Insurance companies' leap into HIE field will change health IT

Health plans are preparing for a change in their business models by investing in health IT firms that will get them more involved in the clinical workflow of providers, according to participants at the recent HIMSS11 conference in Orlando, Fla. This accounts for the recent purchases of leading health information exchange vendors Medicity and Axolotl by Aetna and Ingenix--the latter a subsidiary of UnitedHealth Group--respectively. It also explains why several health plans have sponsored the activities of Prematics, an e-prescribing vendor that recently was acquired by Navinet, which provides online connectivity between providers and health plans.

David Classen, MD, senior partner at consulting firm CSC, says that health plans are "looking at their future business model under healthcare reform." They view health information exchange (HIE) as an implementation tool for the value-based reimbursement methods that are coming, he says. Accountable care organizations (ACOs) also will be a big issue, and Classen expects hospitals to partner with health plans to create ACOs. Health plans have core competencies that most providers lack but will need for ACOs, such as the ability to analyze data and manage care, he notes.

Steve Tolle, senior vice president of provider markets for Ingenix, states that United's desire to partner with ACOs and to help providers form these organizations are among the reasons for Ingenix's acquisition of Axolotl. The company's purchases of other firms like Lighthouse MD (now CareTracker), Picis and A-Life similarly reflect its desire "to get close to the doctor and hospital workflow."

Tolle points out that Ingenix can bring "payer analytics" to bear on ACOs, helping them with care coordination and management. Axolotl will supply clinical data that can be analyzed and used in decision support. He adds that doctors need not fear that their patient data will be made available to United. Ingenix serves many payers and understands how to maintain data security, he says.

Medicity won't aggregate clinical data for Aetna, either, promises Robert Connelly, senior vice president of strategy and innovation for the HIE vendor. The point of the Aetna purchase, he says, is to combine Medicity's access to doctors' "desktops" with the analytic capabilities of ActiveHealth Management, another Aetna subsidiary that contracts with multiple payers.

Aetna views the ability to collaborate with providers as a key to success in the future, says Connelly. More specifically, Aetna's chief financial officer, Joseph Zubretsky, recently told investors that his company acquired Medicity because the firm will help lay the groundwork for accountable care organizations and the new provider reimbursement methods expected under healthcare reform.

Navinet, which contracts with many different insurance companies, bought Prematics because it saw the company's ability to reach doctors on mobile devices as a way to get messages about care gaps in front of providers at the point of care, just before they write a prescription. So now, in addition to sending doctors messages about generic drugs, therapeutic alternatives, and prior authorizations, Prematics also will transmit care alerts provided by ActiveHealth Management. According to Michael Ross, MD, chief medical officer of Navinet, "This is a perfect platform to support the automation of disease management."

Will providers and health plans, heretofore opponents, become collaborators on ACOs? That's hard to say. But one thing is abundantly clear: payers' new interest in health IT will have a fundamental impact on the field. - Ken