How Health Plans Could Benefit From Health IT

Les Masterson, for HealthLeaders Media , April 17, 2009

Hospitals and physicians will spend many hours over the next two years researching and implementing electronic health records to take advantage of the $36 billion slated for health IT in the stimulus law. While providers perform most of the heavy lifting, another healthcare segment might actually benefit more from better health information exchanges.

PricewaterhouseCoopers Health Research Institute's released a report Rock and a Hard Place: An Analysis of the $36 Billion Impact From Health IT Stimulus Funding this week that focused mostly on how the stimulus law's health IT money would affect providers, but one sentence tucked in the report highlights the possibilities for health plans.

"With billions in new funding and government regulations, the health IT market will balloon far beyond the provider segment, providing new opportunities for health plans, pharma companies, and other vendors," wrote PricewaterhouseCoopers.

With employers dropping their coverage and laying off insured employees, and federal policymakers exploring a public insurance option to compete against private insurers, PricewaterhouseCoopers' statement is a rare piece of good news for health insurance companies. The report suggests that health insurers could lead an effort to improve health IT exchange, which could lead to a quality healthcare system that allows providers easy access to patient records, lets health insurers gain a complete picture of their members' health, engages patients to take better care of themselves, and provides businesses more information about their employees' health.

"The practical reality is that the providers are spending the big investment upfront to put these [EHR] systems in and to digitize our health records. The opportunity for payers then is to figure out effective ways to combine that data to be statistically relevant and interject that information into the healthcare delivery process," Dan Garrett, managing director of health IT at Pricewaterhouse Coopers Health Industries Advisory Practice, tells HealthLeaders Media.

Garrett says payers are uniquely able to combine their administrative data with patient records information to create "powerful, value-added offerings to patients, employers, and potentially even healthcare delivery professionals," he says.

"Now that we are pretty certain that we are going to digitize all the data, the next question becomes who in the industry wants to play a significant role in aggregating that data into statistically relevant information and driving that information into a continual improvement cycle in the healthcare delivery process," says Garrett.

Greater health IT means health insurers can take part in a number of different potential partnerships and structures, but health insurers will need to clear potential hurdles. For instance, if health plans are to take a leadership role in health IT, they will need to build bridges to providers, who are usually suspicious of any health insurer initiative.

There are also other issues to iron out, such as how to make the information available to the larger system while protecting patient privacy and security.

Though there are many issues to iron out and plenty of work needed to create larger health IT networks and systems, Garrett says most healthcare officials are looking at the bigger picture—how do we use EHRs to deliver healthcare more effectively and efficiently.

"It's a trying time for the providers because of the challenges, but it's an exciting time for the industry, and for most providers," says Garrett.

Les Masterson is an editor for HealthLeaders Media.

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