Recent healthcare policy changes, in conjunction 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,
- improving outcomes, and
- reducing costs.
The health plan / payer community is an important and large healthcare stakeholder, and has a core expertise in facilitating the goal of “value.”
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 be an enabler to increasing transparency, which is a key component necessary to build trust.
Another potential barrier to this is that most health IT is focused 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.
Convening to Create Solutions
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. HIMSS 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.