Lack of information is one of the greatest obstacles to efficient and effective health care. The data needed to save lives is available, but we must break down barriers to accessibility. A patient-centered approach can align the health care ecosystem to remove barriers.

The search for answers

Since the first early reports of a mysterious viral pneumonia surfaced in Wuhan, the world has struggled to collect information to aid decision-makers in their response to the COVID-19 pandemic. A lack of information about the nature and impact of the novel coronavirus has led to an international effort to collect and analyze any available data that can generate actionable insights, slow and prevent outbreaks, mitigate economic damage, and save lives.

Efforts to collect timely, relevant, and accurate information have been crippled by the chronically deficient state of health care information technology, a state in which health care data is siloed by organizational, technological, and regulatory boundaries. Public health advocates have been trying relentlessly to break down these barriers for decades without success.

In the midst of this global crisis, the world is finally beginning to see clearly the harm inflicted when health care data is not readily available to those who must preserve and protect public health. That harm has always been present, but like most chronic conditions, its onset in public awareness has been so insidiously slow and incremental that it has tragically been accepted as the status quo.

Recent public health challenges like the opioid crisis and the diabetes epidemic have gradually taken more lives than COVID-19, but the loss of life has done little to break down barriers that block continuous efforts to close care gaps, reduce administrative burden, and drive value-based care. Only sudden economic and social disruption at massive scale has succeeded in drawing attention to the urgency of collaboration and innovation in health care.

In a recent interview with TechRepublic, Cotiviti CEO Emad Rizk, M.D., explained why Cotiviti deployed a multi-disciplinary innovation team at the helm of Cotiviti’s flagship data asset, the Caspian Insights data and analytics platform, to aid in the national pandemic response.

To address something as unprecedented and turbulent as this pandemic, the entire health care industry had to respond swiftly, strategically, and collaboratively, bringing the best minds and innovations to meet this challenge.

In the interview, Dr. Rizk discussed Cotiviti’s COVID-19 Resource Center and public Outbreak Tracker. The outbreak tracker was one of several rapid research projects initiated by Cotiviti immediately after the WHO declared a pandemic. Each project targeted different information blind spots, and the outbreak tracker was developed specifically to address outbreak blind spots caused by widespread shortages of testing resources. The outbreak tracker successfully forecast areas where unconfirmed cases were likely spreading by analyzing historical data from Caspian Insights to detect leading indicators of hidden outbreak. As Dr. Rizk said: 

Cotiviti has been working diligently to mitigate the impact of COVID-19, from providing our health plan customers with critical tools and information to applying our deep analytics expertise and answering some of the biggest questions around the pandemic, such as which communities may be next to feel the impact. Equally important, as states and counties reopen under social distancing rules, it will be critical to maintain active surveillance of any early spikes that may be predictive of COVID-19 resurgence.

Breaking down barriers

As a leading provider of health care analytics solutions at the center of the health care ecosystem, Cotiviti is uniquely positioned to surface nationwide insights into public health. With business units in payment integrity, risk adjustment, quality intelligence, and performance analytics, Cotiviti has spent years aligning health care stakeholders, breaking down barriers, and solving data challenges that the health care industry must now solve as a whole.

Organizational barriers

In the wake of this global pandemic, we are seeing the largest public and private organizations in health care working together in unprecedented ways to unlock the power of health care data by sharing proprietary insights to combat COVID-19 and other diseases. These information-sharing partnerships seek to better identify and understand emerging public health issues that require a coordinated and data-driven response. In support of this movement, Cotiviti has joined the COVID-19 Healthcare Coalition, an alliance of public and private organizations working together at breakneck speed to research and provide data-driven insights on everything from testing and medical supplies to treatment options and social policies.

This coalition is one of many that have emerged to promote and facilitate information sharing and cooperation toward the common goal of ending the pandemic. This extraordinary trend toward collaboration has helped the nation rapidly improve clinical care outcomes, stabilize health care systems, support supply chains, and inform decision-making.

Health care collaboration and permissible data sharing has been promoted for many years by thought leaders such as Dr. Rizk. Long before COVID-19, Dr. Rizk frequently advocated for more open data-sharing between payers and providers, recognizing that we must combine disparate clinical and financial data to solve the most challenging problems in health care. COVID-19 has brought clarity and focus to collaboration between organizations, by realigning all entities in the health care ecosystem around patient health. Preserving this alignment beyond the current crisis is imperative and could be one of the greatest and most enduring benefits to emerge from these trying times.

