eHealth infrastructure fits well with communication networks

The concept of transforming healthcare through patient information-sharing networks has been around for a long time. Recently, we've seen several RHIO initiatives struggle to get off the ground, and those are a clear echo of past CHIN efforts. The potential to move the needle on quality and efficiency via patient data-sharing still exists today, except now the technology, economics and cultural focus are all present in the right ratios to enable truly useful and sustainable transformation to occur. This time, however, it is the nation's health plans that are emerging as the visionaries behind the most successful and sustainable patient information-sharing networks. These payer-driven networks are emerging as the foundation for the future of web-powered healthcare.

Sustainability - the key to the long-term success of healthcare community information sharing - is the critical factor that has seemed most difficult to achieve. Federal legislation, Stark safe harbors and RHIO grants help start the process, but priming the pump is not enough. The barriers that plague today's information sharing initiatives – lack of physician adoption, standards squabbles, etc. – are all problems that would dissipate if the economic forces were properly aligned. Unfortunately, they have not been aligned. There is no clear profit in data-sharing among hospitals, RHIOs without a clear revenue model cannot be maintained, and small physician practices (which account for more than half of the nation's providers) are in no position to invest tens of thousands of dollars in EMRs and PHRs without any clear ROI in sight.

For various reasons, payers' contributions to patient information-sharing have remained largely under the radar during the RHIO conversation. The industry has instead focused on hospitals, large groups or purpose-built non-profits as the likeliest candidates to play the role of community information hub. But health plans are actually some of the most active parties in the information sharing game. Their role is at least as critical as the providers', and their efforts look to be much more sustainable and robust in the long run than anything else currently in existence.

Payers also bring a much larger, and in many ways more accurate and actionable, set of data than the provider community. Payer data not only provides a rich longitudinal view of the patient, it also reflects actual care received in a way individual provider-supplied data often cannot. The provider system may document prescriptions for four drugs, but the payer data will show which ones were actually filled and refilled and how regularly. Referrals are also often much better documented by claims data than by the PCP's records.

The biggest surprise for many healthcare pundits is not that the managed care industry is a great source of patient information and a natural economic sponsor of change, but that it has already built the largest and most used health information networks in the country. In the face of the economic benefits of eHealth information sharing, forward thinking payers began cooperating years ago to sponsor multi-payer web communications platforms that allow providers to communicate with many sponsors from a single access point. Today, the largest of these networks enables providers to communicate with the majority of the nation's largest health plans, Medicare, major regional plans and a growing number of non-payer sponsors, such as disease management firms and other organizations that need to communicate electronically with physicians. What started as an effort to increase provider use of payers' electronic transactions has now become the nation's largest clinical and financial health information exchange.

One of the most significant aspects of this healthcare communications evolution is the element of "coopetition" among the major national and regional plans and other sponsors. These are highly competitive organizations, but they have wisely chosen to collaborate - to the extent of putting their proprietary data and processes on the same technology platform. This may be the most compelling testament to the benefits of the multi-sponsor approach to patient information-sharing networks. It is also a great example of healthcare moving into the Web 2.0 stage of its evolution.