The trick to bringing payers, physicians together

The clashes you and your peers have with insurance companies over reimbursement and coverage may dwindle in the future as physicians and insurers exchange more data, according to a report by consulting firm PricewaterhouseCoopers’ (PwC) Health Research Institute.

The report, “Needles in a haystack: Seeking knowledge with clinical informatics,” finds that clinical informatics-the integration of information technology into healthcare-is likely to become even more important in healthcare as the reimbursement landscape shifts from a fee-for-service or volume-based model to an outcomes-based model.

The adversarial relationship between payers and physicians will become more collaborative in an outcomes-based reimbursement environment such as an accountable care organization. Doctors and payers will discover they need access to one another's information and capabilities, according to PwC.

Despite the need for clinical information, the two biggest challenges health organizations face in expanding their clinical informatics efforts are data integration and lack of industry-wide data standards, leading to distrust of the data itself and their usage. Only 31% of providers and 47% of insurers participate in external data exchange.

More than half of providers said they would like to provide data into evidence-based protocols, yet only 20% of health insurers are “very confident” of their ability to offer providers access to evidence-based protocols. Seven in 10 providers and health insurers said that their top technical goal is integrating data from multiple sources. Only 17% of providers and 16% of health insurers reported being very confident that their health information exchange vendors will be able to meet their analytic and integration needs over the next 2 years.

These findings arrive just as the Centers for Medicare and Medicaid Services released the proposed rule for stage 2 of the meaningful use of electronic health records. The proposal requires physicians to integrate more information exchange into their workflows through increased e-prescribing, the integration of more lab and imaging data into records, and the sending electronically of a summary of care record to outside doctors and hospitals for 10% of referrals.

Watch for the March 25 issue of Medical Economics for in-depth information about the proposed rule for meaningful use stage 2 as well as the new proposed rule related to EHR certification. Also follow coverage on Twitter at www.twitter.com/MedEconomics and participate in the national discussion with #MU2.

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