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Hospitals and Insurers Share the Pain for Everybody’s Gain

December 23, 2013 | By: Guest Blogger

Hospitals and Insurers Share the Pain for Everybody’s Gain

The southeastern Pennsylvania health care community—including hospital and insurance leaders who are frequently on opposite sides of the negotiating table—is taking a big step forward to improve the region’s health care. 

Doctors and hospitals are beginning to share patient information via a new health information exchange, HealthShare Exchange of Southeastern Pennsylvania. They will use this information to:

  • Improve patient care
  • Reduce redundant diagnostics and other health care services
  • Help contain rising health care costs

Suppose Mr. Jones is discharged from Hospital A, but then has a setback that lands him in Hospital B’s emergency room. With HealthShare Exchange, Hospital B’s ER doctors will have access to Hospital A’s patient information for Mr. Jones, including the medications prescribed and the diagnostics and care ordered during his recent hospitalization. 

Hospital B’s ER doctors will have a better picture of exactly how to care for Mr. Jones. They will provide the right care without providing unnecessary care.

Getting to where we are, with hospitals poised to begin sharing information, has required significant investment in technology and talent. The consensus reached as to who should pay for these investments and why shows the strong leadership and teamwork of the insurers and hospitals involved in creating HealthShare Exchange.

Insurers agreed to shoulder two-thirds of the funding needed to plan and build the exchange. The region’s hospitals provided the rest, with each hospital’s contribution based on its percentage of the region’s overall admissions and emergency room visits.

Why did insurers take on the lion’s share? Because financially speaking, they will gain the most from the positive changes brought about by HealthShare Exchange. With doctors and hospitals providing more efficient and less redundant health care, insurance claims and costs will be reduced.

In other words, the health care community found a way to share the pain in the interest of a big gain: better, more efficient health care for southeastern Pennsylvania.




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