4. Payer participation is critical, but challenging
Payers have large amounts of information that would be helpful to providers when creating comprehensive care plans for patients, but have been slow in participating in interoperable systems, Jones says. “The question is, do payers want to participate? They have a treasure trove of information about patients that they don’t contribute in the same way providers do.”
For example, payment information for high-risk patients, and those with multiple medications, could be insightful for providers when creating care plans, he says. “[Payers] could offer pre-adjudicated claims and actually be a part of the care teams. Payers could add more value the same way a provider team does.”
More than 90% of payers say they are leaving public health information exchanges (HIEs) to work with regions and states to create private HIEs, according to the April 2016 Black Book Research survey that included 2,300 payers using HIEs. This could leave providers with yet another expensive technology change, as they work to ensure their technology is compatible with the new HIEs.
Jones says that as more value-based care models are introduced, more collaboration between payers and providers will be essential. “Payers are moving to new models, and sharing information has to have a purpose, not just principle. Some of the things we did in the past, such as HIEs, are not as valuable,” Jones says. “When asked to create care plans, there will be less emphasis on HIE and EHRs, and more emphasis on common care plans, alerting patients and practitioners, real-time feedback, and a broader assessment of what patients need.”