Insurers' support for HIEs driven by value-based payment

Despite the problems that have stood in the way of health information exchanges (HIE), insurers are increasingly seeing the benefit of sharing data in large part because of the shift to value-based payment, according to a report in Managed Care magazine.

While both private and public HIEs have often struggled with financial and technical issues, insurers are now recognizing that it isn't just providers who can benefit from swapping data via a large exchange, the magazine said. As a result, more payers are getting involved in HIEs.

That includes two of California's largest insurers--Anthem Blue Cross and Blue Shield of California--who in 2014 backed plans to launch one of the country's largest HIEs. The insurers put in $80 million to fund a not-for-profit statewide exchange called Cal INDEX to make the health records of nearly a quarter of all Californians accessible to providers online.

That's a reflection of payers becoming more invested in the need to access all the information they can about members to keep costs down and people healthy, according to Managed Care. The emergence of value-based payment arrangements have placed an emphasis on keeping patients healthy and avoiding expensive tests and treatments.

"For a long time, payers were reasonably comfortable with the data they got via their claims, which is very structured. But as payers have become more engaged in healthcare by helping to manage complex patients, their appetite for data has grown," Dave Watson, CEO of Cal INDEX, told the magazine.

While health plans have a growing interest in the data HIEs can provide, a 2015 study found that only 40 percent of HIEs in the U.S. have one or more payers providing financial support. Private HIEs are gaining ground, however. According to a Black Book Research survey last year, 83 percent of the nation's public HIEs are in jeopardy, but payers are instead investing in private efforts.

HIEs can help insurers to build a more complete picture of their members, which has enormous benefit, Nick Coussoule, chief information officer for BlueCross BlueShield of Tennessee, said in the Managed Care article. More data and information about members, beyond claims data alone, can allow payers to help members get the best possible care without duplication and unnecessary cost, he said.

To learn more:
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