8 Health Information Exchanges Lead The Way

Humana's recent purchase of Certify Data Systems (CDS), a vendor of enterprise health information exchanges (HIEs), follows similar acquisitions of leading HIE vendors by other health plans over the past few years. Aetna bought Medicity, and Ingenix, a unit of United HealthGroup, acquired Axolotl.

All of this is about getting access to clinical data and becoming closer to providers. But whereas United is interested in using Axolotl to support its partnerships with accountable care organizations, Aetna and Humana view their takeovers of HIE vendors more in terms of influencing physician practice patterns.

In an interview with InformationWeek Healthcare, Brian LeClaire, senior vice president and chief information and service officer for Humana, explained the company's decision to buy CDS as part of a long-term strategy to improve the quality of care and reduce costs. He said that Humana was trying to create a "virtual integrated delivery health care system" bound together by health IT.

Part of that strategy, he noted, was the creation a decade ago of Availity, which provides Web-based connectivity between Humana and several other payers and their healthcare providers. A year ago, Humana purchased Anvita Health, which applies its clinical decision support software to Humana claims data to detect care gaps and provide alerts to members and providers.

[ To see how patient engagement can help transform medical care, check out 5 Healthcare Tools To Boost Patient Involvement. ]

What was still lacking, LeClaire said, was "last mile" connectivity between Humana and its providers' electronic health records. The health plan needed that link -- as well as clinical data that is more timely and accurate than claims information -- to inform physicians at the point of care about the services their members required. "We needed a final piece of the puzzle to deliver on the promise of health IT and that was the Certify acquisition," he noted.

Certify Data Systems has a strong track record in the ambulatory care space, according to John Moore of Chilmark Research. In a recent blog post, Moore also points out, "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."

LeClaire said that Humana has a good relationship with Cerner and will continue to support the HIEs that CDS has built for Cerner customers. In addition, CDS will continue to look for new business opportunities in conjunction with Cerner, he said.

CDS may also build health information exchanges to tie together Humana clinics that have disparate EHRs, he said. Humana operates a number of clinics that focus on Medicare managed care business, especially in Florida.

When Aetna and Ingenix/United made their purchases of Medicity and Axolotl, there was speculation that some providers might not want to use those HIE vendors because of fear that their clinical data would go to the insurance companies. However, LeClaire doesn't see that as a problem with the CDS acquisition.

"Our approach is to work with our providers to share information between Humana and the provider, and with our Humana members. We've had positive feedback, and we have engaged in relationships with providers through other vendors to do the same kind of clinical information sharing."

While Humana did not disclose a purchase price, Moore speculated that the plan paid "a pretty penny" for CDS. As a basis of comparison, Aetna paid $500 million for Medicity, a considerably larger firm, in 2010.

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