In new information, the Office of Health Strategy says their Health Information Exchange (HIE) will not provide insurers or large health systems — Accountable Care Organizations (ACOs) – access to individual patients’ data. Advocates and providers have raised concerns that access to personal medical records could allow insurers and ACOs to inappropriately limit care and to cherry-pick more lucrative patients. Insurers and ACOs gain financially by lowering the cost of their patients’ care. In a new Republican-American article published Saturday, OHS stated that data given to insurers and ACOs from the HIE would only be de-identified. This is similar to OHS’s assertion in a CT News Junkie article from January 30th. OHS also claimed in the CT News Junkie article that insurers already have access to their patients’ clinical data.
However, both statements are contrary to a quote from an Anthem representative in the CT News Junkie article. “What we can tell from the claims data is what a physician or a provider did, but not whether the patient got better,” Jill Hummel, president of Anthem, said recently during a forum sponsored by the Office of Health Strategy. “And it is not easy today to get that data. One of the things we need is a sustainable HIE.” Insurers and ACOs are both well-represented on the nonprofit Board of Directors that will run the HIE.
There are still serious concerns even if OHS now intends to share only de-identified data with insurers and ACOs. A Georgetown Law Review article finds that “data scrubbed of direct personal identifiers can still be readily re-identified if it is combined with another set that also contains data about the same individuals.” Insurers and ACOs have a great deal of other data on their members. The Review states that “The re-identification of anonymized data has far reaching privacy implications.”
In the latest article, OHS is claiming that the HIE will allow insurers and ACOs access to information about social determinants of health for their patients. However medical records typically include very little information about patients’ social needs (an issue public health advocates have been working on for years) and considerable information is publicly available at the community level already which could be used to improve access to social services. In addition, information on social determinants could be used to discriminate against patients, a serious privacy concern. Under the Affordable Care Act, hospitals are conducting regular and robust community health needs assessments with specific recommendations and action plans to address gaps. Insurers and ACOs are encouraged to work with local communities to improve the public’s health.