Sustainability of Healthcare Information Exchanges: A Game-Theoretic Approach

Based on our interactions with the key personnel of three different healthcare information exchange (HIE) providers in Texas, we develop models to study the sustainability of HIEs and participation levels in these networks. We first examine how heterogeneity among healthcare practitioners (HPs) (in terms of their expected benefit from the HIE membership) affects participation of HPs in HIEs. We find that, under certain conditions, low-gain HPs choose not to join HIEs. Hence, we explore several measures that can encourage more participation in these networks and find that it might be beneficial to (i) establish a second HIE in the region, (ii) propose more value to the low-gain HPs, or (iii) offer or incentivize value-added services. We present several other interesting and useful results that are somewhat counterintuitive. For example, increasing the highest benefit the HPs can get from the HIE might decrease the number of HPs that want to join the HIE. Furthermore, since the amount of funds from the government and the other agencies often changes (and will eventually cease), we analyze how the changes in the benefit HPs obtain from the HIE affect (i) participation in the network, (ii) the HIE subscription fee and the fee for value-added service, (iii) the number of HPs that request value-added service, and (iv) the net values of the HIE provider and HPs. We also provide guidelines for policy makers and HIE providers that may help them improve the sustainability of HIEs and increase the participation levels in these networks.