Unlocking the Power of Bi-directional Data Exchange

Medica, a nonprofit health plan serving 1.4 million members across eight states, is tackling one of the healthcare industry’s most persistent challenges: enabling plans and providers to efficiently share clinical information. Using technology from Epic® and InterSystems, Medica coupled an enterprise-wide clinical data repository (CDR) with bi-directional connections to EHRs used by 80% of their providers as well as the plan’s many operational systems. The end result: provider data ingested by Medica’s CDR can be readily deployed by different departments and systems for multiple use cases, and plan data and insights relevant to frontline care and coding can be automatically pushed into preferred provider workflows.

Medica’s mision is to better the lives of its members with care in the moments that matter. Marshalling the right data, at the right time, in the right place has proven a powerful mechanism for advancing this mission, but largely within siloes across Medica’s 27,000 participating providers and 2,800 team members. There is no singular, national solution for automating the flow of normalized data between the mulititude of provider EHRs within most networks and the disparate systems different plan functions use. In short, Medica had to move beyond one-off integrations with individual provider EHRs and its own systems for quality, care management, utilization management, member enrollment, and claims to unlock the power of bi-directional data exchange across its full enterprise in an affordable manner.

Key to Medica’s success was the balance they struck between visionary and pragmatic thinking. Most Medica providers use Epic EHRs, so their efforts centered on scaling bi-directional data exchange with these providers. To do so, they deployed Epic Payer Platform and InterSystems Payer Connector™. InterSystems Payer Connector is an interoperability offering listed in the Epic Connection Hub on Showroom that is purpose-built to push data from and to Epic Payer Platform per Epic-defined specifications. Together, these technologies enabled Medica to automate bi-directional connectivity with the overwhelming share of their providers through a multi-point approach.

To streamline connectivity with their own internal systems - and their wide range of data standards and formats - Medica created an enterprise-wide CDR using InterSystems HealthShare Unified Care Record (UCR). HealthShare UCR enables plans to transform member data from a wide range of disparate sources into normalized longitudinal health records for individual members in real-time. Put another way, Medica used HealthShare UCR to create one source of normalized, digital truth for members to power multiple use cases throughout its own IT ecosystem and push actionable information back into Epic Payer Platform via InterSystems Payer Connector.

Medica’s efforts to unlock the power of bi-directional data exchange is an ongoing initiative. Nonetheless, within less than a year of launching this combined solution, Medica can now:

• Update provider systems with current member enrollment files every two weeks
• Parse and normalize over 700 discrete data elements from Epic Payer Platform data feeds and route select elements to internal plan systems
• Push related patient encounter data and actionable information on care and coding gaps into preferred provider workflows via Epic Health Plan Clinical Summaries, Our Practice Advisories, and Health Maintenance Reminders

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