Payer Participation in Health Information Exchanges

Lessons Learned
Historically, hospital participation has not been difficult for MSeHA to obtain; the greater challenge has been in courting physician acceptance and engagement. “I think the hard part of engagement has been with the smaller physician practices because their perspective very much represents the perspective of the practicing physician, which is ‘why is this important to me, what are the benefits I receive that would offset the cost of participating, and what is the impact on my bottom line?’” says Waller.

Waller has seen several organizations’ utilization plummet when a physician champion of the system leaves the hospital. Waller says that getting more physicians engaged means getting usage of the information exchange embedded into daily clinical workflows.

Waller also notes that due diligence must be spent on privacy and security issues. As he’s learned through attorneys, the laws regarding how personal health information (PHI) can and cannot be used are still being developed from state to state. So, HIEs today have to be cautious, he says, and patients must have trust in system to want to participate.

Holmes sees consolidations in the HIE market on the horizon. “I think you will see some consolidation, maybe not of existing HIEs, but those that are coming up, instead of creating new ones, just sort of folding into ones that already exist,” he predicts. He adds that in states with just a few existing HIEs, like Tennessee (which only has two active HIEs, MSeH and CareSpark based in Kingsport), that new HIEs will leverage the existing infrastructure of those established HIEs instead of creating new exchanges. Holmes mentions there are three such communities in Tennessee that are currently pondering this issue.