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What is the Value of HIE to Payers?

 

  • Improve the timeliness, accuracy, quality and completeness of the data received
  • Improve process efficiency with the ability to receive electronic transactions, instead of fax or phone calls
  • Improve the ability of payers to assist in the management of care for high cost individuals, especially those with chornic conditions who consume 70% of the resources to prevent re-hospitalizations resulting from the lack of adequate discharge education, care transition planning, and information exchange
  • Improve outcomes and reduce medical costs through data analytics and the development of standards of care
  • Monitor episodes of care and manage coordination of services to ensure services are medically necessary, provided in the appropriate setting, and meet quality standards
  • Reduce prescription errors which contribute to hospitalizations and re-hospitalizations
  • Identify and reduce fraudulent practices and other forms of payment abuse
  • Improve patient medication compliance with fill notification information
  • Potential to receive transactions from the largest provider organizations through a single portal, rather than using multiple technical interfaces
  • Assist in real time claim processing with the development of an All Payer Claims Database to manage eligibility and pull data for all payers from a single source
  • Potential payment reform catalyst beyond the standard fee-for-service model
  • Improve provider relations and member satisfaction with more accurate information and fewer phone calls
  • Improve payer provider administration functions, including provider enrollment, licensure verification, provider communications, and support other self-service administrative functions
  • Enhance the ability of the provider to track the percentage of members
  • Increase provider compliance with clinical evidence based guidelines and improve the quality of care delivered to all participants
  • Potential avoidable services in ambulatory care settings and emergency departments