Unlike in European countries with single-payer or similar health insurance systems, the U.S. healthcare market is fragmented among a large number of individual private payer companies and groups.
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That setup brings technological problems when it comes to exchanging information between payers and providers, and between payers and members, or customers.
Enter HL7 International.
The influential non-profit standards and interoperability organization — the steward of HL7 health data exchange standards and the popular emerging new health IT standard, (FHIR) Fast Healthcare Interoperability Resources) – has decided to try to bring more order to the payer world.
In furtherance of that goal, HL7 has launched a payer user group to support insurers that use HL7 standards and protocols to better manage member care, promote better medical outcomes and work toward the long-term objective of more affordable healthcare, according to a release.
The main areas of focus for the HL7 Payer User Group are to:
- Educate and train the payer community on how to put into action HL7 standards
- Share lessons learned during implementations
- Provide feedback to HL7 work groups that are responsible for creation of the standards that affect the payer community
- Be a collaborative resource for other stakeholders at HL7 from the payer perspective
“Over the past year, HL7 has become increasingly active within the payer community. These efforts have provided critical support through the introduction of the payer summit program, and now enabled the launch of the HL7 Payer User Group,” Charles Jaffe, M.D., CEO of HL7, said in the release.
The payer user group is the second user group HL7 has started recently.
Last year, HL7 created an immunization user group in collaboration with the American Immunization Registry Association.
Similarly, HL7 is working on the payer group initiative with insurers such as BlueCross BlueShield, Cambia Health Solutions, Inc., Cigna Health and Life Insurance Company, Humana Inc., and other payers, according to HL7 spokeswoman Andrea Ribick.