The recent purchase of HIE vendor Certify Data Systems by insurance giant Humana raises some interesting questions about what kind of future health insurance companies are planning for. In an environment where insurers’ profits are squeezed by the medical loss ratio rule and their role is diminished by medical practices taking on more financial risk, the insurers of today may look very different several years from now.
There is a growing chorus of commentators suggesting that the push toward accountable care will put insurers out of business. If providers take on the financial risks associated with managing the health of populations, there is not much of a role for insurance providers, the reasoning goes. Furthermore, the Affordable Care Act takes the view that insurance company profits are a major driver of high health care costs and has taken steps to regulate them more closely through the medical loss ratio rules. These two factors together make it hard to envision a future in which insurance companies operate as they do today.
So could the trend of insurers purchasing HIE vendors (Healthcare IT News points out that Aetna and UnitedHealth have also purchased HIE vendors) be a sign of how they plan to operate in the future? Data is valuable to HIE participants. When participants have access to more data, their analytics and population health initiatives become better informed. The U.S. Census Bureau estimates that about 65 percent of the total U.S. population had private insurance in 2010, which means that insurers have access to data on a large majority of the population. Insurers’ data centers could end up being more valuable than the services they provide today.
Perhaps, by purchasing HIE vendors and leveraging their technology, insurance companies are trying to position themselves as brokers of information, rather than takers of financial risk.
For the moment, Humana officials are saying their purchase was simply intended to give the company infrastructure that will facilitate care coordination. But it could be more of a hedge against overreliance on a business model that has a relatively dim future. Only time will tell.