February 18, 2015

Black Book Foresees Rise in Payer-Funded Private HIEs

A new research study from Black Book Rankings, a research institution for the clinical technology industry, explores the current state of and future predictions for health information exchanges (HIEs). HIE adoption is still quite low, but there is a growing need for providers and payers to share health information and industry consolidation is expected to lead to a mass rejection of public, government-sponsored solutions in favor of private HIEs for enterprise-grade interoperability. Furthermore, Black Book expects that payers will in fact be the ones to foot the bill for this transition so the benefits can be spread throughout the industry.

The report surveyed nearly 2,000 health plan members, 800 physicians, 700 hospital executives, 1,200 insurers and 500 health information technology vendor staffers over an eight month period.

Despite a government decree mandating a national, public HIE by 2014, Black Book found that the United States is still at least ten years away from that achievement. A full 94 percent of surveyed healthcare providers, agencies, patients and payers remain meaningfully unconnected, barring a small amount of simple health information being exchanged among parallel EHR systems in pockets of communities. In addition, providers have shown an overall deprioritization of HIE, as evidenced by the five percent drop in regional connectivity from last year.

“Although the Office of the National Coordinator for Health IT recently released a draft detailing a ten-year nationwide road map for basic health record connectivity by 2017, fewer and more specifically defined interoperability objectives are needed to focus stakeholders to prevent the technology industry from backing further away from HIE initiatives,” said Doug Brown, Black Book’s Managing Partner for this nationwide study.

Ditching public HIEs in favor of payer-owned and private network vendors is a rapidly growing trend in the industry, mostly due to a shift towards value-based care models as well as the inability of public HIEs to meet accountable care organizations’ (ACOs’) data requirements. Some 98 percent of respondents believe a private, community-based HIE is the best means of achieving successful value-based care models, and almost 60 percent of multi-provider networks and hospital systems reported plans to adopt private HIEs to enable standardized sharing of patient data among their organizations. However, 93 percent perceive a lack of interoperability between payers and providers due to the lack of financial drivers and regulatory demand.

Adoption is still slow since providers are waiting to see if payers will foot the bill for the necessary data sharing technology; simultaneously payers are realizing the benefits of HIEs and thus will begin to play a prominent role in their adoption and use. The most attractive aspect of private HIEs is the reciprocal data flow, which grants access to the clinical data of covered members.

"Providers are simply not benefiting financially yet from HIE development. Without proven worth or certain return, the shift to payer investment in private HIEs was inevitable with value-based care emerging", said Brown.

Almost all provider respondents agree that HIE utilization constitutes a reward from payers due to reduced readmissions, testing and episodes of care. As a result, shifting the financial burden to payers ensures maximum benefit for all involved parties. Some 90 percent of clinicians and 96 of payers responded that, with HIE utilization, the former can provide members with better access to health data and the latter can fill information gaps regarding eligibility.

Black Book ranked four HIE companies as top vendors in their respective categories: Cerner, Orion Health, Aetna Medicity and Intersystems. More information about the study and its development is available on Black Book’s website.

Edited by Maurice Nagle

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