The law, which will take effect in September, prohibits payers from requiring pre-approval from certain providers. While providers believe the law will cut administrative burdens, and improve care delivery, payers say it could lead to patient harm.
The EHR giant will integrate its payer platform with the insurer's operating system to facilitate two-way data exchange with providers. Through this integration, the organizations hope to support clinical decision-making and streamline administrative processes like prior authorizations.
Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.
The partnership between the insurer and EHR giant — announced a year and a half ago — will now focus on streamlining prior authorizations and offering providers enhanced insights about their patients. Ochsner Health will be among the first to implement the new capabilities offered by the companies.
The rule would require payers in the Medicaid, CHIP and QHP programs to build and maintain application programing interfaces to improve data exchange and the prior authorization process. But the rule does not include Medicare Advantage plans, which the American Hospital Association called "disappointing."
The company, which was a winner of the MedCity INVEST Digital Health Pitch Perfect contest, was founded with the aim of using digital technology to improve the experience and efficiency of prior authorizations, in particular determining whether they are needed.
McKesson will pay about $1.1 billion, and an additional $270 million is contingent upon CoverMyMeds financial performance the next two years.
At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.
The system connects payer networks to providers and payment systems, breaking down data silos and helping to streamline authorization, claims submission and payments.