Payer incentives are closely aligned to those of health information exchanges. As care coordination and management is enhanced through HIE, and outcomes improve with appropriate delivery of care the first time around, payers are seeking to determine the impact to reimbursement. Payers can ensure improved outcomes and reduce the rate of increase in costs, as HIE improves the delivery of care. As such, many payer organizations are willing to team up with HIE efforts and foster growth of information organizations.

Payer contributions to HIE include the sharing of claims data to add to the existing repository of health information and set up of basic summaries of care for a significant number of patients. A health plan’s participation in an HIE fosters communication with providers regarding administrative data such as coverage and payment information. Additionally, some payers are funding EHR implementations for practices and helping them connect up to appropriate health information exchanges. Start-up costs for HIE may even be provided by payers, who are eager to connect their patient populations to an exchange.

Health plans have a growing interest in participating in HIEs and have the ability to contribute funding to them to help achieve HIE financial sustainability. A small but growing number of HIEs are finding creative ways for health plans to participate in HIEs. The Indiana Health Information Exchange has the Quality Health First program, that utilizes claims data from health plans and clinical data from providers, to generate quality outcome reports for physicians. HEALTHeLINK, in Buffalo, generates ADT alerts for health plans when a patient is admitted, discharged, or transferred from the hospital. This alerts the health plan’s care management team to a change in care several weeks earlier than relying on claims information.

Nebraska Health Information Initiative (NeHII)

Blue Cross Blue Shield of Nebraska (BCBSNE), a nonprofit organization, has been an early supporter of health information exchange in the state of Nebraska. In addition to contributing startup capital to the Nebraska Health Information Initiative (NeHII, Nebraska’s state designated entity for HIE), Blue Cross Blue Shield of Nebraska contributes fees annually and additional per member per year contributions. BCBSNE leverages the HIE to assist in its claims adjudication process.

Massachusetts Simplifying Healthcare Among Regional Entities (MA-SHARE)

Minnesota Health Information Exchange (MN HIE)

America's Health Insurance Plans Research: Trends and Innovations in Health Information Technology

Health Data Management: The Payer Role in HIEs