With the goal of serving accountable care organizations, three Northeast Blues plans and a data aggregation/analysis vendor will acquire NaviNet Inc., a health care transactions processing vendor. Terms of the acquisition, expected to close within 30 days, were not disclosed.
The plans are Highmark Inc., Horizon Blue Cross Blue Shield of New Jersey and Independence Blue Cross, joined by vendor Lumeris. Boston-based NaviNet is a veteran processor of clinical and administrative transactions between providers and payers. The company in 2011 launched Doc Xchange to enter the clinical transactions processing arena, enabling providers to transmit medical documentation among themselves, or with insurers, government agencies and health information exchanges.
The Centers for Medicare and Medicaid Services has designated NaviNet as a Health Information Handler under the first phase of Medicare’s electronic submission of medical documentation program to automate the handling of attachments when Medicare contractors ask for additional information to support a claim.
Lumeris sells a cloud-based accountable care delivery platform that collects, aggregates and analyzes information to enable emerging ACOs and other new programs for delivering services to assess the strengths and weaknesses of potential provider partners.
Before contracting with a group practice, for example, an ACO can assess the practice’s organizational structure, payer relationships and experiences with assuming risk, information technology capabilities, panel size sufficiency for an ACO, quality and care management programs, and primary populations served, among other factors.
Three-quarters of the nation’s physicians are enrolled in NaviNet’s platform, according to the vendor, so the acquisition gives the Blues and Lumeris access to desktops. Lumeris’ capabilities will be integrated into the NaviNet platform with the new ACO platform integrated to electronic health records systems to feed patient information that can influence physician behavior.
NaviNet and Lumeris, however, will remain separate companies and continue marketing their core products to their respective markets, while also offering enhanced services to ACOs and other new care delivery methodologies.
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