The majority of patients, or health care consumers, don't pay directly for the health care services they receive. Rather, these patients essentially pay payers, and the payers then pay the providers. This means these three groups – patients, payers and providers – must be able to communicate with each other.
LaHIE enables the communication of both simple and complex health information. It allows this health information to be "pushed," or sent, to external recipients, like payers, and allows payers and providers to "pull," or request health information.
The overall value proposition of LaHIE is to facilitate the exchange of this clinical data to improve the quality of patient care. Payer participation in LaHIE represents an opportunity for payers to improve their ability to undertake quality and performance improvement programs by gaining greater access to the clinical data of their covered members within LaHIE.
For payers, support for LaHIE offers a significant return on investment, including:
• Decreases in overall health care costs through reduced utilization of emergency departments, imaging procedures and diagnostic tests as well as hospital readmissions
• Access to quality data to support care management and wellness/preventive care programs
• Improved medical loss ratios through reductions in costly medical errors and increased system efficiencies
• Improved relationships with purchasers who are demanding greater value and lower costs
• Access to key benchmark data enabling the identification of future health care trends and costs and the development of care management and population health programs