Health information exchanges (HIEs) have been around for a while with a spotty history of success (see: Sharing Medical Records across Hospitals with Epic's Care Everywhere; Health Insurance Companies Jump into Healthcare Network (HIE) Business). The problem with some of the earlier non-profit, community-based HIEs is that they lacked an adequate business model. There are several organizational models for HIEs (see: HIE Toolkit). We now learn that yet another health insurance company is acquiring an HIE (see: Humana Acquires Certify Data Systems Company a pioneer and leader in health information exchange technology). My sense is that the HIE business model pursued by these health insurance companies does make sense for them but perhaps not for me. In addition, these companies also have very deep pockets. Below is an excerpt from this latter article:
Humana..., one of the nation’s leading health and well-being companies, announced today it has acquired Certify Data Systems, a pioneer in health information exchange (HIE) technology. Terms of the transaction were not disclosed.“Humana remains focused on leveraging the power of technology to provide a more coordinated patient experience for our members that will enable quality, affordable health care”. Hospitals, physicians and laboratories across the nation have adopted the HealthLogix Enterprise HIE platform from Certify. The platform provides two-way sharing of clinical information across disparate electronic health record systems (EHRs), connecting healthcare providers and allowing them to share relevant patient health information in real-time.
John, who blogs over at Chilmark Research had this to say about the CDS purchase by Humana (see: Another HIE Purchase by a Payer):
Today, national health insurer, Humana, announced that it has acquired Certify Data Systems (CDS). This marks the third HIE vendor (UHG acquired Axolotl & Aetna acquired Medicity) that has been acquired by a payer in the last couple of years. Not that surprising when one looks at how aggressively payers are moving into the accountable care arena and seeking to form tighter links with physicians in their network, particularly those in the ambulatory sector, where CDS has done particularly well. A key part of CDS’s success in the market was through its partnership with Cerner where it provided the technology stack for connecting ambulatory practices. The Certify HealthLogix is a well architected platform that has seen strong adoption. While terms of the deal were not disclosed, it is our guess that Humana paid a pretty penny for CDS, likely all cash deal at about 6-8x estimated 2012 sales.
Here's as press release from 2009 documenting the relationship between Cerner and Certify Data Systems (see: Cerner Offers Enhanced Solution to Enable Information Sharing between Hospitals and Physician Practices).
I think that John is definitely right when he says that "payers are moving into the accountable care arena and seeking to form tighter [communication] links with physicians in their network, particularly those in the ambulatory sector." However, it's not clear to me that independent, physician owned, ambulatory practices will be enthusiastic about having a health insurance company provide them with networking services. How ethical will they be in terms of providing these services. UnitedHealth, for one, has not shown any qualms about taking liberties with the information that it manages and ignoring conflicts of interest (see: UnitedHealth to Develop Telehealth Network with Cisco; UnitedHealth Settles Suit with New York Attorney General Cuomo; UnitedHealth deal draws concern).
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