Payer Transparency - oxymoron no more?

Providers "know" that payers are inefficiently, slowly, underpaying them. Providers don't understand the payers' unwritten rules and are unable to keep up with changes in handling of claims. Post-HIPAA, payers and providers are moving literally tons of paper around the healthcare system and rework in claims handling is enormous.

So how are the payers actually performing, from the perspective of the physician?

athenahealth and Physicians Practice just announced the 2008 PayerView survey results. PayerView gives providers visibility on payer performance by payer type, by region and by key performance metrics.

athenahealth collects the statistics on payer performance as they handle the claims processing for thousands of physicians.

The best overall commercial payer? Aetna. And the worst payer for Days in AR? New York State Medicaid.

Other trends:

• Denials increased due to inconsistent payer rules related to the exchange of CMS National Provider Identifier (NPI) information needed for claims handling. They forecast that the adverse impact of this will grow during the coming year.
• Surprisingly, patient liability was just about flat in the year over year comparisons, compared to a 19% increase in the prior year.

Whither the Nationwide Health Information Network?

The Office of the National Coordinator for Health Information Technology has announced the expansion of the participants for the Nationwide Health Information Network (NHIN) trial. The six new awardees join the 9 federal agencies that manage health information that already have NHIN contracts.

So where are NHIN trials headed over the next year?

HHS announced that the trials will address four areas of health information exchange:

1. Patient lookup and information retrieval
2. Secure information routing and delivery (including, but not limited to a defined summary patient record)
3. Provision of data for population uses
4. Consumer managed access to appropriate information

The trials will test use of the NHIN standards to address these critical areas of health information exchange. The trials will use sample data to avoid any inadvertent issues with privacy and security. The trials are scheduled to complete mid 2009.

The awards are called cooperative agreements and bring together IDN's, state, regional and other health information exchange participants into the NHIN. Some very capable, high profile organizations are the awardees announced by HHS:

• HealthLINC/Bloomington Hospital
  An e-health collaborative with a multi-stakeholder board of directors consisting of representatives of multiple competing organizations, physicians, and hospitals that serves a ten county area in South Central Indiana with a population of 367,000.

• Cleveland Clinic
  A multi-specialty multi-facility academic medical system based in Cleveland, Ohio that integrates clinical and hospital care with research and education for 5.3 million patients. Cleveland Clinic facilities include the main, downtown Cleveland campus, nine regional hospitals, a Florida hospital, and 13 northeast Ohio community Family Health Center outpatient clinic locations.

• Community Health Information Collaborative
  A partnership among hospitals, clinics, long-term care facilities, tribal health facilities, higher education, and public health departments that serve 650,000 patients in a rural, 18-county region in Minnesota.

• HealthBridge
  The largest and oldest health information exchange located in Cincinnati, Ohio, serving a tri-state region connecting 24 different hospitals and health systems, 17 local health departments, two national and multiple local laboratories, radiology and diagnostic centers, physicians offices, community health center and nursing homes, and currently covering 1.8 million patients.

• Kaiser Permanente
  The nation's largest private integrated health care delivery organization, serving over 8.7 million members in 10 states and DC.

• Wright State University
  HealthLink RHIO, West Central Ohio's regional health information exchange, represents hospitals, providers, Medicaid managed care, labs, state and local public health, public schools, social services and safety net providers, and Clark and Champaign County Health Information Exchange, and covers a population of over 500,000.

Google and the Personal Health Record

Google has announced the official launch of the Google Health Personal Health Record.

Will Google Health's foray be a game changer?

There are more than 30 different personal health records distributed today in the US, with at least 15 or so in serious contention for market share. With this kind of fragmentation, there are substantial challenges to integration.

The industry has responded with high interest to Google, Microsoft and Revolution Health's entrance into the Personal Health Record space. They both bring consumer "neutrality", advanced web technology know-how and are rapidly playing catch-up in the domain.

The privacy aspects of this are significant. Will patients trust Google with their health information?

Google's announcement includes early partnerships with Cleveland Clinic and Beth Israel Deaconess in Boston.

Beth Israel will allow patients to upload their own health record into Google Health. This gives the patient electronic access to their provider's health record and standards-based portability that they control. Significantly, this approach can help resolve a couple of the thornier problems of health information exchange: patient identification and authorization. The patient is able to authenticate to the various HCO's. The patient also now has control over the record and can decide when and with whom it should be exchanged.

The major vendor enterprise clinical systems' advantage has been their tight integration with their own personal health records. In rural areas where there's a dominant Academic Medical Center, or dominant ambulatory vendor clinical system, this advantage will continue to be compelling. In more competitive healthcare environments, that advantage will likely be mitigated by standards-based exchange of health information among heterogenous systems, including mediation through the Personal Health Record.