Health information exchanges (HIEs) need to do more to align payer and provider interests in order to successfully and sustainably engage payers in the process, according to a new report published in the Journal of the American Medical Informatics Association.
The report sought to identify those factors that impede payer engagement in HIEs, as well as strategies to address those impediments. It did so by undergoing an analysis of input from leaders at 17 payer organizations from across the U.S., ranging from large, national payers, to state Blues plans and local Medicaid managed-care plans.
Engagement lacking
In a nutshell, the report finds that payer organizations have often been asked by HIEs to provide financial support without the option to participate in data exchange, or that when they are allowed to participate, their data needs have been made secondary to those of providers.
"Efforts to engage payers in pursuit of more robust and sustainable HIE need to better align their value proposition with payer HIE use cases," the report states. It finds that this will require addressing provider concerns about payer access to clinical data.
At the same time, the report warns 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."
The authors suggest the solution to this stalemate may be the use of ACOs and other risk- based contracting approaches, particularly if they are negotiated for multiple years at a time.
"For providers, this increases the value of more timely access to claims data, as well as decreases the need to limit payer access to clinical data (to prevent profiling or impede fee negotiations)," the authors write. They conclude that HIE efforts with provider organizations using risk-based contracts are therefore best positioned to increase payer engagement.
Industry feedback
The report's findings appear to mesh with those of industry leaders.
According to Joel White, President of the Council for Affordable Health Coverage, many insurers have the data and savvy to link to HIEs, but don't for reasons more to do with business incentives than technological barriers. "If allowed to combine their data with clinical data, insurers could gain and share valuable insights into the most effective care," he tells Healthcare Dive.
"Until business incentives change, however, it is unlikely lackluster HIE performance will improve. One would think the performance would drive these coalesced opportunities, but that has not been the case to date," he says.
Toward that end, the report lists five principles for the optimize the HIE experience, from the payer perspective:
- A single network or single connection to a network of networks
- Inclusion of clinical and claims data
- The use of data as a shared asset, as opposed to a source of competitive advantage
- Stakeholder support in proportion to the value derived
- Value proposition tied to the Triple Aim
The authors conclude, "Specific actions by those leading HIE efforts, complemented by policy efforts nationally, could greatly increase payer engagement and enhance HIE sustainability."