Abstract
Health Information Exchange (HIE) network allows securely accessing and sharing healthcare-related information among healthcare providers (HCPs) and payers. HIE services are provided by a non-profit/profit organizations under several subscription plans options. A few studies have addressed the sustainability of the HIE network such that HIE providers, HCPs, and payers remain profitable in the long term. However, none of these studies addressed the coexistence of multiple HIE providers in the network. Such coexistence may have a huge impact on the behavior of healthcare systems in terms of adoption rate and HIE pricing strategies. In addition, in spite of all the effort to maintain cooperation between HIE providers, there is still a chance of competition among them in the market. Possible competition among service providers leads to many concerns about the HIE network sustainability and behavior. In this study, a game-theoretic approach to model the HIE market is proposed. Game-theory is used to simulate the behavior of the three different HIE network agents in the HIE market: HIE providers, HCPs, and payers. Pricing strategies and adoption decisions are optimized using a Linear Programming (LP) mathematical model. Results show that the relation between HIEs in the market is crucial to HCP/Payer adoption decision specially to small HCPs. A small change in the discount rate proposed by a competitive HIE provider will highly affect the decision of HCP/payers to join the HIE network. Finally, competition opened the opportunity for more HCPs to join the network due to reduced pricing. Furthermore, collaborative HIEs provided better performance compared to cooperative in terms of profit and HCP adoption rate by sharing their overall costs and revenues.
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References
Tzeel A, Lawnicki V, Pemble KR (2012) Hidden value: How indirect benefits of health information exchange further promote sustainability. American Health and Drug Benefits
Ahmed A(2016) Optimization of health information exchange network: study of sustainability from a cost-and-benefit perspective. State University of New York at Binghamton
Akhlaq A, Sheikh A, Pagliari C (2017) Defining health information exchange: scoping review of published definitions. Journal of innovation in health informatics 234:684–764
Anderson SP, Waldfogel J, Stromberg D (2016) Handbook of Media Economics, vol 1A. Elsevier
Bae J (2014) Health information technology and its impact on health services use and quality. PhD thesis
Berman O, Zahedi F, Pemble KR (2001) A decision model and support system for the optimal design of health information networks. IEEE Transactions on Systems, Man, and Cybernetics, Part C (Applications and Reviews) 31(2):146–158
Brennan PF, Ferris M, Robinson S, Wright S, Marquard J (2005) Modeling participation in the NHII: operations research approach. In: AMIA Annual Symposium Proceedings, vol. 2005, p 76
Carr CM, Digioia CH, Wagner J, Saef SH (2013) Primer in health information exchange for the emergency physician: Benefits and barriers
Demirezen EM, Kumar S, Sen A (2016) Sustainability of healthcare information exchanges: A game-theoretic approach. Information Systems Research
Devine EB, Totten AM, Gorman P, Eden KB, Kassakian S, Woods S, Daeges M, Pappas M, McDonagh M, Hersh WR (2017) Health information exchange use (1990-2015): A Systematic Review. eGEMs 5(1)
Dimick C (2012) ACOs driving HIE development, competition. Journal of AHIMA, 1
Dimick C (2012) Open for business: private networks create a marketplace for health information exchange. Journal of AHIMA 83(5):22–26
Dixon BE, Zafar A, Overhage JM (2010) A Framework for evaluating the costs, effort, and value of nationwide health information exchange. Journal of the American Medical Informatics Association
Dullabh P, Ubri P, Loganathan S, Latterner M. (2014) Evaluation of the State Health Information Exchange Cooperative Agreement Program: State Approaches to Enabling HIE: Typology Brief. Washington, DC: Office of the National Coordinator for Health Information Technology. [Accessed 2018-12-01]. https://www.healthit.gov/sites/default/files/statehietypologybrief.pdf. [Google Scholar]
Edaibat EA, Dever J, Stuban SMF (2017) System dynamics simulation modeling of health information exchange (HIE) adoption and policy intervention: A case study in the State of Maryland. Operations Research for Health Care
Edaibat EA , Dever J, Tanju B, Stuban SMF (2014) A system dynamics simulation modeling: health information exchange adoption in the US healthcare system. In: Proceedings of the 2014 Winter Simulation Conference
eHealth Initiative (2012) The rise of the private health information exchange and changing role of public exchanges. Technical report, Optum Health
Everson J (2017) The implications and impact of 3 approaches to health information exchange: community, enterprise, and vendor-mediated health information exchange. Learning Health Systems 1(2):e10021
Frisse ME, Holmes RL (2007) Estimated financial savings associated with health information exchange and ambulatory care referral. Journal of Biomedical Informatics
Gaynor M, Ho K, Town RJ (2015) The industrial organization of health-care markets. Journal of Economic Literature 53(2):235–84
Goldfield NI, McCullough EC, Hughes JS, Tang AM, Eastman B, Rawlins LK, Averill RF (2008) Identifying potentially preventable readmissions. Health care financing review 30(1):75
Greene J (2012) Competition among health information exchanges slows development of Michigan system. [Accessed 2018-12-01]. https://mihin.org/2012/10/competition-amonghealth-information-exchanges-slows-development-of-michigan-system/
Grundey D (2009) Branding strategies during economic crisis: avoiding the erosion. Economics & Sociology 2(2):9–22
Kern LM, BarrónY Dhopeshwarkar RV, Kaushal R (2012) Health information exchange and ambulatory quality of care. Applied clinical informatics 3(2):197
KFF (2018) Health insurance coverage of the total population
