Why Doctors Don't Share Data with Insurers

Once President Clinton's secretary for Health and Human Services, current University of Miami president Donna Shalala neatly summarized the reasons healthcare providers hesitate to share data with insurers.

In an appearance at the eMerge Americas digital business conference in Miami Beach this week, sitting on a panel with Patrick Geraghty, the CEO of the health insurer Florida Blue, Shalala said the reason for holding back is "we know if we turn over every piece of data to you, you do your analysis -- and we get paid less."

Shalala served for eight years as HHS secretary, the longest anyone has held that office, but now she speaks from the perspective of a provider, given that the university operates a medical school, a hospital, and a health system, in addition to affiliating with Miami institutions like Jackson Memorial Hospital.

"As the healthcare and health insurance industries, together with regulators, seek ways to deliver world-class healthcare at an affordable price, it matters that there are different financial interests in play, Shalala said. "It's important to know who has the data, who are the stakeholders, and who has the interest in providing the data, or in controlling the data."

Maybe so, but payers and providers are going to have to learn to work together, Geraghty said. "Any part of the system doesn't have enough data to truly understand what is happening to the patient." Healthcare providers have clinical data that insurers do not, but they are also missing data on the care patients receive outside their systems -- data the insurer captures through claims. "What we're seeing today is that many collaborations are coming together where the health systems and the payers are combining their information, combining their view of the data."

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