Humana, Providence team on data exchange initiative

Humana and Washington-based health system Providence have joined forces on an initiative to streamline and secure data exchange between payers and providers.

The collaboration establishes a scalable ecosystem for secure and standardized data sharing, the organizations said. 

By leveraging national HL7 Fast Healthcare Interoperability Resources (FHIR) standards, Da Vinci Project Implementation Guides and modern APIs, the data exchange is meant to give clinicians actionable insights while reducing administrative complexity and protecting patient privacy.

"True interoperability should serve clinicians, patients and payers,” said George Renaudin, Humana’s President of Insurance. “Together with Providence, we’re enabling providers to deliver more effective care and helping our members spend less time on paperwork and more time on their health.”

WHAT'S THE IMPACT 

According to the payer and the health system, upcoming federal regulations – such as the Centers for Medicare and Medicaid Services’ Interoperability and Patient Access Rule – will require that organizations provide standardized, secure access to health data.

Humana and Providence took early action to build the needed infrastructure, they said.

The first phase – automated member attribution for Humana Medicare Advantage members – will go live this month, allowing clinicians to quickly identify which patients are under their care, thereby eliminating manual processes and improving care coordination, they said.

Future phases will expand data exchange capabilities to further reduce administrative burden and enhance clinical decision-making, they said. Both organizations anticipate their framework will be easily replicable, serving as a scalable model for the national healthcare industry.

Humana and Providence were among the 60 organizations – including five payers and 11 health systems – that pledged to adopt the CMS Digital Health Ecosystem, thereby aligning with federal interoperability priorities, including the White House’s recent commitment to create a patient-centric healthcare ecosystem, the organizations said.

THE LARGER TREND 

Last week a Texas court struck down Humana's second lawsuit challenging Medicare Advantage star ratings released by the Centers for Medicare and Medicaid Services.

Preliminary data from last fall showed only about 25% of Humana's members are enrolled in Medicare Advantage plans rated with 4 stars or higher, down from 94% in 2024, according to Marketwatch. As the main reason for the ratings dip, Humana cited a drop in ratings for its H5216 plan, which fell from 4.5 to 3.5 stars. The plan contains about 45% of the insurer's Medicare Advantage membership and 90% of its employer group waiver plan membership.