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Payer Strategies in Health IT: A Focus on Analytics

June 3, 2011
by David Raths
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There always seemed to be a high level of skepticism from CIOs, but as we enter the era of HIEs and ACOs, providers may find themselves working more closely with insurers than ever before

At the conferences I have attended in the last few years, I have perceived a slight chill in the air whenever representatives of payer organizations make presentations about how their use of information technology had the potential to transform healthcare by engaging patients.

There always seemed to be a high level of skepticism from CIOs and physicians representing hospitals and health systems. But as we enter the era of health information exchanges (HIEs) and accountable care organizations (ACOs), providers may find themselves working more closely with insurers than ever before on wellness, care management and clinical analytics. (With an eye on clinical work flows, health plans have already invested in HIE vendors, with Aetna purchasing Medicity and Ingenix, a subsidiary of UnitedHealth, buying Axolotl.

Insurers are also tied into the patient-centered medical home movement. America‘s Health Insurance Plans (AHIP) reports that health plans are participating in more than 46 patient-centered medical home initiatives, 26 accountable care initiatives, 16 bundled payment initiatives, 19 value-based purchasing initiatives and four comprehensive/global payment initiatives.

Therefore, it may make sense to pay closer attention to their priorities in IT investments to see where the overlaps will occur and understand how market disruptions will impact providers.

On June 2, I attended a webinar by Janice Young, program director for IDC Health Insights, about changes payers and the software vendors in their market are making to respond to ARRA, PPACA, ICD-10 and other market forces.

One of the first changes that Young noted is a shift in software investment focus picked up in surveys of plan executives. “For 2011, nearly half of healthcare payers polled reported no new investments in core claims applications,” she said. Instead they are planning to work on process efficiency, consumer acquisition, and health and care management.

To engage consumers, payers are developing personalized health and care management tools with triggers and alerts, and a key goal is integration with physician services, she said.

Of even greater interest, 77 percent of surveyed payers plan to invest in clinical analytics, and the majority of care management vendors have or plan to invest or partner heavily in clinical analytics, triggers and alerts, she added. The shift to paying for outcomes from paying fee for service means that payers will become much more deeply embedded in analyzing clinical data to assess outcomes and also to determine what works best in terms of consumer interaction.

As population health and ACOs become increasingly important, analytics and business intelligence will play a key role. But how payers and providers end up sharing that data with each other and with consumers will be interesting to watch. Both must provide transparency about how personal health information is being used. And they will have to overcome the historical cultural distrust issues.

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David Raths

Contributing Editor

David Raths

@DavidRaths

www.linkedin.com/in/davidraths

David Raths’ blog focuses on health IT policy issues ranging from patient privacy to health...