Assessing payer perspectives on health information exchange

Dori A. Cross, Sunny C. Lin, Julia Adler-Milstein

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Objective: To identify factors that impede payer engagement in a health information exchange (HIE), along with organizational and policy strategies that might effectively address the impediments. Materials and Methods: Qualitative analysis of semi-structured interviews with leaders from 17 varied payer organizations from across the country (e.g., large, national payers; state Blues plans; local Medicaid managed care plans). Results: We found a large gap between payers' vision of what optimal HIE should be and the current approach to HIE in the United States. Notably, payers sought to be active participants in HIE efforts - both providing claims data and accessing clinical data to support payer HIE use cases. Instead, payers were often asked by HIE efforts only to provide financial support without the option to participate in data exchange, or, when given the option, their data needs were secondary to those of providers. Discussion: Efforts to engage payers in pursuit of more robust and sustainable HIE need to better align their value proposition with payer HIE use cases. This will require addressing provider concerns about payer access to clinical data. Policymakers should focus on creating the conditions for broader payer engagement by removing common obstacles, such as low provider engagement in HIE. Conclusion: Despite variation in the extent to which payers engaged with current HIE efforts, there was agreement on the vision of optimal HIE and the facilitators of greater payer engagement. Specific actions by those leading HIE efforts, complemented by policy efforts nationally, could greatly increase payer engagement and enhance HIE sustainability.

Original languageEnglish (US)
Pages (from-to)297-303
Number of pages7
JournalJournal of the American Medical Informatics Association
Volume23
Issue number2
DOIs
StatePublished - Mar 1 2016

Bibliographical note

Funding Information:
This work was supported by the California HealthCare Foundation grant #18107.

Keywords

  • Exchange
  • Health information
  • Payers
  • Sustainability

Fingerprint Dive into the research topics of 'Assessing payer perspectives on health information exchange'. Together they form a unique fingerprint.

Cite this