Expanding Payer and Provider Participation in Data Exchange

Policy, contracting, and financing options for California

Manatt Health


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States have struggled for decades to establish infrastructure that allows for the efficient and secure sharing of health information, despite it being associated with improved quality and reduced duplicative services and associated costs. California has made some progress, including the growth of regional health information organizations (HIOs), but significant gaps remain. As a result, many residents still receive care in settings that do not have their complete health records, which can lead to care that is inefficient at best and dangerous at worst.

This report outlines the following policy, contracting, and financing levers available to states working to advance interoperability — the ability of health care entities to seamlessly exchange patient data — including their pros and cons:

The report also reviews the efforts of five other states — Minnesota, Florida, Michigan, Maryland, and North Carolina — to use some of these levers and extracts lessons from their successes and failures.

An Important Prerequisite

The levers covered in this report, however, should be seen for what they are: a means to a greater interoperability end. Before considering the details of which of these levers to deploy when, California’s government and industry leaders would benefit from consensus on a broad, shared vision for advancing health information exchange. This vision could:

  • Identify the highest priority and most feasible use cases, and their value propositions for stakeholders
  • Articulate the state’s role in data exchange and the desired data-sharing relationships among critical state programs
  • Clarify California’s interest in leading, shaping, and/or participating in growing data-sharing efforts on a national level

Once there is a clear vision to guide California’s efforts, stakeholders can turn to deciding the best means of achieving it.