Recent healthcare policy changes, with ever advancing health and health information technologies, are facilitating this country’s movement toward the trifecta goal of improving the quality of patient care and outcomes while reducing costs. The payer community is an important and large healthcare stakeholder, and has core expertise in facilitating the goal of “value.”
The advancement of health IT and increasing adoption and utilization rates of these systems are supporting not only important transformations in care delivery, but transformations in the payer space as well. While numerous, these transformations can best be summarized by the notion that payers are shifting from predominately being the “transaction manager” to becoming a true healthcare “informediary” for the purpose of partnering in care delivery to improve health outcomes.
The payer industry is not only in transition from focusing on employer-based insurance services to consumer-based retail markets (i.e., the holistic wellness of the individual), but is also in various stages of altering their platforms and culture to be able to partner with providers differently.
A hurdle to this revolution is the lack of trust and understanding between payers and providers. Health IT can enable to increasing transparency, which is a vital component necessary to build trust.
Another potential barrier to this is that most health IT focuses on care delivery, not on improving the healthcare system. To realize the trifecta goal, payers and providers need each other. Payers have vast amounts of historical claims data, whereas providers have the clinical data.
Combining the two data streams could result in a powerful source of information to improve care, quality and value. While payers and providers talk about collaborating to improve patient care and outcomes, it is not in widespread practice, in part because of technical, infrastructure, and trust hurdles.
HIMSS is working to remove these hurdles by being the health IT advocate, educator, and convener for the entire healthcare industry to support its mission of transforming healthcare through the effective use of information technology and management systems. The Society builds on its extensive educational resources, expertise in key healthcare information technology issues and collaborative partnerships to support the payer community in their emerging efforts.
Look for these HIMSS resources on Payers and Providers:
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What do you think of payers and providers working together with health IT? What examples can you share? What issues do you see helping, or preventing, as I mention here in my post, the combination of these two data streams that could result in a powerful source of information to improve care, quality and value?
Note: This article first appeared in HIMSS Payer Insider on Sept. 12, 2011.