News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
Sign In

Insurer-Organized HIE in California Struggles to Get Participation from State’s Hospitals, Physicians, and Clinical Pathology Laboratories

California insurers are building a massive health information exchange (HIE), but so far only one healthcare system is interested in participating

Healthcare Big Data is big business. But it requires large databases with complete records of many patients, including their medical laboratory test results. That’s why two big California insurers would like to build such a data warehouse, however, hospitals and physicians are wary of feeding their patient data into an insurer-organized HIE. Why? Because he who holds data, holds power.

Thus, doctors in California don’t want to give that power to health insurers. Meanwhile, hospitals and health systems in the Golden State that operate accountable care organizations (ACOs) want to protect their own ability to serve patients.

The HIE that is struggling to collect the patient data it needs to be successful is the California Integrated Data Exchange (Cal INDEX). Founded in 2014, it is an independent not-for-profit organization that was created by Anthem Blue Cross and Blue Shield of California—the second and third largest insurers in the state. According to their statement, the two organizations intended to build a statewide health information exchange (HIE) based on electronic patient records that include clinical data from healthcare providers and health insurers.

By the end of 2014, Cal INDEX expected to be “providing physicians and nurses with secure, online access to approximately nine million health information records—or nearly one-fourth of the state’s population,” the statement declared. (more…)

Consolidation of Nation’s Health Insurers Is Bad Medicine for Local Labs and Pathologists

While no one was looking, nine big insurers grabbed 76.7% of privately-insured patients!

Consolidation of major health insurance companies in recent years is a trend which reinforced the market clout of the nation’s two largest lab companies at the expense of local laboratories and pathology groups. However, few pathologists and clinical lab managers know precisely how much market power is currently concentrated into the hands of only a few health insurance companies.

Dark Daily now unveils a remarkable analysis. At this moment, just nine companies control 76.7% of all privately-insured individuals in the United States! Moreover, the three biggest of these health insurance firms—UnitedHealth Group, WellPoint, and Aetna—collectively cover 85.6 million of the185 million Americans enrolled in private health plans. That’s 48.3% of the total U.S. market.

As shown in the table below, when the other six companies are added—Humana, HealthCare Service Corp., Cigna Group, Kaiser, Highmark and Health Net—the nine biggest health insurers cumulatively insure 141.9 million of the 185.1 million Americans with private health insurance—or 76.7% of the total.
(more…)

;