Black Book: Payers leading snub of public HIEs

As federal funds supporting health information exchanges dry up, 83 percent of the nation's public HIEs are stalling, according to a new report from Black Book.

The report found payers snubbing the bureaucracy, fees and complex architecture of government-sponsored HIEs and instead investing in private efforts. That exacerbates the public HIEs sustainability woes.

Without more effective processes, revenue streams and business models, as few as 10 of the operating public HIEs are expected to still be in business by 2017, according to an announcement.

Black Book polled 1,550 provider organizations that participate in HIEs and 794 payers and insurers over the last six months of 2013.

Doug Brown, managing partner of Black Book, called payer investment in private HIEs "inevitable" as they fail to see financial gain from government efforts.

In addition, 83 percent of hospitals and 70 percent of physicians see "most public HIEs ... failing to provide meaningful connectivity." And 97 percent of physicians said they don't trust the records they currently receive from HIEs to be complete or technically accurate.

Six in 10 of the nation's 220 operational HIEs were funded by $546 million in HITECH funds. Without further grants, HIEs are forced to assess high fees while developing other revenue streams. However, health insurers participate in fewer than 31 percent of public HIEs, and 86 percent of payer respondents refuse to pay the public exchanges' annual fees.

"Payers are determining how they can best manage the HIE ecosystem by gaining access to the clinical data of covered members," Brown said. "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."

He said that the stakeholders that benefit most from connectivity will be the ones supporting successful exchanges going forward.

Among other findings from the survey:

  • 33 percent of multi-provider networks and hospital systems are considering private HIEs
  • 98 percent of healthcare organizations favor private, community/regional HIEs to achieve accountable care organization goals
  • 91 percent of respondents say financial drivers and regulatory demands to increase interoperability between payers and providers are still needed

Previous research has been setting off alarm bells about HIE sustainability and interoperability woes for some time

"Given the surge of payers investing in private networks, and EHR vendors working collaboratively to establish standards for interoperability, it would appear that public HIEs may only have a subordinate position in successful stakeholder connectivity as the industry progresses," Brown said. 

To learn more:
- here's the announcement