Health information exchange has numerous anticipated benefits for payers, yet most health information organizations (HIOs) report no engagement or financial support from payers. This qualitative study was motivated by a need to understand: (1) How payers conceptualize the optimal approach to HIE; (2) The key factors that determine whether or not payers choose to support existing HIE efforts; and (3) Actions that could be taken by policymakers and those leading HIE efforts to foster greater payer support.
While there was consensus as to what the core principles of optimal HIE are -- including user-friendly infrastructure, broad access to combined clinical and claims data, and shareholder support in proportion to value derived -- payers perceive strong misalignment between principles of an optimal HIE approach and current operational efforts. Payer financial support has been limited by an inability to create a strong value proposition and lack of true partnership between payers and providers in local exchanges. Our findings highlight several areas in which to strengthen State and Federal policy efforts to promote payer engagement. These include: improved setting and enforcement of interoperability standards; incentivizing greater provider participation in HIE; and supporting ACOs and other delivery reforms that may rely on HIE as a backbone for care coordination and population health.