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Humana (HUM) Extends Ties for Automating Prior Authorizations

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Zacks Equity Research
·4 min read
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Following the completion of first stage of the partnership, Humana Inc. HUM recently expanded ties with Epic, which is the most extensively used comprehensive health record across the United States. This is in a bid to offer point-of-care assistance for automated prior authorizations and member insights.

On one hand, electronic prior authorizations accelerate patients’ access to care by speeding up the providers’ process of evaluating if a procedure is being covered by insurance or not. On the other hand, valuable member insights enable information derived from Humana to enhance the real-time decision-making process of providers. Notably, the information may range from previously due preventative services, medication adherence history and care coordination for known chronic diseases.

Both Humana and Epic have been working closely together for developing these capabilities with the joint aim of speeding up prior authorization decisions and alleviating the burden imposed on providers. The companies will continue to introduce other capabilities during 2021 aimed at offering decision support for specialist referrals. While recommending a patient to a specialist, the added capabilities are likely to empower physicians select in-network providers thereby bringing down out-of-network costs.

Moreover, the leading non-profit academic healthcare system of Louisiana named Ochsner Health will be one of the earliest utilizers of Humana’s offered prior authorizations and member insights.

Notably, the relation between Humana and Epic can be traced back to June 2019, when both the companies teamed up for integrating technologies aimed at safe and secured exchange of information between providers and patients. The tie-up also intended to offset the administrative burden on the healthcare system. Since then, both the companies have been sharing a strong bond, which is quite apparent from the first 18 months of the alliance. During the said time frame, clinical data of Humana’s over half a million health members have been exchanged. Also, the Real-Time Benefits Check (RTBC) platform of Humana named IntelligentRx has been put to use by over 50,000 providers within the same time frame. This platform has been providing real-time prescription benefit information through Epic’s platform.

Shares of Humana have gained 36.1% in a year compared with the industry’s rally of 33.8%.

Furthermore, the latest move underscores the urgent need of having real-time and integrated access to the medical history, health insights and treatment options available for patients. On availability of these details, it is easier for clinicians to address the diversified healthcare needs of patients by devising a suitable treatment course for them. They can also try to eliminate any barriers faced by patients while getting the much-needed care. In fact, the COVID-19 pandemic has further necessitated the importance of real-time platforms for rendering medical treatment to patients without potentially exposing oneself to the virus.

Humana has left no stone unturned to reach every corner of the United States through its Medicare and Medicaid product offerings amid the pandemic. Keeping in mind an aging U.S. population, the company has recently introduced the CenterWell brand, which will bring together the company’s senior-focused primary care centers in a bid to offer personalized health care plans for senior patients. It has also encouraged increased use of telehealth services by virtue of which its telehealth visits witnessed a spike in 2020 compared to the previous years.

Other health care providers, such as UnitedHealth Group Incorporated UNH, Teladoc Health, Inc. TDOC and Cigna Corporation CI, have also been actively developing their telehealth services.

Humana presently has a Zacks Rank #4 (Sell).

You can see the complete list of today’s Zacks #1 Rank (Strong Buy) stocks here.

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