Kierkegaard P, Kaushal R, Vest JR (2014) How could health information exchange better meet the needs of care practitioners? Applied clinical informatics 5(04):861–877
Kohler S (2002) Connecting for health: A public-private collaborative. Markle Foundation
Kruse CS, Regier V, Rheinboldt KT (2014) Barriers over time to full implementation of health information exchange in the United States. JMIR Medical informatics 2(2)
Landi H (2018) One New York regional HIE opposes expansion of another, highlighting issues with competition among HIEs
Martinez DA, Feijoo F, Zayas-Castro JL, Levin S, Das TK (2018) A strategic gaming model for health information exchange markets. Health care management science 21(1):119–130
Mello MM, Adler-Milstein J, Ding KL, Savage L (2018) Legal barriers to the growth of health information exchange-boulders or pebbles? Milbank Quarterly 96(1):110–143
Menachemi N, Rahurkar S, Harle CA, Vest JR (2018) The benefits of health information exchange: an updated systematic review. Journal of the American Medical Informatics Association 25(9):1259–1265
Merrill JA, Deegan M, Wilson RV, Kaushal R, Fredericks K (2013) A system dynamics evaluation model: implementation of health information exchange for public health reporting. Journal of the American Medical Informatics Association 20(e1):e131–e138
Miller AR, Tucker C (2014) Health information exchange, system size and information silos. Journal of health economics 33:28–42
Mondal WI et al (2013) The health insurance exchange: An oligopolistic market in need of reform. Journal of Business & Economics Research (JBER) 11(12):569–576
Moorthy KS (1985) Using game theory to model competition. Journal of Marketing Research
NRHRC (2012) ROI calculator. Technical report, National Rural Health Resource Center
PRWeb (2014) Payers reject public HIEs and pony up to lead private enterprise interoperability, reveals recent black book survey. New York
Reis J, MacKenzie L, Soelberg T, Smith J (2016) Assessment of the usability and impact of the Idaho health data exchange (IHDE). Journal of Medical Systems
Rudden J (2018) Market share of leading U.S. health insurance companies 2018, by direct premiums
Shapiro JS, Kannry J, Lipton M, Goldberg E, Conocenti P, Stuard S, Wyatt BM, Kuperman G (2006) Approaches to patient health information exchange and their impact on emergency medicine. Annals of Emergency Medicine
Shen W, Gharibdousti MS, Rezaeiahari M, Khasawneh MT (2017) Designing a sustainable health information exchange network. In: 67th Annual Conference and Expo of the Institute of Industrial Engineers 2017
Sridhar S, Brennan PF, Wright SJ, Robinson SM (2012) Optimizing financial effects of HIE: A multi-party linear programming approach. Journal of the American Medical Informatics Association
Swain M, Charles D, Patel V, Searcy T (2015) Health information exchange among US non-federal acute care hospitals: 2008–2014. ONC Data Brief 24:1–12
Symeonidis G (2000) Price and nonprice competition with endogenous market structure. Journal of Economics & Management Strategy 9(1):53–83
Thompson KH (2019) SHIEC
Vest JR, Kern LM, Campion TR, Silver MD, Kaushal R (2014) Association between use of a health information exchange system and hospital admissions. Applied Clinical Informatics
Vest JR (2010) More than just a question of technology: Factors related to hospitals’ adoption and implementation of health information exchange. International journal of medical informatics 79(12):797–806
Vest JR, Greenberger MF, Garnatz A (2017) Diverging views on health information exchange organizations. Learning Health Systems
Vest JR, Greenberger MF, Garnatz A (2017) Diverging views on health information exchange organizations. Learning Health Systems 1(3):e10031
Walker J, Pan E, Johnston D, Adler-Milstein J, Bates DW, Middleton B (2005) The Value Of Health Care Information Exchange And Interoperability: There is a business case to be made for spending money on a fully standardized nationwide system. Health affairs 24(Suppl1):W5-10
Winston, W. L., & Goldberg, J. B. (2004). Operations research: Applications and algorithms (4th ed.). Thomson Brooks/Cole
Wu H, Larue E (2015) Barriers and facilitators of health information exchange (HIE) adoption in the United States. In: System Sciences (HICSS), 2015 48th Hawaii International Conference on, pp 2942–949
Wu H, LaRue EM (2017) Linking the health data system in the US: Challenges to the benefits. International journal of nursing sciences
Yakti S (2015) A game-theoretic approach to optimization of pricing policies for healthcare information exchange network using genetic algorithm. State University of New York at Binghamton
Yakti S, Dauod H, Lam SS (2017) Optimization of HIE network subscription rates and investigation of effect of a new hybrid subscription plan on HIE sustainability. In: IIE Annual Conference. Proceedings, pp 1097–1102
Yaraghi N (2015) An empirical analysis of the financial benefits of health information exchange in emergency departments. Journal of the American Medical Informatics Association 22(6):1169–1172
Yasnoff WA, Humphreys BL, Overhage JM, Detmer DE, Brennan PF, Morris RW, Middleton B, Bates DW, Fanning JP (2004) A consensus action agenda for achieving the national health information infrastructure. Journal of the American Medical Informatics Association 11(4):332–338
Zhou Y, Ancker JS, Upahdye M, McGeorge NM, Guarrera TK, Hedge S, Crane PW, Fairbanks RJ, Bisantz AM, Kaushal R et al (2014) The impact of interoperability of electronic health records on ambulatory physician practices: a discrete-event simulation study. Journal of Innovation in Health Informatics 21(1):21–29
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Shabbar, R., Sayama, H. Health information exchange network under collaboration, cooperation, and competition: A game-theoretic approach. Health Care Manag Sci 26, 516–532 (2023). https://doi.org/10.1007/s10729-023-09640-9
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DOI: https://doi.org/10.1007/s10729-023-09640-9