Critical to HIE Success, Payers Still Lag

Health information exchange continues to face obstacles to widespread adoption with health insurers being part of the problem.

To date, payers in large part have not been engaged in HIE development despite the fact that their buy-in and active participation is vital to realizing the full benefits industry-wide.

That is the finding of new research published in the Journal of the American Medical Informatics Association. Authors contend there has been no systematic effort to collect national data that captures payer perspectives on HIE—a shortcoming that has cost the industry dearly in terms of leveraging this as-yet untapped resource.

“While existing studies call for active inclusion of payers as key partners and have provided some empirical evidence of a business case for payer involvement, there has been very little qualitative exploration of payer expectations, needs, and approaches to HIE engagement,” states the article. “This study offers the first set of data focused exclusively on the specific factors impeding payer engagement in HIE efforts, and what actions could overcome these impediments.”

In particular, researchers found “strong agreement” across 17 payer organizations in their vision of what constitutes optimal HIE and in their perspective that the current approach to HIE does not adhere to that vision—a misalignment that limits broad payer support for HIE efforts.

Also See: Health Information Exchanges Show Little Evidence of Benefits

The authors conclude that increasing payer engagement requires that HIE efforts “allow payers to become central participants in data exchange, including providing and receiving data.” In addition, they argue that HIE efforts will need to consider strategies for how to overcome resistance from providers to payer participation and promote more collaborative relationships.

“Policymakers can facilitate this transition by driving greater provider engagement in order to increase the volume of electronic clinical data that is exchanged and by promoting standards that improve data quality and usability,” according to the authors.

At the same time, although researchers believe that increasing payer HIE engagement is feasible, they do not say it will be easy or without consequences. “For HIE efforts, the key question is whether pursuing these strategies and increasing payer engagement will affect the degree to which providers find HIE participation attractive. This is a challenging balancing act. Ideally, both providers and payers would shift away from norms of information opaqueness and data hoarding to valuing transparency, openness, and sharing.”

Researchers warn that while payers “claim to have the right intentions for seeking greater access to clinical data, as long as reimbursement rates are regularly renegotiated, providers have reason to be skeptical of payer involvement in HIE.” Still, the authors are hopeful that accountable care organizations and other risk-based contracting approaches—especially if they are negotiated for multiple years at a time—could be the solution to this problem.