Consumer-Directed Payer Data Exchange
- Release 0.1.0

Consumer-Directed Payer Data Exchange, published by CARIN Alliance. This is not an authorized publication; it is the continuous build for version 0.1.0). This version is based on the current content of and changes regularly. See the Directory of published versions

Benefit to Consumers and Health Plans

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Allowing third party applications to access payer data can directly impact the triple aim of health care to provide the right service to the right member at the right time. Members will undoubtedly engage at higher rates because they self-select the applications they find most appropriate to their unique circumstance. In addition, consumer data exchange is bi-directional. A consumers right to access their health data can include an opt-in provision allowing sharing of their historical health information with their health plan. Within days of enrollment, versus the months it typically takes, a plan can appropriately assess risk, identify gaps in care and triage the member to appropriate plan resources such as case management, care management, or disease management to name a few.

While the benefits of third-party applications targeting a consumer are vast, below are a few examples of benefits a consumer and health plan can achieve:

  • All of the data exchange is based on the foundation of a consumer who invokes their individual right of access or consent to request their own health information. This type of data exchange does not involve any covered entity to covered entity data exchange.
  • Reduced administrative expenses for payers resulting from the migration of expensive care management into consumer self-management and from fewer customer service inquiries regarding eligibility, claims, and benefits.
  • Reduced medical expenses for consumers and payers resulting from more efficient use, fewer repeat diagnostic tests, and lower overall demand for health care services.
  • Patient engagement which is enabled by data driven digital applications empowers consumers to stay healthy, share data with providers and thereby eliminate wasteful repeat services.
  • Redirected use of health care services away from facility and office-based care to a less expensive setting through the efficient use of telemedicine and telehealth.
  • Increased medication adherence, a focus of many applications, results in fewer acute care episodes and reduced emergency department utilization.
  • Reduced gaps in care will benefit payers when consumers and providers share vital information regarding chronic illnesses.

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