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At HIMSS20, Change Healthcare prioritizing APIs to bridge payer, provider workflows

Change Healthcare’s big-picture goals are similar those most everywhere across healthcare nowadays, says Bill Krause, the company’s VP of experience solutions: “drive outcomes, reduce waste, increase value and support increased consumerism.”

The good news, he said, is that Change exists at a unique vantage point to help make those goals a reality: Unlike many IT vendors, whose customers are either primarily insurers or primarily hospitals, “we sit at the center of healthcare, from the standpoint of bridging data workflows across payers and providers.”

At HIMSS20, “we really want to show showcase the innovation that we’re driving and the impact that we’re delivering,” said Krause.

From an innovation standpoint, there’s lots going on at Change Healthcare right now: artificial intelligence, APIs, blockchain and new approaches to interoperability and digital experience.

From an impact standpoint, he said, “we want to connect those innovations back to how we’re delivering value to our customers, how we’re making those real.”

For example, “we think about some of the AI work we’re doing on the claims process: using the more than 500 million service lines that show up in our Change Claims Lifecycle and  applying AI to help in the prediction of denials – and therefore inform the workflow that providers are going through, from a revenue cycle standpoint, to minimize denials on the front end and save work,” said Krause. Or, for another example, “using AI with products like our CareSelect imaging decision support, which helps really improve workflow for providers.”

Change Healthcare – which just today released its new 2020 Industry Pulse Report – has already unveiled a handful of new products during the run-up to HIMSS20.

In early January, it launched its API & Services Connection, an AWS-hosted marketplace for open, standards-based API products – enabling payers, providers, vendors and independent developers to innovate new digital health tools at scale. As part of the effort, Change is offering enablement tools such as implementation guides from HL7’s Argonaut Project.

“Increasingly, our customers across the ecosystem will want to consume services and into their own applications and they want the ability to construct different solutions using APIs,” Krause explained. “So whether it’s our Eligibility API, or any variety of API, by making it available to the market in a manner that’s very easily accessible, it extends the value of our solutions and creates a lot more flexibility for our customers.”

The goal, he said, is to “accelerate innovation in healthcare, and make it much easier for a variety of players to include things like eligibility checking – but there’s also a whole portfolio of API based solutions that they’ll be able to incorporate into their own into their own offerings.”

Another new Change Healthcare update is a bunch of new enhancements to its claim attachments technology: a provider-payer data exchange tool enabling providers to submit documents and data electronically to all payers in both the Medical and Workers’ Compensation market segments.

Built on Change’s Intelligent Healthcare Platform, the new tool is meant to offer a new approach to the fragmented workflows and paper-based processes that are still so often the rule when it comes to sharing clinical and other supporting documentation with payers. That approach enables submission of documents and data within a single workflow, easing the process of claims adjudication.

“Because we’ve got that connectivity to so much of the provider ecosystem and so much of the payer ecosystem, it makes it much more scalable and efficient for us to help our customers adopt these solutions much faster.”

Bill Krause, VP of Experience Solutions, Change Healthcare

“This is another example of where we center and bridge workflows and data across payers and providers,” said Krause. “The goal here is to really accelerate the ability of our customers to convert from paper based processes, to digital processes in the back office.

“It’s utilizing the the network infrastructure we have in place to drive more transactions, to help our customers digitize more of their transaction steps – whether those are revenue cycle, things like claim attachments – as well as payments and other capabilities where there’s a lot of manual and paper-based properties that are going across industry stakeholders that are going to cost providers and payers,” he said.

“And because we’ve got that connectivity to so much of the provider ecosystem and so much of the payer ecosystem, it makes it much more scalable and efficient for us to help our customers adopt these solutions much faster.”

A big theme at Change Healthcare’s HIMSS20 booth, said Krause, will be the patient journey.

“We’ll have an interactive digital experience that’s going to map the patient journey across the patient’s different stages,” he explained. “Our teams will be talking about how, whether it’s on the clinical side, financial or engagement, how we’re ultimately helping our customers to support the patient journey in a variety of ways.”

One of those ways might be an as-yet-unannounced product, that Krause says is aimed at improving consumer experience.

“I’m not able to go into a lot of details with you at this point,” he said coyly, “but it’s focused on helping our providers create more consumer centric experiences around the access side of healthcare: connecting into our networks and bringing forward capabilities in very consumer-centric ways.

“It starts from the consumer and then works back, to the requirements and data and connectivity needed by healthcare,” he explained.

“That’s different from most of our industry today, which starts with the healthcare first standpoint – how does healthcare optimize back office and mid-office functions – and then extends to the consumer. We’re taking a fundamentally different approach in that. So we’re excited about what that means, and we’ll share a lot more around what consumers are saying and the value that this is delivering, and will deliver.”

Making blockchain work for workflows

As has been the case for the past few years, there will be plenty of discussion of blockchain at HIMSS20, from the pre-conference Blockchain Symposium to the Blockchain Session series on March 11.

But while a lot of that discussion is still often aspirational, focused on building out limited pilot projects of focusing on promising future use cases, Change Healthcare has been innovating with distributed ledger technology for some time now, and it’s become a core part of many of its products.

“We’ve made a lot of early investment in blockchain and we’ve really helped to shape and lead the industry,” said Krause.

Blockchain’s best usefulness for healthcare is similar to AI, he said, “where where the capability shows up in the course of existing workflows to make them more streamlined, to make data sharing easier, to basically improve on an existing infrastructure.”

Toward that end, Change Healthcare has been incorporating blockchain into our Intelligent Healthcare Platform.

“I’ll use claims processing as one example,” said Krause. “Rather than coming at blockchain from the standpoint of an entirely new sort of disruptive ways of applying the technology capability, our point of view is that by incorporating it into existing those existing processes, those existing solutions, that our customers are already getting value from – and and extending the value of those.

“That’s really how we’re going to drive this type of blockchain and that’s where we’re really focusing on the development and product roadmap standpoint,” he said. “We’re continuing to explore lots of new ways to leverage the technology. There’s lots of potential, lots of promise, and the way we create impact with blockchain is getting it into our existing solutions and workflows for our customers.”

Change Healthcare is in booth 6759 at HIMSS20.

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