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Benefits for Payers

The majority of patients, or health care consumers, don't pay directly for the health care services they receive. Rather, these patients essentially pay payers, and the payers then pay the providers. This means these three groups – patients, payers and providers – must be able to communicate with each other.

LaHIE enables the communication of both simple and complex health information. It allows this health information to be "pushed," or sent, to external recipients, like payers, and allows payers and providers to "pull," or request health information.

The overall value proposition of LaHIE is to facilitate the exchange of this clinical data to improve the quality of patient care. Payer participation in LaHIE represents an opportunity for payers to improve their ability to undertake quality and performance improvement programs by gaining greater access to the clinical data of their covered members within LaHIE.

For payers, support for LaHIE offers a significant return on investment, including:

• Decreases in overall health care costs through reduced utilization of emergency departments, imaging procedures and diagnostic tests as well as hospital readmissions
• Access to quality data to support care management and wellness/preventive care programs
• Improved medical loss ratios through reductions in costly medical errors and increased system efficiencies
• Improved relationships with purchasers who are demanding greater value and lower costs
• Access to key benchmark data enabling the identification of future health care trends and costs and the development of care management and population health programs

How Payers Can Help
Payer support for and participation in LaHIE offers many reciprocal benefits, including improved quality, reduced costs and better outcomes. There are a number of ways in which payers can get involved in LaHIE. Payers may:

• Develop incentive programs to promote EHR adoption and LaHIE connectivity among Louisiana's health care providers and organizations.

• Submit claims-derived data to augment the clinical data made available by LaHIE's participating EHR users.

• Provide external support for EHR adoption and LaHIE participation in the communities they serve.
Benefits for Purchasers
Louisiana's employers care about their employees and their families and therefore invest in heavily in their health. This investment yields multiple benefits for this group of purchasers: healthier employees, higher productivity, reduced health care costs and improved quality of care.

Our state's employers also recognize that there are a number of primary issues in health care that contribute to employee absenteeism, lost productivity and high health care costs. Those issues include:

• The poor communication and information exchange among health care providers that leads to many medical errors and adverse drug events

• The lack of population health data that can be used to design improved wellness and preventive care programs for improved health outcomes

• Inadequate educational tools and resources to assist employees in making good decisions about health and health care

• Fragmented, uncoordinated care systems in which providers don't have timely access to consistent medical histories for patients

• Poor coordination and management of care for chronic conditions

By supporting LaHIE, our state's purchasers are helping to advance a health IT system designed to address these issues. LaHIE ensures the exchange of clinical data to create greater efficiency in health care delivery by eliminating redundancy and providing data to measure and improve the quality of care their employees receive.

LaHIE also represents an opportunity to improve transparency of cost and quality while educating consumers about value and reducing costs through increased preventive care, reduced waste and lower hospital admissions.
How Purchasers Can Help
There are a number of ways that Louisiana's employers can support the advancement of health IT to drive improvements in health care quality in our state.

• Encourage health insurance plans, third party administrators (TPAs), health care providers and other health care-related organizations to participate in and support LaHIE.

• Request that health insurance plans and TPAs encourage ambulatory care providers to adopt and meaningfully use electronic health records (EHRs).

• Promote the use of LaHIE's quality measurement and improvement functions among health care plans, TPAs, health care providers and other health care-related organizations with implementation incentive programs.

 
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