- New Black Book market on health information exchange highlights the growing need for providers to share health information but a lack of HIE adoption is still commonplace among physician practices and hospitals. Additionally, industry consolidation is expected to drive healthcare organizations, providers, and payers to reject public and seek out private HIEs to ensure enterprise-level interoperability.
The survey comprises feedback from over 4000 HIE clients, users, and prospective customers during the between second and last quarters of 2014. Additional information comes from a survey of 1290 healthcare payers, insurers, and related organizations.
Despite playing a “crucial” role in the transition from fee-for-service to value-based care, HIE adoption was still low in the final quarter of 2014 among private physician practices and non-system hospitals. The research indicates that 90 percent of the former and 70 percent of the latter “remain meaningfully unconnected outside of garden wall EHRs.”
For healthcare organizations and providers working as accountable care organizations (ACOs) or considering taking on risk-based arrangements, nearly all respondents (98%) report a belief in the value of private, community-based HIEs as the means for achieve the aims of value-based care models. That finding fits with another indicating that only three percent of ACO managers consider operational public HIEs able to meet their data requirements as presently constituted.
The shift from volume to value is the only driving force pushing the healthcare industry to leverage private rather than public HIEs.
“The HIE market will dramatically change during the next two years as providers seek electronic health records systems that support data exchange to qualify for meaningful use incentives,” state the authors of the report. “As HIEs consolidate, it is vital that they keep and cultivate the confidence of their original stakeholders by involving them in the operational progression. The key challenge for consolidating HIEs will be to maintain the stakeholder trust that has taken extraordinary efforts to develop.”
On the provider side, nearly 60 percent of multi-provider networks and hospital systems are eyeing private HIEs to address standardizing sharing of patient data among their organizations. And despite gains in HIE use between 2012 to 2014 to 69 percent, 93 percent of respondents to the Black Book survey still perceive a lack of financial drivers and regulatory demands to have contributed to a lack of interoperability between payers and providers.
Coupled with the rise of ACOs, healthcare payers and providers are further embracing private HIEs for fear that public, regional, and state exchanges may not be survive long enough to help them achieve meaningful use requirements for HIE or other incentive programs.
Increased role of payers
The findings from the Black Book report demonstrate the instrumental role healthcare payers could have in improving and driving HIE use among providers.
“Payers are determining how they can best manage the HIE ecosystem by gaining access to the clinical data of covered members,” states the report. “With the majority of hospitals and medical practices fully functional with EHR, reciprocal data flow with payers has been the tipping point to provoke insurers to initiate leadership roles in private HIEs.”
With nearly all provider respondents wanting rewards from payers for HIE utilization tied to reduced readmissions, testing, and episodes of care, the time is ripe for health plans and insurers. Already, as many as 90 percent of clinicians and 96 percent of payers agree on the role that the latter can play in filling in information gaps related to eligibility and enabling the former to provide increased access to health data for members.
The coming year should cement the role of healthcare payers in determining the use of private HIEs, the authors of the report predict for 2015:
Commercial payers are investing in private connectivity solutions and snubbing the bureaucracies, fees and complex architecture of government sponsored health information exchanges compounding the sustainability problems of public HIEs. Black Book’s annual satisfaction survey of all HIE users and stakeholders discovered 86 percent of the nation’s 224 operating public HIEs are failing despite the recent announcement of limited federal grants to rescue some networks.
So it is that health plans and other commercial payers rather than healthcare organizations and providers could determine how patient health data flows between clinicians.