Payers Reject Public HIEs and Pony Up to Lead Private Enterprise Interoperability, Reveals Recent Black Book Survey

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Payers en masse are investing in private connectivity solutions and snubbing the bureaucracies, fees and complex architecture of government sponsored health information exchanges compounding the sustainability problems of public HIEs. Black Book’s annual satisfaction survey of stakeholders discovered 83 percent of the nation’s 220 operating public HIEs are stalling as federal grants supporting half of the state and regional HIEs are dried up.

Most public HIEs are struggling with flawed business models and are failing to provide meaningful connectivity according to 95 percent of payers, 83 percent of hospitals, and 70 percent of physicians HIEs as reported in a recently released Black Book survey. Black Book polled 1,550 provider organizations utilizing health information exchanges, and 794 payers and insurers over the last six months of 2013. Survey respondents also ranked the vendor performance of eighty interoperability developers.

72 percent of HIE stakeholders forecast 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.

Six in 10 operational HIEs were funded by $546M in HITECH funds but 94 percent of payers do not see the value proposition in public HIEs. Without federal grants, HIEs are forced to assess high fees for stakeholders while developing alternative revenue generating prototypes. At the same time, 97 percent of insurers claim that public HIEs are struggling to exchange trusted patient data sets between payers and providers.

Health insurers participate in fewer than 31 percent of public HIEs. 86 percent of payer respondents overwhelming reject paying the annual fees of public exchanges, despite the fact that payers are seen as the primary beneficiaries of interoperability, realizing significant saving by reducing redundant testing, experiencing fewer repeated procedures, decreasing readmissions, and identifying population health trends.

"Payers are determining how they can best manage the HIE ecosystem by gaining access to the clinical data of covered members", said Doug Brown, Managing Partner of Black Book. "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."

Additionally, 88 percent of clinicians and 96 percent of payers agree 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.

"Providers are not benefiting financially yet and without proven worth or certain return, the shift to payer investment in private HIEs was inevitable with value-based care emerging", said Brown. "The stakeholders that benefit the most from connectivity are the ones that will pay to support exchanges, and they will pilot the most successful initiatives going forward.”

HIE is a field in relative infancy but its measures for success are clearly mapped. Black Book polled users of 220 operational exchanges, both public and private to determine the top performing vendors on eighteen HIE-specific gages.

Page 2 - Payers Reject Public HIEs and Pony Up to Lead Private Enterprise Interoperability, reveals recent Black Book survey January 28, 2013

Current users ranked four HIE vendors as top performers in their specialty theatres of engagement. Ranking first in their respective categories in the Private/Enterprise marketplace for 2014 are:

Covisint – Payer-Centric HIEs
ICA –Core HIEs Systems
Infor (formerly Lawson) – Complex Data, Multi-organizational HIEs
Cerner – Inpatient EHR/HIEs
dbMotion Allscripts – Ambulatory EHR/HIE’s

Other vendors receiving top honors in specific key HIE performance indicators were: Aetna Medicity, Alere, Availity, Caradigm, dbMotion Allscripts, GSI Healthcare, Intersystems, McKesson RelayHealth, Optuminsight, and Oracle.

Additional findings from the survey include:

33 percent of multi-provider networks and hospital systems are considering private HIEs for more standardized sharing of patient data.

82 percent of all payers and providers agree that an operational national public HIE is at least a decade off.

92 percent of physicians, 81 percent of hospitals, and 94 percent of insurers/payers remain meaningful unconnected, in regards to intelligent interoperability.

98 percent of healthcare organizations believe that private, community/regional HIEs are the preferred choice to comprehensively achieve accountable care organization deliverables.

Although HIE use has increased 69 percent from 2012 to 2013, there’s still a need for financial drivers and regulatory demands to increase interoperability between payers and providers, according to 91 percent of survey participants.

99 percent of providers agree 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.

"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.

About Black Book™

Black Book Rankings, a division of Black Book Market Research LLC, provides healthcare decision makers, IT users, media, investors, analysts, quality minded vendors, and prospective software system buyers, pharmaceutical manufacturers, and other interested sectors of the clinical technology industry with comprehensive comparison data of the industry's top respected and competitively performing technology and managed services vendors in the sector.

The largest user opinion poll of its kind in healthcare IT, Black Book™ collects over 400,000 viewpoints on information technology and outsourced services vendor performance annually. For methodology, auditing, resources, comprehensive research and ranking data, see

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Douglas Brown

Dr. Kevin Parker, Healthcare Research Director
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