A company whose industry reputation has long been as a clearinghouse for medical claims, Nashville, Tenn.-based Emdeon has recently expanded its boundaries as the market continues to evolve. And despite having that historical reputation, Emdeon CEO George Lazenby emphasizes that the clearinghouse business currently accounts for only about 14 percent of the company’s total revenue. “It’s a legacy of our company, and it’s an important strategic component of our business, but it’s not the majority,” he says.
Lazenby takes pride in the fact that Emdeon is “independent,” as he emphasizes. “The vision of our company, at the highest level, is to make healthcare efficient. What supports that vision is that we’re independent and central to the system. We’re not a pharmacy or a dental office or a physician office or a payer. Theoretically, when you are reducing the overall cost in a system, you could disadvantage a stakeholder. But we believe having that central position gives you an advantage in solving a problem that is very complex—in this case making healthcare more efficient.”
In recent years, Emdeon—whose wide-ranging network encompasses 340,000 providers, 1,200 government and commercial payers, 60,000 pharmacies, and 5,000 hospitals—has added applications to that independent central structure for its customers, including a suite of revenue cycle management solutions on the hospital side. And the results have been there, says Lazenby. “We have found that every efficiency that we provide in a hospital to make it more effective creates an efficiency on the payer side as well,” he says. “So the things that cause problems in the system are often a result of the unintentional consequences of the complexity of what we do.”
BIG MOVES WITH BIG DATA
These days, says Lazenby, everyone is thinking about big data. But big data is more than just a wealth of information; it is an opportunity to find insights in new and emerging types of data and content. Enter Emdeon’s recent collaboration announced at this year’s HIMSS conference with Atigeo, a Bellevue, Wash.-based data analytics company. The two companies plan to collaborate on the development of new software solutions, and will explore the use of intelligent analytics layered on top of petabytes of healthcare data to improve health outcomes. The agreement calls for using Ategio’s x-Patterns data analytics platform to rapidly expose insights abstracted across vast repositories of structured and unstructured data. Not getting the data in the right condition to review in a relevant period of time has been a problem, says Lazenby. “We want to create that platform where our customers can be advantaged by the info that’s flowing through our systems in their efforts to reduce cost of care and make their workflow more efficient.”
Atigeo CEO and founder Michael Sandoval says the combination of the data analytics platform and Emdeon’s data repository will reveal insights that would not have been possible before. He describes x-Patterns as a “data agnostic” platform with regard to whether the data is structured or non-structured. He says the way the x-Patterns platform absorbs and integrates data in a way that avoids the problems of traditional data mining with disparate data systems and dissimilar taxonomies.
“In true ‘big data,’ analysts talk about volume, variety and velocity,” Sandoval says. “We are able to do that well above the petabyte scale on the volume side, of any type of varietal, and in the velocity category in microseconds in an automated way.” He added that on the human language side, the platform is able to identify the proper context and apply the data against any existing application or workflow of the provider, “so that it appropriately optimizes the applications and workflows.”
David Talby, Ph.D., Atigeo’s vice president of engineering, says that one example of an application that was showcased at HIMSS13, was a hospital readmissions application that uses Atigeo’s analytics platform to build a statistical model for when a patient is likely to be readmitted. “We are thinking about the patient, have more signals, and we have the algorithm to actually use those signals,” he says. Talby adds that the collaboration encompasses national coverage, and that the application is compliant with the Health Insurance Portability and Accountability Act (HIPAA) regulations.
Emdeon has begun to take the next steps in terms of big data, creating views into the data that flow through the system and processes that allow its customers to have better insights in their business. For example, says Lazenby, the company’s web-based Vision for Claim Management tool (currently used by well over 100,000 providers) allows its customers to see in real time, the condition of their practices with regard to their billing, so they can see all claims processed each day. It helps them keep up with their business through a mobile device, and analytics is driving that, says Lazenby. “Instead of returning a big blob of data to our customers, we’re creating graphics and trends for them.”