Fierce Exclusive—Healthcare executives on overcoming the barriers to payer-provider data exchange

Electronic Data Capture
If you want physician buy-in, you need to provide them with direct evidence that allows them to compare their data to their peers’ data.

Editor's note: This is the third in a three-part series. The first article explored how payers and providers collaborate to lower costs and improve member experience and care; the second how payers can better work with physicians. This article covers health IT.

The holy grail of data-sharing is integrated clinical and claims data. But there are plenty of barriers, from cost to interoperability challenges to lingering distrust between payers and providers. But when we gathered a group of more than 20 executives to discuss payer-provider collaboration, they all agreed that health information technology and data play an integral role.

“I’m the data geek in my executive group. They all want to talk about quality outcomes and population health,” said one attendee. But, she reminds them, “You’re only as good as your data. The rest of it doesn’t work unless your data is spot-on.”

RELATED: Payer and provider executives talk about breaking down the historical barriers to collaboration

To encourage our guests to speak freely, we aren't publishing their names or the names of their organizations. But the comments below come directly from the CEOs, chief information officers, chief medical officers and other payer and provider leaders who attended the event.

The gathering took place last month in Austin, Texas, during the annual meeting of America's Health Insurance Plans. FierceHealthcare Editor-in-Chief Gienna Shaw led the discussion.

Here’s what attendees had to say about making data-sharing work.

Getting clinicians on board

Good relationships with physicians sets a foundation for data-sharing, the group agreed. “We have people that care about the community—who really want the community to be healthier,” said one executive.

If you want to share data with physicians, you need to understand four things. First, they’ve been trained to ask questions and have highly developed critical thinking skills. Second, they don’t like to make decisions without evidence. Third, they’re too busy to crunch numbers on their own. And fourth, they tend to be competitive.

Health insurance companies can help with all of that.

Unblinded data can overcome some of the common objections from those who don’t think the data applies to them—those who believe their patients are sicker or less compliant than others. If you want physician buy-in, you need to provide them with direct evidence that allows them to compare their data to their peers’ data.

A bonus—that can spark competition that drives physicians to improve their numbers.  

Unblinded data takes advantage of that competitive streak, as well. And some payers are taking it a step further, sharing unblinded data not only within organizations but across them.   

“We share best practices [and performance data] among organizations,” one payer executive said. “Because we rise together.”

RELATED: How payers are building better relationships with their network physicians

Choosing what data to share

With so much data that organizations could share, it’s important to focus on what you should share.

“Our case managers have access to our claims files,” said one attendee. “We have a 24-hour nurse line—they can see the patient’s medical record, so they don’t just know the patient has a cough, but can also see the patient has asthma.”

Case managers and nurses have access to physician and hospital medical records and access to a claims files and can make decisions based on the data, he added. One caveat: All the data isn’t integrated, mostly because of budget constraint. “But we do have access in our clinical setting to all of the above.”

Data on populations of patients can help with medication adherence and improve care for patients with costly chronic conditions, attendees agreed.

"We focus on those with chronic conditions—diabetes, hypertension, cholesterol," one attendee said. Her organization gives providers and pharmacists weekly pharmacy claims data to identify patients that need extra attention.

Overcoming technological barriers

“The biggest problem at the operational level is sharing data that’s meaningful and digestible,” and that physicians can synthesize and use to make decisions at the point of care, one attendee said. The second is moving data back and forth.

“I don’t think anybody has really solved those challenges seamlessly,” she added.  

In hindsight, universal platforms would have been great, one attendee said. “But mandatory EHRs in the early 2000s means [we have] all different systems that don’t speak to each other. You have to use plug-ins, applets [and] whatever you can just to get the data to where it needs to go.”

On the other hand, “there’s lots of sensitivity around plugging in directly to the EHR system,” another attendee said. In that case, a cloud-based solution could help, allowing each organization to choose the information they consider relevant.

When we asked the group if the healthcare industry, in general, is doing a good job of health information exchange, the question was met with a chorus of nos.

“We’re so bad at it,” one attendee said. “It’s so complicated,” said another.

“You have health plans and providers that built all of these potpourri and legacy systems that cost too much to abandon and don’t meet the criteria to be able to adequately introduce data to the exchange. It’s a mess.”

Privacy regulations further complicate efforts to share data, even as the federal government has pushed the industry to share more data in an effort to improve care and lower costs.

“We’re the most highly regulated industry on the planet, but there’s nothing on the exchange of information, no universal platforms,” one attendee said. “It’s our responsibility to guide that.”