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Payer Trends in HIT

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What technologies, care initiatives health plans need to be piloting now

In a recent webinar about payer trends in HIT, I found the Gary Austin’s perspectives to be very refreshing. Not only did he urge payers to embrace technology for their consumer initiatives, but he also advocated they underwrite health information exchanges (HIEs), which many in the industry have been saying for a while now.

In the National eHealth Collaborative (NeHC) webinar, “Payer Trends in HIT,” Gary Austin, principal and co-founder, TranzformHealth (a Las Vegas-based healthcare consultancy), spoke about many quality and technology initiatives payers should be initiating for their patients.

For starters, Austin said that that payer websites left much to be desired, citing one research study that showed only 50 percent customer satisfaction, which was equal to satisfaction of utility websites. Consumer information on payers indicating quality and cost of providers was sorely absent. “[The information] is not there pervasively; it’s not there easy to find; it’s not current,” he said. “We need to move towards that.”

Austin speculated that online physician review websites were not far off in the future and recommended payers get in the game before it was too late. “Now you can be a part of that somehow,” he said, “Or you can be the recipient of it. If you are Cigna, United, or your regional HMO, and some of these websites really start to take hold, every little problem you have is going to be vastly magnified in the public sector.”

Other technologies payers should be piloting include, embedding care coordinators in practices with substantial membership base, and monitoring consumers through devices offering real-time data and providing alerting to the physician for chronic patients, said Austin. He added there was huge potential for providing home video access to patients to their doctors, which would help drive cost containment and care coordination.

In his article “ACOs: A Call to Arms for Payers?,” Austin warned that national payers need to be on the watch for highly disruptive entrants focused on the retail market. “If successful acquiring individual business, these retail payers will then point their sights on the small business market, which is extremely price sensitive,” he wrote. “As an aside, those disruptive entrants that exhibit early success will be well positioned to be acquired at rich multiples by the national payers.”

To this end, Austin noted that some payers are currently using a Starbucks-like model to develop telemedicine kiosks in retail locations, like Targets, that have medical devices to send information to the patient’s doctor.

Payers should be piloting projects like eCommunications, Austin said, including medication adherence communications for patients, and creating initiatives to promote wellness around healthy eating and exercise. He suggested payers create affinity programs to reward consumers for appropriate behavior, by tying incentives into local gyms and grocery stores.

Austin also recommended commercial plans take a look at Blue Button. “I think Blue Button might get enough of a market share between all the governmental members that it might become the defacto standard in the industry,” he said.

In his ACO article, Austin predicted that by 2014 most payers will be shedding “care management operations” within their walls as a core competency, and paying a kicker to their provider network to assume that responsibility. “Operationally, that may play out as the delivery entity hiring its own care management personnel, or the payer placing payer personnel directly into the delivery entity,” he wrote. “Real-time analytics will make this service far more valuable at the point of care rather than as an afterthought.”

Payers need to give more than just lip service to their local HIEs, Austin said, and really dedicate the manpower and IT resources to help support large-scale HIE projects. He said that enough practices now have an EMR, so the last mile to make HIE a reality is payers that should mandate them for their provider networks. “If you look at where the HIEs have prospered,” Austin said, “I think the payers particularly, as well as one or two big delivery entities in the area, have gotten behind this.”