Exchanging health data has never been easy. In fact, sharing and receiving patient data is inherently complex due to the need to safeguard privacy and security, a lack of standardization across systems, outdated technology in many healthcare organizations and numerous technical and regulatory requirements.
Today, many providers and payers still use phones, fax machines and other manual, time-intensive processes to exchange data. Even with major advances in technology, clinicians often log in and out of multiple systems to find and send the right information. These outdated workflows cost the healthcare industry nearly $25 billion annually.
Blue Shield of California believes bidirectional data exchange can transform this process, ensuring a true exchange of data flowing both inward and outward between payers and providers. The result is a better healthcare experience for members because providers can focus on patient care instead of administrative tasks.
Since joining Blue Shield in 2023, Krishna Ramachandran, senior vice president of Health Transformation and Provider Adoption, has made significant progress in this space with the rollout of the Epic Payer Platform. Here, he explains Blue Shield of California’s data exchange vision, priorities and accomplishments to date.
What is bidirectional data exchange and its benefits?
Creating a bidirectional data exchange means providers can more easily send us data and vice versa. Instead of having to log into different tools or portals to gather member data or fax information back and forth, they can send and receive data within one platform.
In addition, we’re able to deliver more meaningful insights to providers, pulling from multiple health systems to create a more holistic view of their patient’s health. At the moment, most providers have a deep but narrow view, mainly of the care delivered within their facility’s four walls. A broader view of a patient’s health journey allows the healthcare team to uncover and address important information and act on insights that can help improve quality of care.
What is the Epic Payer Platform, and how does it work?
Implementing the Epic Payer Platform across our eligible provider partners in California is a big part of our multi-pronged data exchange vision. The platform’s integrated workflows allow for more timely communication about patient care gaps, admission or discharge notifications and overall health status. It enables us to more easily acquire relevant data from providers and push insights to them to support their decision-making, and ultimately improve patient care.
The platform is a key driver for Blue Shield’s recent launch of the Member Health Record, which makes it easier for members to interact with their health information in one place. The platform also builds on Blue Shield’s efforts with Manifest MedEx to develop a network of real-time digital health records for all Californians.
Where is Blue Shield in the implementation process?
Our implementation strategy is modularized, meaning we go provider by provider to ensure that each provider group or health system is up-and-running with data flowing seamlessly. We’re live with 10 of our health systems and provider organizations and continue to roll out the platform to health systems and groups using Epic throughout California. Fortunately, it’s a relatively fast, low-lift implementation process — typically three to six weeks, depending on provider capacity. We welcome other providers in our network using Epic to join us on this journey to reduce administrative burden and help improve member health outcomes.
What are some other priorities that your team is focused on for 2024?
As the senior vice president of Health Transformation and Provider Adoption, I lead strategic partnerships and innovations to improve quality, affordability, access and equity. Our focus areas this year — or ‘big rocks’ as our team calls them — include data exchange, pay-for-value, health equity and affordability initiatives.
For example, as the industry shifts towards value-based care, we are developing and implementing new pay-for-value models with our provider partners. We’re also leading the industry in new payment models that lower costs and move toward sustainably affordable care. It’s all part of Blue Shield’s Health Reimagined initiative, which pushes us to reimagine what’s possible so that we can improve the healthcare experience for everyone.
Krishna Ramachandran, senior vice president of Health Transformation and Provider Adoption, specializes in looking at the healthcare system from the technology, provider and payer perspectives. Before Blue Shield of California, he was at Health Care Service Corporation (an independent licensee of the Blue Cross Blue Shield Association). He also spent many years on the provider side, partnering with clinicians to generate actionable insights from health data. And early in his career, he was at Epic, an electronic health record (EHR) platform used to store and organize patient data. He is grateful to have the opportunity to actively work to improve the healthcare system for members and providers.