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To HIE or Not To HIE… that is the question payers are pondering

First, I want to point you to a two-part recent post:

Some great stuff posted by the prolific Mr. Rao before heading out to HIMMS12. But I’ll get back to that…

So, to HIE or not to HIE?

HIEs continue to struggle with sustainability – between 18 and 24 (depending on the source) out of 255 HIEs have achieved sustainability. Though this number is increasing, it still represents a small percentage of HIEs. While there may be some argument as to viability of HIEs, I believe there is the general agreement that HIEs at some level (enterprise, regional, state-wide) are key to facilitating, at least initially, electronic information sharing among healthcare providers. So, why is sustainability such an albatross to HIE success?

According to a recent article in Government Health IT, there are essentially 5 key roadblocks that HIEs continue to face:

  • Data sharing
  • Patient consent
  • Standards
  • Complexity
  • Competition

Some great topics for future discussions.

A Healthcare IT News article argues that this can really be boiled down to the following: the cost and the slow pace associated with integration of disparate data sources.

Who, in addition to healthcare organizations, are most likely to be interested in aggregation of disparate data sources? Who stands to gain from investments in HIT? Who benefits from reduced cost of patient care? Bingo: payers!

From the forecast posts referenced above, there are a few ways that payers are testing the waters in terms of HIE involvement:

Getting involved at the infrastructure level

  • The two leaders in HIE infrastructure, Axolotl and Medicity, found themselves acquired by insurers in 2010.
  • United Health Group/Optum (Axolotl) and Aetna (Medicity) are leveraging these acquisitions for future growth in the healthcare IT space.
  • There may be little opportunity left for other payers to follow suit since the major HIE technology vendors are spoken for.

Exclusive funding of HIEs

  • Penetration in this space is limited as providers continue to be skeptical of payer’s intentions.
  • Availity, based in Florida, was established in 2001 and has managed to stay in the black. A more recent example of this type of collaboration is hard to find.
  • This model requires full investment by the payer in a space where HIE ROI can be hard to quantify.

Regional HIE

  • Typical stakeholder mix will include corporations with a large employee base, provider organizations and the payer(s) with shared operational expenses.
  • This model demonstrates a more realistic approach:
  • Partnering with organizations reduces the skepticism regarding payer’s intentions and creates a “fabric of trust.”
  • HIE operating costs are shared between stakeholders.
  • Active exchange in patient data can actually result in reducing payer’s coverage cost.

Payer involvement in the HIE landscape is a foregone conclusion. At what level and what makes the most sense remains to be seen.

What are your concerns about payer activities related to data sharing? What are the benefits to payers having “skin in the game” in terms of reducing cost of patient care?

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