Automates the exchange of clinical information needed to support new payment models. Helps streamline quality reporting and care coordination efforts.

JACKSONVILLE, FL – Health information network Availity today launched its suite of expanded clinical documentation capabilities, announcing that four major health plans, seven vendor partners, and multiple physician groups and hospitals are live and successfully utilizing these solutions across its network. The solution suite automates the costly, manual exchange of clinical information needed to support today’s revenue cycle, as well as emerging value-based payment models and quality improvement programs. The announcement comes as Availity participates in the annual conference for America’s Health Insurance Plans (AHIP) in Salt Lake City, Utah.
“Our business has always been about solving workflow inefficiencies faced by health plans and physicians. These challenges get bigger as the industry innovates payment structures based on quality and patient outcomes, driving greater demand for trusted clinical information,” said Russ Thomas, CEO of Availity. “With our newly launched clinical network capabilities, we are extending our proven ability to drive workflow efficiencies and cost reductions to an evolving set of payment models, while accelerating our ability to solve problems today.”
Clinical capabilities launched today by Availity include:
Inpatient Information Exchange — Enables the real-time exchange of patient admission, concurrent review, lab results and discharge information between hospitals and health plan case management staff.
Medical Attachments — Allows physician practices and hospitals to track and respond to health plan requests for documentation electronically.
Clinical Summaries — Facilitates automated extracts and submissions of information from physician EMRs to health plans for HEDIS reporting and Medicare star ratings, reducing the need for manual chart reviews.
EMR Integration with Availity® CareProfile® — Integrates patient care history information sourced from the health plans with physician EMRs, providing physicians with a more holistic view of the patient.
“The Availity network is ideally suited to expand from our core business solutions to solving tomorrow’s demand for integrated business and clinical data,” said Jon Zimmerman, general manager of clinical solutions for Availity. “Not only does today’s fee-for-service payment structure require it, but our customers are migrating toward fee-for-value models that demand an expanded information suite to support the efficient delivery of patient-centered, coordinated care.”
Availity collaborated with multiple health plans, physicians, and key solution vendors in developing these clinical capabilities, and is proud to announce a number of “early adopter” network participants who are successfully live with one or more clinical solutions:
Health Plans
• Florida Blue
• Health Care Service Corporation
• Humana Inc.
• WellPoint, Inc.
Practice Management/ Technology Partners
• athenahealth
• Care360 EHR from Quest Diagnostics
• Greenway
• Jopari Solutions, Inc.
• NextGen Healthcare
• Passport
• Recondo Technology
“Announcing new capabilities is always exciting. Doing so with a list of outstanding partners on our network who are already live and benefitting from our solutions makes it real,” said Russ Thomas. “The early adoption by so many is a testament to the industry’s need for these solutions.”
“As we move forward with new physician payment models such as ACO and PCMH, we believe that it’s important to leverage our existing success and the trusted relationship our providers have with Availity. We’re particularly excited because the new suite of clinical documentation services will help us—and our network providers–become more efficient and effective in the care management process,” said Joyce Kramzer, senior vice president of business operations at Florida Blue.
“As the nation’s largest member-owned health insurer, our extensive provider relationships help us promote healthier outcomes for our members and allow us increased opportunity to partner on programs that enable improved quality and coordination of care,” said Terri Kline, senior vice president and chief health care management officer, Health Care Service Corporation. “Availity’s expanded clinical capabilities will further enhance our relationships with providers, ultimately helping the entire health care system work more effectively.”
“Humana and Availity are now deploying our health information technology solution that enables the secure, electronic exchange of patient information between health plans, hospitals and providers,” said Brian LeClaire, senior vice president and chief service and information officer of Humana Inc. “This solution replaces costly, paper-based procedures and processes; reduces administrative burden at providers’ offices; and supports the coordinated care of patients.”
“As we have more information about the history of members in our affiliated health plans, our staff and the members’ physicians can more accurately fill in the gaps of members’ health records,” said Elizabeth Bigham, WellPoint vice president of health information technology strategy. “With a broader sharing of medical record information, gaps in care, admission, discharge and authorization information made through Availity’s network, we hope to facilitate better decision-making and more timely, effective interventions, as well as help us to maintain affordable care.”
“Through the Availity network, the Care360 platform now has increased capabilities to help improve the coordination of care by healthcare professionals,” said Richard A. Mahoney, vice president of healthcare information solutions for Quest Diagnostics, and president of its healthcare IT subsidiary MedPlus. “Care360 is a pivot point for 80,000 physician offices across the country with the 24/7 aim of access to data that supports evidence-based decision making. The addition of the Availity network strengthens this offer to those on the front lines of healing and caring.”
“The clinical data exchange made possible through the cooperation between Availity and Greenway is another success for care coordination,” said Greenway chief operating officer Greg Schulenburg. “This program is a good step forward to improve quality of care, and it is the right thing to do for our providers and their patients.”
“The ability to submit Workers’ Compensation billing and attachments electronically is a significant advantage for Availity customers” explains Don St. Jacques, senior vice president of business development and client services for Jopari Solutions, Inc., a leading nationwide eBilling connectivity supplier to the rapidly expanding Property & Casualty (Workers’ Compensation and Auto Medical) marketplace. “Enabling medical practices to have one system to handle all lines and nuances of billing workflows is the cornerstone to achieving overall administrative simplification. Workers’ Compensation revenue cycle management has long been a challenge for providers, particularly due to the attachment issue. The integrated capability provided by Availity streamlines the process, and already is achieving improved results for both the provider and payer communities.”
“Exchanging clinical data is an obvious next phase in Passport’s long-standing partnership with Availity; more specifically, doing so in the context of reimbursement and care coordination. Together, we create an unrivaled real-time network for innovation. It is exciting to see providers and plans collaborating to improve processes such as authorization, concurrent review and discharge,” said Paul K. Joiner, vice president of corporate development for Passport.
“Recondo is pleased to be offering our capabilities in hospital and health plan integration and communication to help streamline the care process,” said Rick Adam, chairman and CEO of Recondo Technology.