HERNDON, Va.–As temperatures rose across the nation, so did opinions on health information exchanges (HIEs) in two panel discussions June 21 at the Healthcare IT Connect Summit. During the panels, the overriding consensus among participants is the need to build a use case for HIEs.
Are HIEs positioned to add value and provide timely support to patient-centered medical homes (PCMHs) and accountable care organizations (ACOs)? asked Lynn Dierker, senior program director, National Academy for State Health Policy (NASHP).
John Kansky, vice president of product management at the Indiana Health Information Exchange, noted that patients attributed to ACOs will receive 30-45 percent of their care outside of the ACO system. That raises the question of how to entice health plans, providers and payors to foot the bill to share clinical data--data generally hoarded for leveraging purposes.
According to Dave Goetz, vice president, state government solutions, Optum, health plans have been reluctant to support HIE because:
- Savings are based on assumed reductions in future spending;
- Saving must be real, near-term and accrue to the plan;
- HIE has no focused clear use cases on where the risks and returns are;
- Company structure can inhibit ability to realize value and provide support;
- Low adoption lessens impact and perceived value; and
- Health plans are often explicitly excluded from governance and data-sharing.
“[HIE] must have a business case,” said Goetz. If an HIE must present a business case, how can an organization build value among its targeted community?
One piece of advice Jeffrey Milller, CEO, North Carolina Health Information Exchange, mentioned was to start with basic functions before trying to advance services. “You don’t want to swim with sharks if you can’t [swim] freestyle,” Miller commented. Jan Lee, executive director, Delaware Health Information Network (DHIN), echoed this sentiment by stating a key principle to drive adoption and utilization at DHIN was doing core services “very well” before expanding service lines.
For DHIN, that service was an electronic clinical results delivery service for lab, pathology and radiology results. She said she can present data to potential HIE participants where, within the provider community of Delaware, from the time discovery tools were made available, there was a 30-33 percent reduction in the rate of high costs, labs and radiology studies in two years. “At Medicare reimbursement rates, that equates to $6.5 million in the state of Delaware over a two-year period of time,” she said.
Assessing sustainability, Kanksy doesn’t know how an HIE that isn’t well established can help an ACO. Because accountable care models and HIEs rely on the reality that clinical data needs to be present within the system, how can HIEs make a business case to show that they a) have enough clinical data and b) that data can show value to other organizations?
Another piece of advice Miller gave was that a “death knell” for HIEs is to fixate on the initiative plan. For example, one of the main services North Carolina HIE provides is a hosted EMR; a service not mentioned in the first draft of their model. When asked by an audience member if he felt he had wasted time on his original plan, Miller responded that if you don’t have a plan, you’ll never know where you’re going. “If you have a plan, you can see if you’re not on that plan and react to it,” he said, noting organizations can adjust plans to change focus or adjust operations to get back on track.
While he admitted he spent money upfront on governance and policy issues he would’ve not had or baked into a residual budgetary timeline based on what he knows about current HIE adoption in his state, Miller concluded plans are important to have to drive toward goals.