Payors Are Pushing for Direct EMR Access. Providers Must Push Back. 

Featuring: Stacie Sutter | Senior Director, Payor Performance

Providers Must Take a Thoughtful Approach Before Granting Full EMR Access to Payors


Major payors like Anthem, UnitedHealthcare, Aetna, Cigna and Humana are pushing providers to grant them direct electronic medical record (EMR) access. The benefits to payors are clear – direct access to records to drive HEDIS and Stars quality measures, accurate risk adjustment for capitated members and access to real-time records for utilization management. However, this step toward interoperability has huge potential for providers as well, if implemented appropriately.

As the dominant EMR, Epic has introduced the Epic Payor Platform (EPP) as the conduit for connectivity between payors and providers. EPP contains several different modules, including Clinical Data Exchange, Electronic Authorizations, Claims Payments and Value-Based Care Management. Payors adopting EPP are mainly prioritizing connectivity that meets their needs – gaining access to necessary clinical documentation and quality outcomes to adjust risk scores of beneficiaries (and associated government reimbursement) as well as enhance their rankings against other health plans.

But using EPP to streamline claim adjudication, automate the authorization request process, reduce or eliminate requests for information, and ultimately accelerate payments for providers is equally as critical.

Since access to EMR data is so valuable to payors, we encourage providers to take a thoughtful approach before giving it away without an equitable exchange. Establish a strategically aligned agreement to improve revenue cycle outcomes and ensure your organization sees as much value as the payor’s. Avoid providing unchecked access to your EMR system by establishing the right access restrictions and performance-based contracts to meet your objectives and retain control of your information.

Ensemble offers comprehensive revenue cycle managed services to clients, including strategic guidance for health system executives and managed care departments to improve payor relationships.

Stacie Sutter brings nearly 20 years of healthcare experience in managed care and revenue cycle operations to Ensemble Health Partners as the Senior Director of Payor Performance.