Most Interesting Vendor: Emdeon — Simplifying the Business of Healthcare

Another aspect of the next real frontier of big data is around surveillance. To this end, Lazenby says Emdeon has started to look at specific activity, which based on the company’s central position, could prove to be very valuable to its customers. “For instance, because we see an electronic prescription flow through the system, and we see the subsequent prescription claim as a result of that prescription, you can determine that the patient was not only prescribed that prescription but also picked it up. The activity data is equally valuable from surveillance standpoint.” 

And while most healthcare analytics today are done on paid claim data that is probably 90-120 days removed from the date of service, Lazenby says that because Emdeon has access to that same information within eight days from the date of service on the medical claims side and same day on pharmacy side, it can give its customers the ability to intervene from what they derive from their analytics sooner than what they could do on their own. That’s a key to the company’s strategy, he says.

In a nutshell, Emdeon strategizes to advantage the system so it makes hospitals more effective. “All of our customers have the objective to pay accurately on time. They are not motivated to act any other way than that,” says Lazenby. “We don’t want to disadvantage either side; we just want to eliminate the inefficiencies. The better providers are at the process that we help them enable, the better the payers operation are as well. “

A real-world example of this is taking a look at a Medicaid recipient or a Medicaid advantage recipient that moved from plan to plan over the course of the relationship with the provider. If the system runs the eligibility verification transaction at the point of entry into the system, it improves the accuracy of the claim that is filed.  But if it doesn’t run that transaction, and the provider has in its patient history that Patient X is a member of Cigna, for instance, it might send the claim to Cigna not knowing that the patient switched payers. Cigna then gets that claim and if its systems aren’t paying attention to it, it may pay the bill. Now Cigna is in a situation where it paid for something it shouldn’t have and has to work to recover it. But according to Emdeon, if Cigna used the company’s eligibility service, that claim would have gone to the right payer in the beginning and efficiency would have been created. “That’s a way that it benefits the whole system,” says Lazenby. “The provider doesn’t have to go through denial process and the payer doesn’t have to go through process and claim would get routed appropriately and paid accurately.”

SOLIDFYING ITS POSITION

In the always-changing competitive landscape that is healthcare, Lazenby knows that Emdeon needs to be proactive to keep ahead of the pace. To this end, Lazenby describes how convergence has become a trend that will help Emdeon further solidify its position in the marketplace. Convergence, says Lazenby, involves stakeholders coming together (such as a payer buying a physician practice or a pharmacy performing true medical services), adding that Emdeon is well positioned to help the industry with the transition. “For example, when a pharmacist administers a medical benefit or a vaccination, Emdeon can handle that transition from pharmacy workflow to medical benefit seamlessly because we see all those stakeholders. We know a pharmacy’s workflow and processes and we also know the medical billing workflow and processes—pharmacies don’t know that.”

Lazenby also feels Emdeon’s natural point of integration will be an advantage if or when that convergence happens. “What has been key for us in being able to process the six billion transactions we do annually is the ability to integrate with an interface to virtually every system type in the industry, whether it’s a pharmacy system, payer administrative system, EMR vendor, or anything else. So when a hospital requires 15 different physician practices and they’re all on different systems, we have become a nice way for that hospital to aggregate information about those physician practices that’s in real time and monitor that behavior. If we have confidence at anything, it’s integrating,” Lazenby says.

Theoretically, getting everyone on the same system and pulling information from one’s own internal capability would be ideal. But practically, that takes years to develop, Lazenby admits. “A lot of our customers would not have to force their stakeholders to completely change their systems to get access to information that Emdeon already has. So as things converge, we help bridge the gaps and knowledge and because we’re that natural point of aggregation, we help give an enterprise-wide view for a hospital across physician practices without causing those practices to change systems and move from one vendor the next.”