Payers Demanding More From HIEs

A new study has found that while providers using HIEs are focused on interoperability, payers are demanding better access to clinical data.

The survey, which was conducted by the eHealth Initiative Foundation (eHI) and backed by population health tech vendor Orion Health, collected responses from 53 U.S.-based HIEs in 35 states. The group of HIEs included some that were backed by their home state, some that were privately funded/proprietary and some that were built on a hybrid model.

The top business drivers identified by the HIEs included the desire of stakeholders to deliver on value-based care contacts (58%), easier integration using APIs, FHIR etc. (47%), providing clear value to end users such as care transition management and medication reconciliation (34%) and an increased demand for population health analytics tools (32%).

If you ask eHI, the most significant findings from the survey center on value-based care, which is no surprise given that 92% of respondents said that such arrangements influence their technology adoption decisions.

Not only that, eHI found that for 58% of respondents, managing risk and delivering on value-based contracts is their top business driver, while value-based care is also a priority for 43%. That’s alongside 47% who are prioritizing interoperability and 40% the integration of workflows over the next two years. The HIEs were also interested in integrating non-traditional types of data such as genomics and social (34%) and enhancing care coordination (34%).

But the HIEs have a lot more going on than value-based care support. For example, 77% of them have built out services such as provider alerts, and 72% HIE-to-HIE data exchange functionality. Just 6% are offering remote patient monitoring and 40% said they were unlikely to deploy such a service over the next two years. On the other hand, 40% said it was likely or very likely that they’d deploy care coordination tools, 34% plan to roll out medication reconciliation and 30% e-referrals/e-consults.

Meanwhile, payers are expecting more from HIEs over time as they look at better ways to use their data. At present, half of the respondents have 3 or fewer payers participating in their exchange, and 15% aren’t working with any payers at all. Moreover, just 24% of participating payers have access to claims data for more than 3 million members. Meanwhile, 85% of respondents with 3 million to 10 million members are able to integrate clinical and claims data.

However, according to eHI, 67% of responding HIEs have seen a significant or very significant increase in payer demand for clinical data access. Their toughest challenges when managing claims and clinical data included data quality issues (58%), technology costs (56%) and availability of qualified staffers (49%).

It’s also worth noting that as the array of data they might share is expanding, HIEs are likely to face some additional challenges in managing it. They said the most challenging data to exchange included social determinants of health-related (52%), followed by behavioral health (50%), advance directives, living wills and power of attorney documents (46%), genetic information (35%)

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

  • Did the HIEs say why the most challenging data to exchange were those things? (Social determinants of health-related, followed by behavioral health.)

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