Payers and Unified Patient Information Management

We at NaviNet believe that the future of healthcare will be patient-centric

. Having a holistic view of the patient will enable physicians to deliver more efficient and effective care. This means having all the right patient data at the right time, all in one easy-to-access location. This could include medical history, all physician and specialist visits, lab results, diagnosis, prescriptions and more. Plus, clinical decision support tools such as guidance on best practices would be available, too. The question remains as to how and when our industry can get to this nirvana of unified patient information management. And what roles do government, payers, providers, IT vendors and patients themselves have to play in this transformation of patient data lifecycle management?

Health Industry Insights' Lynne Dunbrack shares that "Undeniably, payers have more electronic health data than any other healthcare stakeholder, and so are uniquely poised to play an important role in contributing data to their own and other stakeholder electronic health records (EHRs)." We concur that payers can play an important role in creating a single patient view that assists physicians in delivering better care to their patients, and helps patients to better understand how they can take better reigns of their own health. And we have great working examples in place:

* One of NaviNet's payer customers, Aetna, uses NaviNet to deliver clinical alerts to providers. The alerts are derived though a program developed by ActiveHealth Management, an independent subsidiary of Aetna. The alerts are based on analysis of Aetna's data, including claims history, current medical, lab and pharmacy claims, and patient demographics. The data is mined on a weekly basis and is compared against thousands of evidence-based care guidelines that have been adopted within the medical community as the standard of care. Aetna also uses NaviNet to deliver personal health records (PHRs) that contain health information derived from Aetna medical and pharmacy claims and laboratory results, as well as patient-reported information.

* The AmeriHealth Mercy Family of Companies leverages an existing administrative workflow within the office -- checking a patient's insurance eligibility via NaviNet-- to deliver care gap alerts to providers via NaviNet along with the results of the eligibility inquiry. As a result, AmeriHealth Mercy has seen that care gaps are 57 percent more likely to be closed when the alerts are viewed.

To us, these examples indicate providers' increased willingness to accept clinical data from payers. Based on these experiences, we can say with a great degree of certainty that progressive payers will continue to seek partnerships with clinical decision support vendors, medical record vendors and provider and patient communications vendors to address the patient data management challenges the industry faces today and to strive for a unified view of the patient across the care delivery spectrum.

We concur with Dunbrack that a more continuous relationship between payer and member, and between patient and provider -- as well as a more streamlined way to access and exchange patient data held by all those stakeholders -- will pave the way to finally achieve more broad adoption of EHRs. Ultimately, this will help us all get closer to our point of arrival - where we in the US are proud of the way we consistently provide quality care for our fellow citizens, regardless of where they are, which providers they see, or what medical conditions or kind of insurance coverage they have. NaviNet, with the help of our payer customers and IT partners, is well on our way to facilitate such developments with the rigor and depth that is required to achieve widespread adoption.

Sincerely,

Kimberly Labow

Chief Marketing Officer

Payers and Unified Patient Information Management

By: NaviNet Inc

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