While health plans are not usually included in conversations about data sharing legislation and initiatives, they play a critical role in ensuring that complete, longitudinal health information is available to patients when they need it and to providers at the time of care. Here are the common misconceptions surrounding health plans and their relationships with efficient health data sharing.
Myth #1: Health plans treat claims and payment as their only priority
While many perceive health plans as mere insurance providers, primarily concerned with processing claims and handling financial transactions, their scope extends far beyond. They serve as critical data custodians, responsibly accumulating a plethora of information about their members’ health, utilization patterns and medical history. Health plans leverage this data to share claims and clinical data with hospitals and providers, which helps them coordinate care, reduce costs, manage population health and proactively identify at-risk populations to further enable high quality care.
Myth #2: Health plans are chief data blockers
There are often concerns raised about health plans potentially impeding the sharing of health data, primarily due to worries regarding data privacy and security. However, health plans often play a pivotal role in aggregating data from several sources, standardizing data, maintaining electronic health records, and processing and analyzing claims data. They are instrumental in rendering this information usable while also upholding stringent standards for safeguarding patient confidentiality. Health plans partner with all others involved in a patient’s care to provide a holistic view of a patient’s medical history, leverage data analytics to identify trends and risk assessment and coordinate care among different providers.
Myth #3: Health plans do not prioritize social determinants of health
Health plans recognize the profound impact of non-medical factors, such as socioeconomic status, education, housing, and access to healthy food, on an individual’s health. Addressing social determinants is a priority for health plans seeking to improve the overall well-being of their members. Health plans are increasingly investing in programs aimed at addressing social drivers by collaborating with community organizations, government agencies, and nonprofits to provide resources and support in areas like housing assistance, nutritional programs, job training, and education. The Data Exchange Framework (DxF), an agreement across health and human services systems and providers to share information safely across California, is one of the initiatives health plans are generally eager to see implemented. A key premise of the DxF is that data must be more robust than traditional clinical information and in order to truly impact change, include information such as social determinants of health (SDoH).
Myth #4: Health plans do not support preventive care
Most people tend to think about and address their personal health needs only after a symptom or illness has emerged. Health plans have a false reputation for solely focusing on curative care when actually, most offer a range of wellness services, including health screenings, vaccination programs, and chronic disease management. By harnessing various sources of data and employing data analytics, health plans can identify at-risk individuals, offer timely interventions, and promote healthier lifestyles. Health plans also provide evidence-based preventive care guidelines, engage in member outreach and education, and facilitate care coordination.
There’s no question that data silos and fragmentation are common issues in the healthcare landscape. Effective data sharing—defined as comprehensive, timely, usable and secure digital information exchange—is crucial as it benefits patients by enhancing individual care and providing policymakers with valuable insights into population health needs. By linking shared data to success and quality metrics, health plans serve as a vital connector to help contribute to narrowing healthcare disparities. This privilege and responsibility is important, and often misunderstood, but has the power to ultimately lead to improved patient outcomes and effective delivery of healthcare services.
A health care transformation advocate, Shruti has worked as a health educator, community mobilizer, quality improvement leader, early stage startup operator, and in venture capital. She currently leads Industry Initiatives for Blue Shield of California and is the founder of Women of Community, an organization increasing representation of Women of Color in health care leadership. Shruti is also the co-founder of the start-up Crown Society. She’s been recognized on lists like Business Insiders 30 under 40 and frequents the healthcare conference speaking circuit.