Payers and providers should come together in the cloud

Payers and providers should come together in the cloud

by Brendon Nafziger, DOTmed News Associate Editor | June 27, 2013
From the June 2013 issue of HealthCare Business News magazine

A few years ago while coming back from Guatemala, I was mistaken for a terrorist or high-level drug dealer – it was never clear which one I was supposed to be. Taken aside from the rest of the passengers after we landed in Houston, I was forced to wait in a security area with a rather nervous man who insisted he was the innocent owner of a “coffee farm” in the Guatemalan highlands. Agents X-rayed all of my bags several times, opened them up and removed the lining of my suitcases to look for secret compartments. One agent even began reading aloud pages from a novel I was carrying, apparently looking for clues.

Meanwhile, other investigators had printed out what appeared to be the past five years of my air travels, and asked me what I was doing in all the cities I had visited. I explained myself, they realized their mistake, and I was on my way. But note what they were able to do with the push of a few buttons: summon up my entire flight history for the past half decade.

What if that ready access to a main repository of data were possible in medicine, but instead of tracking travelers you could look at patients, seeing the history of their medications and procedures? For the past 10 years, Dr. Emad Rizk has thought something similar was possible, and he thinks one good way to realize such a system, at least at a facility-by-facility basis, would be to break down the wall between physicians and payers.

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“The payers have claims, the providers have clinical medicine, and the two shall not meet,” he tells DOTmed Business News. “But if we connect in to the payers, that will be a huge step forward.”

Rizk, a physician and the president of McKesson Health Solutions, envisions a system that would, in effect, let physicians benefit from the rich historical clinical information contained within claims data, while also allowing better administrative decisions by embedding payer rules.

The potential clinical benefit comes from the nature of claims. When you visit a doctor’s office or hospital, claims are generated by almost every procedure, test and prescription. And giving providers point-of-care access to retrospective claims is, in many ways, like giving an airport cop a quick computer record of a flight itinerary.

“They see in my record all my drugs I’m on in the claims system,” Rizk explains. “They see everything in the last five to 10 years. It makes it easier. In the old days, when patients used to come to me, I had to figure out [their medical history] on my own.”

“All of a sudden, if you have all that information at the point of care, you can make a more data-driven and comprehensive decision,” he adds.

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