KLAS: Epic’s Payer Platform Generates High User Satisfaction

Healthcare organizations using Epic’s payer platform are satisfied with the product’s performance, including its ability to deliver meaningful information without disrupting workflows, according to early findings from KLAS.

The payer platform aims to improve efficiency and patient care by connecting payers and providers and transferring information to the right places. KLAS interviewed six organizations that are currently using the platform to get an early look at users’ experiences with the product.

Most respondents chose Epic’s payer platform because they have a large share of patients covered by the vendor’s EHR and needed complete and reliable information exchange. Four organizations were highly satisfied with the platform’s overall performance, while two were satisfied. All of the respondents said they would buy the product again.

Users expected the platform to generate cost savings around clinical data acquisition and provide direct access to more complete clinical data, two feats they say were accomplished. They also expected to see reduced friction between payer and provider organizations, an outcome that is still pending.

All six organizations reported using the platform for clinical data exchange, which automates the electronic release of appropriate information to payers, and event notifications, which automatically notify payers when patients are admitted or discharged and when patients schedule, reschedule, or cancel appointments.

Half of the respondents used the payer platform for care gap exchange, which automates the exchange of care gap status and relevant details for attributed populations from the health plan to the health system. Similarly, half of the organizations used the health plan clinical summary functionality, which automates the exchange of clinical information from the health plan to the health system.

A third of respondents used the functionality that allowed for the electronic exchange of prior authorization requests, responses, and related clinical documentation.

According to users, Epic’s strengths with its payer platform include its ability to follow through on commitments and the effective training it provides to payers. In addition, users said the payer platform delivers meaningful information without disturbing workflows.

However, respondents noted that Epic’s expertise in the payer market is still maturing and there could be better layout consistency between the vendor’s payer platform and its EHR system. They also said upgrade testing could be stronger.

Success with this platform requires payers to maintain a dedicated team to manage the different functionalities, according to users. Payers would also benefit from an arrangement in which Epic hosts the product and a strategy that includes sharing its business processes with the vendor.

From Epic’s point of view, payers should form an enterprise steering committee to ensure they correctly use the clinical and demographics data they receive. Cataloging third-party vendors who make authorization decisions and provide medical necessity criteria could help automate as many authorizations as possible.

Additionally, payers should identify the highest-priority health systems to work with based on claims volumes and strategic partnerships to get the most out of the platform.