Technological barriers

Even with the prevalence of seamless technology and widely adopted interoperability standards such as HL7, FHIR, and DICOM, historical abrasion between payers and providers continues to hinder cooperation and integration. Organizational barriers aside, technology itself is no longer an insurmountable obstacle. In recent years, big tech companies including Amazon, Microsoft, and Google have introduced cloud-native health care solutions that resolve daunting technology challenges in data management, advanced analytics, and interoperability.

The outstanding technological barrier is a residual mindset of complacency toward technological innovation. Historically, the health care industry has been slow to adopt new technology. That trend has seen a dramatic reversal in the last five years, with many of the most disruptive technologies finding early adopters in health care. COVID-19 has applied an immeasurable selective pressure on organizations to evolve, with much of that pressure focused on interoperability.

A powerful example of this pressure was seen when the CDC designated COVID-19 as a reportable condition for mandatory public health surveillance case reporting. Many mandatory reporting providers still submit case reports in paper form, and the flood of COVID-19 cases drove the CDC to rapidly deploy a FHIR-based electronic Case Reporting API. The CDC has already initiated collaborative integration into EHRs through the health care coalition and has streamlined onboarding from months to days.

This crisis-driven sense of urgency for technological advancement has permeated every area of health care IT. It will accelerate digital transformation, and has the potential to create a renewed industry, poised to take the lead in disruptive innovation and technology.

Regulatory barriers

One of the largest obstacles to data portability continues to be misperceptions about the Health Insurance Portability and Accountability Act (HIPAA), which was created explicitly to improve the portability of health care information. Special guidance on permitted uses of Protected Health Information (PHI) from The U.S. Department of Health and Human Services (HHS) seeks to clarify HIPAA’s intent.

Information is essential fuel for the engine of health care. Physicians, medical professionals, hospitals and other clinical institutions generate, use and share it to provide good care to individuals, to evaluate the quality of care they are providing, and to assure they receive proper payment from health plans. Health plans generate, use and share it to pay for care, to assure care for their members is well coordinated and that populations of individuals with chronic conditions are receiving appropriate care. The capability for relevant players in the health care system–including the patient–to be able to quickly and easily access needed information to make decisions, and to provide the right care at the right time, is fundamental to achieving the goals of health reform.

The Privacy, Security, and Breach Notification Rules under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) were intended to support information sharing by providing assurance to the public that sensitive health data would be maintained securely and shared only for appropriate purposes or with express authorization of the individual. For more than a decade, the HIPAA regulations have provided a strong privacy and security foundation for the health care system. 

Although the regulations have been in effect for quite some time, health care providers frequently still question whether the sharing of health information, even for routine purposes like treatment or care coordination, is permissible under HIPAA. Confusion about the rules has been cited by many as a potential obstacle to interoperability of digital health information.

The need to coordinate and evaluate the quality of care at massive scale has never been greater. The urgency and impact of COVID-19 has moved HHS to temporarily adjust HIPAA requirements to promote remote telehealth, expand mobile testing sites, and enable health care providers and their business associates to share data for public health oversight activities. These actions underscore the importance of balancing regulatory and public health concerns.

As a more permanent reflection of this balancing act, HHS has recently finalized historic rules to liberate patient data from the organizational silos that divide payers, providers, and other stakeholders in the health care ecosystem. The new rules, which further empower patients to control and coordinate the portability of their own health records between care providers, were finalized on March 9 against the protests of those who have profited from the exclusive control of lifesaving, proprietary insights derived from patient data. In the press release announcing the changes, HHS declared that the rules would provide patients more access to their data, spur innovation, and aim to end information blocking.

The days of patients being kept in the dark are over. In today’s digital age, our health system’s data sharing capacity shouldn’t be mired in the stone age. Unfortunately, data silos continue to fragment care, burden patients, and providers, and drive up costs through repeat tests. - CMS Administrator Seema Verma

Patients should have control of their records, period. These rules are the start of a new chapter in how patients experience American health care, opening up countless new opportunities for them to improve their own health, find the providers that meet their needs, and drive quality through greater coordination. - HHS Secretary Alex M. Azar

Despite the persistent efforts of HHS to make clear the intent of HIPAA, health care institutions continue to use consumer privacy as a reason not to innovate or collaborate. We must instead see HIPAA as a marked path to innovate and collaborate responsibly. HIPAA was designed to enable appropriate, patient-centered sharing of PHI by making privacy, security, use, and disclosure rules clear to all those who are trusted stewards of patient information and health.

