General Business Issues

Insurer Groups Are Set to Propose Member-Friendly Personal Health Record Standard

Reprinted from the Dec. 11, 2006, issue of HEALTH PLAN WEEK (formerly Managed Care Week), the industry's leading source of business, financial and regulatory news of health plans, PPOs, and POS plans.

The health insurance industry is poised to announce a major initiative that would allow health plan members who switch plans to have their personal electronic health records follow them. Several health plans already offer members personal health records (PHRs).

On Dec. 13, America's Health Insurance Plans (AHIP), the Blue Cross and Blue Shield Association and the National Health Council will release the results of an 18-month pilot test with 10 insurers to make sure PHRs would be portable for members. The group is also expected to make recommendations on minimum standards for PHRs. AHIP and others have been working with the major health IT standards organizations to ensure that the record is compatible with other industry efforts.

"We think it's important that organizations working on these efforts build on what's already going on," says Susan Pisano, a spokesperson for AHIP.

The record will include 14 categories, or data elements, such as a member's allergies, family history, basic information on medical encounters, medication lists and immunization lists.

The records are based on the claims data that insurers collect. Although Pisano acknowledges that these PHRs might not be a long-term solution to the health care industry's efforts to make patient records electronic, she says it's a start. "Health insurers, through claims data, are in a unique position to advance something that works with consumers in the short term," Pisano says.

Health insurers are expected to use the PHR as a model. Already, plans such as Aetna, Inc. are introducing such records to their members. In October, Aetna announced it would make an online health history report available to all members by January 2007. The report will be automatically populated by each member's Aetna claim activity. In February 2007, Aetna will begin testing another PHR with several large customers, including United Parcel Service of America. That PHR will include individual personalized messages and alerts, detailed health history and educational information to help members make care decisions. Additional employers will have access to the enhanced PHR in July 2007.

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