Reengineering the Business of Healthcare

Healthcare is human care. It can be easy sometimes to forget that. Many of us are focused on the business of healthcare—those back-end administrative processes built around the business of healthcare—and we lose sight of what our roles as providers, payers, and tech innovators are all about: Caring for humans, often in moments when we are most vulnerable.

Avaneer Health, whose founding members include Anthem (now Elevance), Cleveland Clinic, CVS Aetna, HCSC, IBM Watson Health (now Merative), PNC Bank, and Sentara Healthcare, sees a new way forward, one where healthcare information can be shared freely and in real time. But to do that, we needed to come together, just as our founding members have, to address the issues of trust, data ownership, access, privacy, and governance—all issues impacted by a lack of transparency.

A New Type of Interoperability

The term interoperability has different connotations for different people. While most would agree that sharing data is at the heart of the definition, there are disparities in what that looks like. While Fast Healthcare Interoperability Resource (FHIR) has given us a common set of protocols and standards for a payload of transactions on a network, FHIR itself does not create interoperability.

 ​The Avaneer Network™ facilitates the ease and speed of connecting to multiple stakeholders across the ecosystem, supporting the speed to market much-needed innovation 

In a truly interoperable healthcare system, data wouldn’t have to be requested, aggregated, and validated each time it’s needed. Instead, it would be continuously refreshed and always accessible in real time to those who are permissioned to access it. It is THIS type of interoperability that will completely revolutionize the way healthcare is transacted.

Consider how different our healthcare delivery system would be if:

• There was no need to build and maintain application programming interfaces (APIs) with each trading partner.

• We didn’t need a third party to validate data or transactions.

• We could eliminate the need to aggregate data altogether.

• We could make BAAs, data use agreements, and other contracts immutable.

• Coverage information would always be accessible, refreshed, and current.

• Prior authorizations could be completed in minutes instead of days.

• Referrals could take seconds.

• Providers could tell patients with 100% certainty what a procedure will cost and what they will owe.

• Payers, providers, and innovators could collaborate over a single network and deploy solutions over a single platform to all stakeholders without building multiple connections.

• We could eliminate expensive manual workflows, enabling revenue growth and unlocking more investment dollars for technology, facilities, and staff resources.

Think this is just a utopia? I don’t. This is 100% achievable and it’s closer than you think. But it can’t be done by building more API connections, establishing more health information exchanges (HIEs), or adding bolt-on solutions to “streamline” already broken processes. It can only be done by completely disrupting the way the business of healthcare is conducted today and reengineering a new model. That brand new model is already in play at Avaneer Health.

The Network
Avaneer Health has created a secure, permissioned network leveraging innovative technology in new ways to ensure transparency and trust. Once connected to our network, participants—payers, providers, innovators—no longer must request information because it’s always available and accessible in a standardized format. And that information is always refreshed and current, eliminating the need to verify validity or question accuracy.

Through a permissioned process, participants on the network enable their data to be accessed by anyone else on the network. Data remains decentralized and participants can control how and with whom they choose to share it. Once this connection is established, data can be accessed in real time with permission.  Leveraging a common set of tools built on a common infrastructure, the network eliminates interoperability barriers and allows for seamless integration and data fluidity.

Core to Avaneer Health’s mission is to invite developers and innovators to the network to utilize our platform to accelerate the scaling of solutions for improving administrative processes, revenue cycle, analytics, quality improvement, and more. The Avaneer Network™ facilitates the ease and speed of connecting to multiple stakeholders across the ecosystem, supporting speed to market of much needed innovations.

A New Way Forward
While Avaneer Health’s focus is on reengineering the fragmented processes of healthcare administration, we will never lose sight of the ultimate recipient of all that we do – the human being who deserves to receive the care they need, when they need it. I invite you to join us on our journey.