platform, called the Intelligence Hub.

Today, the health system remains mired in an environment of siloed information systems, which Larsson herself experienced last year after suffering a herniated disk. She needed to find an orthopedic specialist and called her primary care physician and got a referral, but ordering an MRI and getting authorization was all done manually or by phone. The electronic records of the PCP and specialist were not connected and so neither had complete records for Larsson. When she needed another consultation in another delivery system, she had to carry her MRI records to the visit.

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The Intelligence Hub is designed to make it easier for providers, payers and third-party vendors to connect their systems across networks to electronically authorize and schedule treatment, give clinicians demographic and specialty information about other physicians in the network, and analyze the contractual obligations between providers and payers to automatically and accurately pay claims in accordance with the contract terms that each provider has made with his or her insurers, Larsson explains.

For example, an insurer could automatically be notified that a member is getting a knee replacement, according to McKesson. As claims arrive, they would be electronically parsed, processed and paid as part of a bundled payment arrangement. If a patient goes to a lab for pre-admission tests, the insurer could automatically know it is not paying for the labs based on fee-for-service, as the labs are part of the bundle.

“Over time, as payers adopt the Hub, physicians will start to see administrative duties reduce,” she predicts. “In summary, the goal is to take administrative waste out of the system for providers and payers via automation, enabling higher quality, more effective care and improved outcomes.”

Now, McKesson Health Solutions is talking with insurers about ways to educate vendors and providers on the new service.