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Is Anthem heading for an Epic fail?

A May 20 Healthcare Dive story reports on an imminent partnership Anthem is forging with data analytics giant Epic that could shift the authority in patient care decisions from doctors to… Anthem.

Anthem (big health insurance company) is going to team up with Epic (large data analytics and health tech company) to leverage Epic’s massive medical records database for its internal purposes. Through this collaboration, Anthem will gain access to patient data from any hospital that uses Epic, which means a lot of data. Epic’s got 250 million patients’ profiles, including conditions, treatment plans, and granular details around it all.

As part of this partnership, Anthem “will integrate Epic’s payer platform into Anthem’s operating system.” This seems reasonable, until you consider this bone-chilling detail imparted by the Dive story: “The payer will be able to capture consumer information from the clinician, analyze it, and develop insights it can then send back to a care team to inform treatment decisions.”

To put it simply, if you’re an Anthem member, your health insurance company could be getting way more involved in dictating the treatment your doctor can or can’t provide. If you’re following the ethically dubious track of health insurers in general—and Anthem in particular—you’ll feel as spooked as we do.

In what we see as a public relations spin, Anthem claims that this partnership will help decrease the prior authorization issues that providers rail against because of the delays they can cause in treatment. Anthem has drawn heavy criticism from doctors over their practice of requiring an undue number of prior authorizations. Now, Anthem claims they will be able to streamline prior authorization processes using Epic’s administrative workflow and database tech tools.

While we see how this collaboration could possibly smooth the prior authorization journey, we’re deeply wary of putting Anthem (or any commercial insurer) in a position to advise on patient treatment decisions, due to the clear conflict of interest. Will this partnership give Anthem leverage to overrule doctors’ decisions on the kind of care that’s best for their patients? We think so. Why? We’ve covered this kind of disturbing partnership before, in our story about the U.S. Department of Justice’s investigation of the merger between data analytics firm Change and insurer UnitedHealthcare.

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