Health care privacy is a shared trust between patients and those who provide care. Millions suffer from misdiagnosis and medical error because providers lack patient data and are often blocked in their efforts to access life-saving insights despite having explicit patient authorization. All those engaged in patient care must be able to access patient data quickly and securely with a relentless focus on patient health and wellness.

A patient-centered approach

With Caspian Insights, Cotiviti has invested in a vision of health care where the needs of payers, providers, and other entities in the health care ecosystem are realigned around the health and wellness of the patient. Patient focus is critical to improving quality, access, and affordability of care. With better patient outcomes, employers benefit from a healthier more productive workforce, providers reduce complexity and overutilization, and payers eliminate waste, overpayment, and administrative overhead. Dr. Rizk described the importance of a patient-centered approach when he joined the Healthcare Leadership Council (HLC), a coalition of chief executives from the nation’s leading health care organizations focused on making affordable, high-quality care accessible to all Americans.

I truly believe in HLC’s mission and its commitment to bringing the public and private sectors together to leverage data in order to meet the needs of consumers and improve overall health outcomes. I am ready to collaborate with this prestigious group to drive innovative solutions to health care’s problems, focusing on addressing key industry issues such as convergence among stakeholders, quality improvement, and value-based care. – Emad Rizk, M.D., Cotiviti CEO

The Caspian Insights data and analytics platform provides an industrial-scale supply chain to collect, connect, analyze, and deliver appropriate data and insights to disconnected entities in the health care ecosystem at the direction of patients and their preferred care providers and payers. As a trusted intermediary, Cotiviti has opened new communication and coordination channels between payers, providers, and patients. With a patient-centered approach, Cotiviti maintains the continuity of historical member health and care as patients choose and move between payers and providers, creating longitudinal health records that are rich with individualized patient insights. This consistent and comprehensive view enables coordinated care and powers advanced analytics that predict and mitigate the onset of high-cost, rare, chronic, and preventable conditions.

Cotiviti’s pandemic response has surfaced only a small portion of what is possible when we overcome organizational, technological, and regulatory barriers to unlock the power of data. Cotiviti mapped the emergence of COVID-19 using a signature care pattern to classify syndromic, COVID-like cases across multiple episodes of care. That same capability allows Cotiviti to predict the onset of chronic disease, find emerging trends in high-risk cohorts for population health, and detect the spread of new fraud schemes. Cotiviti deployed Caspian Insights to monitor real-world data tracking the outcomes and efficacy of COVID-19 proposed treatments and interventions such as Remdesivir and Hydroxychloroquine, which could ultimately contribute to urgently needed research. This same capability can provide real-world evidence to life sciences for pharmacovigilance, aid CMS in value-based purchasing, assist payers with coverage and reimbursement decisions, and guide providers with patient engagement and experience.

The world is full of questions, and no one seems to have the answers. What is the source of the virus? How rapidly and by what means does it spread? Who is at greater risk of infection, complications, or death? Which interventions and treatments are effective? Where are outbreaks emerging? When will the pandemic end?

Collectively, we have the data needed to begin to answer these questions. However, challenges remain in overcoming the organizational, technological, and regulatory barriers that prevent data and the value it carries from flowing freely for the benefit of patients. COVID-19 has shown us that we must overcome these obstacles because health care is not just a consumer issue; it is a humanitarian issue. We can and must do better.

The opinions expressed in this article are solely those of the author and do not necessarily reflect the opinions of Cotiviti.

About the author

Joshua Uda serves as the director of platform strategy and innovation at Cotiviti and is responsible for thought leadership and "intrapreneurship."

Cotiviti frequently turns to Uda as a resident entrepreneur to launch new initiatives with the agility of a startup and the scale of a global enterprise. With five years in health care, 10 years in technology, and 20 years of experience in operations and marketing strategy, Uda leverages a strong multidisciplinary background bringing competitive products and solutions to market.