A recent Black Book survey revealed that payers are rejecting health information exchanges (HIEs), a fact that ultimately means many public HIEs face serious problems of sustainability once federal grant funding dries up.
The survey, from the New York-based Black Book Market Research, revealed that a whopping 83 percent of the nation’s 220 operating public HIEs will stall with the end of the federal grants, which support half of the state and regional HIEs. For the survey, Black Book polled 1,550 provider organizations utilizing HIEs, and 794 payers and insurers over the last six months of 2013.
Ninety-five percent of those payers say that public HIEs are failing to provide meaningful connectivity. They only participate in fewer than 31 percent of public HIEs, with 86 percent of those payers saying they reject paying the annual fees of the exchanges. This, the researchers say, despite the fact that payers are seen as the primary beneficiaries of interoperability, since they could save by reducing redundant testing, fewer repeated procedures, decreasing readmissions, and identifying population health trends.
Also, 88 percent of clinicians and 96 percent of payers from the survey say that payers will fill an information gap for clinicians at the point of eligibility and will allow them to administer better care via access to aggregated data on members.
"Payers are determining how they can best manage the HIE ecosystem by gaining access to the clinical data of covered members", Doug Brown, managing partner of Black Book, said in a statement. "With the majority of hospitals and medical practices fully functional with EHR, reciprocal data flow with payers has been the tipping point to provoke insurers to initiate leadership roles in private HIEs."
Almost every single provider surveyed said that payers need to reward providers for HIE utilization that leads to tangible reduction in readmissions, elimination of duplicate diagnostic testing and decreasing episodes of care. Ultimately, while HIE use increased 69 percent from 2012 to 2013, almost all respondents say there’s still a need for financial drivers and regulatory demands to increase interoperability between payers and providers.
Providers, for their part, are also looked at in-depth in the report. Eighty-three percent of hospitals, and 70 percent of physicians HIEs said public HIEs are failing to provide meaningful connectivity. Seventy-two percent of those involved with HIEs say that by 2017, as few as 10 of the currently functioning public exchanges will sustain operations without more effective processes, participation schemes, revenue or funding streams, and effective business models.
A whopping 82 percent of all payers and providers agree that an operational national public HIE is at least a decade off.
The survey's authors also polled users of 220 operational exchanges, both public and private, to determine the top performing vendors on eighteen HIE-specific gages. For payers, Covisint was the best ranked vendor; for inpatient electronic health record (EHR)/HIEs, it was Cerner. dbMotion Allscripts was ranked best for ambulatory EHR/HIE’s
"Private exchanges will continue to outpace public HIEs as organizations are exploring how they will effectively aggregate data to support their ACO efforts", said Brown. "Eventually, given meaningful use, the industry can expect to see connections between private and public exchanges emerging for the purpose of sharing public health data and to support the portability of medical records. But there is an obvious challenge of whether public, regional and state exchanges will still be around to connect to when that happens, or if these private exchanges and EHR vendors will instead connect stakeholders directly to a national exchange.”
“Given the surge of payers investing in private networks, and EHR vendors working collaboratively to establish standards for interoperability, it would appear that public HIEs may only have a subordinate position in successful stakeholder connectivity as the industry progresses,” concluded Brown.