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To engage payers, HIEs must better meet their needs


To fully engage payers in robust and sustainable health data exchange, health information exchanges (HIE) need to better align their value proposition with payers', according to research published in the Journal of the American Medical Informatics Association.

While data sharing would seem an ideal way to reduce redundancy or avoidable costs, HIE efforts have struggled to engage payers, and only 40 percent of HIE efforts in the United States have one or more payers providing financial support, the authors say.

The researchers interviewed leaders from 17 diverse payer organizations across the country to determine their issues with HIEs. The organizations complained that payers were often asked to financially support HIE efforts without the option to participate in data exchange, or, when given the option, their data needs were secondary to those of providers.

Their vision of an ideal HIE generally was far from reality. Among the things payers would like to see:

  • A single network or single network of networks: National payers had the greatest misalignment with HIE organizations, since they would have to participate in multiple local or state/regional HIE efforts.
  • Inclusion of clinical and claims data: Payers want to expand their analytic capabilities beyond what claims data can offer. They want to use clinical data to strengthen payer-led case management.
  • Data as a shared asset, not a source of competitive advantage.
  • Stakeholder support in proportion to the value derived: Payers recognized their role in sustainability, and stressed that they would be willing to pay "their fair share" for data access, but wanted to know that other stakeholders were also contributing in a way that would keep HIE efforts sustainable in the long term.

Most respondents felt the government's HITECH and Meaningful Use efforts did not go far enough in supporting HIE development and wanted the federal government to be more active in setting and enforcing interoperability standards.

Black Book reported last year that payers are leading the snub of government-sponsored HIEs in favor or private efforts. In another report, it said that the U.S. remains at least 10 years away from achieving a secure, robust exchange of patient data.

Anthem Blue Cross and Blue Shield of California are providing $80 million to fund one of the country's largest health information networks, called Cal Index, an independent, not-for-profit organization.

To learn more:
- read the article

Related Articles:
Black Book: Robust data exchange still a decade away
Black Book: Payers leading snub of public HIEs
Blue Shield, Anthem fund statewide info exchange in California
HIT Standards task force: Suggestions for interoperability all over the board