Health Plans And EMRs: Do They Mix?

Even if the best hopes of EMR supporters come true, the truth is that widespread adoption won’t touch one of the key contributors to healthcare waste and inefficiency.  As long as the health insurance companies continue to stand to one side and stay aloof from the EMR adoption process, they’ll effectively undermine providers’ best intentions.

OK, maybe this is a bit confusing.  Let me be a bit clearer. As long as EMRs are designed to control and even improve healthcare quality — but not necessarily to address other health plan priorities — there will be a difficult and (to my mind) embarassing clash of wills involved.

But wait, you say, isn’t the Accountable Care Organization supposed to bring everyone together into a single happy group of cheerleaders?  You know, health plans dole out money in manageable flat bundles, doctors and hospitals work together to create streamlined programs of care and EMRs document that the whole arrangement is working out?

Well, that’s the idealized picture. But let’s face it, for the foreseeable future, only a small percentage of well-funded, well-organized providers will create successful ACOs.

And that leaves the rest of providers on the tiresome modified fee-for-service track, one which forces them in to Dances With Insurance which could eat away at or even cancel out any productivity gains an organization makes from their EMR investment.

Let’s face it:  in reality, health plans aren’t just interested in clinical care, they’re interested in cheap care.  It’s hard to integrate their methods for saving money — such as the ever-so-popular need to pre-authorize expensive procedures — with the efficiencies one would hope for in an EMR-based organization.

I hope insurance companies find ways to work towards quality that draw on EMRs’ capabilities, such as population management, better care for chronically-ill patients and data sharing.  At the moment, however, I don’t think they’ve come nearly far enough in that direction. When will the health plan business find a way to make money in a way that actually takes advantage of EMRs’ strengths?

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

1 Comment

  • I believe that the answer to your question is contained in your last sentence. Once the advantages of EMRs strengths have been significantly realized, then the health insurance business will use it to make money.
    Without doubt, the health insurance companies will eventually make money by taking advantage of EHRs, but they would be foolish to spend their own money on EHR at the current time. The EMR adoption process is currently being fully funded privately by the providers (physicians and hospitals), with federal government funds serving as encouragement with the promise of incentive payments. Since the primary responsibility of the health plan/health insurance business is ultimately to their shareholders by maximizing profits, they would be failing in their responsibility if they wasted money at the current time when other entities are funding the EHR initiative.
    Once the EHR process is further along, probably by 2014 to 2016 when the programs are nearing completion, I would fully expect the health insurance industry to aggressively enter the EHR conversation. By holding off until that time, the health insurance business will gain the advantages of EHR efficiencies, having already allowed the government to deal with the “growing pains/issues” during the implementation process, without having to pay for it.

Click here to post a comment