New care and payment models are compelling healthcare provider organizations to seek health information exchange solutions to help manage shared payment risk and joint responsibility for patient and population outcomes, according to a new report from Chilmark Research. But analysts are surprised that HIE vendors seem to be ignoring the provider-payer re-alignment.

"This is a missed opportunity as new payment models are forcing providers to become more actuarial," concludes Chilmark’s 2013 HIE Market Report: Analysis and Trends.

"What we found among the majority of HIE vendors was an apparent lack of attention to the massive changes taking place in the relationships between payers and providers," Chilmark founder John Moore told Healthcare IT News. "This realignment creates both challenges and opportunities, however, most vendors are focusing almost solely on the provider side and not paying enough attention to payer needs."

That said, “This is beginning to change among a select few of the more progressive HIE vendors who in the last 3-6 months have begun capitalizing on this opportunity," he added.

Chilmark’s market report describes an evolving market for HIE solutions that mirrors changing conditions for providers. HIE vendors now aim squarely to help address the major new challenges of cross-enterprise care coordination and population health management.

In this third edition, Chilmark Research defines HIE 2.0 – a major and necessary evolution in HIE technology, says Moore. Significant market forces are forcing HIE vendors to support multi-disciplinary, cross-enterprise care teams in support of community-wide, coordinated care delivery. These patient-centric care plans must also meet the population health management needs of provider organizations, analysts note in the report.

[See also: More payers using consumer technology to engage plan members.]

While existing HIEs supply provider-to-provider messages containing subsets of patient medical records, HIE 2.0 will provide richer information and more functionality to support collaboration across venues and fill many of the functional gaps left by unconnected, incompatible and heterogeneous EHRs.

"Messaging – Direct or proprietary – is but one element in a provider's IT interoperability strategy," said Brian Murphy, lead analyst of the report, in a news release. "It has replaced a lot of letters, faxes and phone calls but more complex care coordination applications that really use the longitudinal patient record and shared applications are inevitable."

As Murphy sees it, "HIE 2.0 applications will be knit together by comprehensive notification services that deliver the right information to the right clinician at the right time on the device or in the clinical application of their choice. No vendor is there yet," he said, "but several are aggressively moving to HIE 2.0 capabilities, while many others lag behind."

[See also: Chilmark report sees HIEs moving into 'post-EHR era'.]

Murphy found that some providers are partnering with payers, others are acquiring smaller payer organizations and likewise, payers are acquiring providers. Analytics based on HIE-sourced data is still primitive along with nascent efforts to support population health management, clinical quality and public health reporting, all critical needs in this realignment.

"Dabblers like IBM, Microsoft, ACS and Verizon have executed strategic retreats from the HIE market," Moore noted. "Companies with great promise like Caradigm have also turned their attention to other opportunities and discontinued their own internal HIE development efforts. The HIE market is only for the skilled and the clinically knowledgeable. Clinical interoperability has never been a cakewalk but the companies featured in our latest report, in spite of their differing strengths and flaws, are in this for patients, care teams and caregivers."