Closing the Gaps: Benefits of HIE for Care Coordination

sgruber-200 (1)Closing the Gaps: Benefits and Barriers of  HIE Part 2

By Sarianne Gruber
Twitter: @subtleimpact

Today’s health care leaders are also the emissaries for bringing new technology, coupled with the demand for improving health delivery makes this a critical role.  At this month’s NYC Healthcare Business Leaders forum, Laurel Pickering, President and CEO of the Northeast Business Group on Health, moderated a distinguished panel of Population Health solution experts. The discussion focused on their current practices, needs and opportunities for closing gaps through the use of Health Information Exchange (HIE). Panelists included:

  • Kevin Carr, MD a Partner, Population Health and Value Lead at Price Waterhouse Management Consultants
  • Tony Trenkle, Chief Health Information Officer, IBM Global Healthcare
  • Deborah Hammond, MD Vice President and Medical Director, Healthfirst
  • Tom Check, President and CEO, Healthix.

How do you talk to your clients about the about the value of health information exchange?
“When we talk to our clients, it is about the world is changing,” replied Tony Trenkle, “not fee for service that we have been used to, now we are moving to value-based care both the government pushing it and the industry changing it.  And because of it, the need to get data to support programs to support better health is more critical than ever.  So the role of exchange is one that can bring a lot of it together. That is what we say to our clients”.    Trenkle conveyed that the industry as an ecosystem, not just health care plans or providers, and it is more about growing closer together and that is why exchanges play a key role.  Traditionally, IBM has played support role providing the infrastructure for exchanges (Initiate).  With their new acquisitions (Truven, Explorys, Merge and Phytel), they are getting more involved with clients on population health and care coordination.

What are the barriers and challenges that you hear as you are talking about health information exchange?
“There is a word – trust.  And sometimes trust is translated into ‘competition’ between the organizations,” admittedly stated Dr. Carr.  A sigh of agreement echoed from the other panelists.    Dr. Carr thinks at the core there is the competition component that comes into play.   An inherent question an organization may ask itself as stated by Dr. Carr, am I going to give my data to a health plan when I may actually be secretly thinking about creating my own health plan as well? Then why would I give my data to the health plan and make them stronger and give up my competitive differentiation over time? He went on to clarify that competition was always there, but it had a “different flavor”.  In the past, there was a tradition line of what a health plan did and what a provider did but now the lines are blurred.  And in the decision process to join an HIE, providers and health plans may be questioning who is a friend or foe.  Dr. Carr elaborated, “If you are a friend, are you going to stay my friend?  Or perhaps just I will give you enough data to get through this contract, and the end of the contract I am going to create my own health plan anyway.”  To this point, Mr. Trenkle added that more and more plans are provided based, with 60% of Medicare Advantage primarily provider based.

What value does HealthFirst’s HIE provide to its members and sponsors?
“Everyone agreed that an HIE is the way to get us from 4 to 5 stars”, professed Dr. Hammond. HealthFirst has become the only 4-star plan in downstate New York for Medicare, and the only 5 star Medicaid plan two years in a row. Dr. Hammond shared that one of the reasons why HealthFirst has an HIE is that they have a unique relationship with their 18  sponsored, non-profit hospitals.  Basically a series of 18 ACOs, they are one of the largest ACO models with value-based payment in the US.   About 60% of the primary care physicians are in some kind of value-based payment and the other 40% are on their way there.  All excess premiums go back to the hospitals, returning anywhere from 2 to 5% on a yearly basis. Currently, they serve 1.2 members in the five boroughs and Nassau, Suffolk and Westchester counties.  Not having a clinical in-house, its HIE serves as the clinical, population health warehouse, which is full of information as well as proprietary information such as risk scores and predictive models.

An inner systems HIE platform was chosen, keeping in sync with 70% of the other hospitals in New York. The system is agnostic and accommodates any kind of connection to those hospitals.  Shareable information with member hospitals and doctors fosters collaboration. In fact, a small care plan pilot was started on long-term care.  HealthFirst is getting ready to drop all claims and encounter information into the HIE for all their member hospitals without financial information.   At risk hospitals can use this information for their population health programs.  “We see the  HIE as a super highway  of  information that allows us to go out those  hospitals, present them information in a way that works for them  and allows them to pull  that information  or to see it or pull it into their  population health programs.  Almost all our hospitals are in the midst of purchasing decision support tools and other population health capabilities. It is very important for them to have this data so they can advance care,” touted Dr. Hammond.

What are the ways plans working with Healthix can use and leverage your data?
Healthix is one of the 8 health information exchanges in the State of New York regulated, sponsored and funded by state health department. “It has been around for about 8 years now. And part of the fabric of doing this as a state-sponsored organization is exactly to address the trust issues we heard about,” noted Tom Check.  Healthix has been successful at getting data from 235 health care organizations at 1300 locations of care, constantly from their EMRs. Tom Check provided the following details to the attendees.  Health plans that are members contribute data as well. Providers have gotten past the issue of this data being competitive data.  They want to hold to themselves, aided by state policies that are requiring healthcare providers to contribute that data.  Working with more of the information from an HIE really creates a composite picture of what’s going on for the individual.   And as a result, you will get better treatment, a better diagnosis and care management.  It also gives the ability to alert whoever is managing the patient in case the patient runs into trouble. The provider, care manager or health plan can set up rules for alerts like if the patient goes to the emergency department or the provider wants to know if this patient is incarcerated. The provider can even set an alert to know if this patient’s risk for medical problems increases based on analytics. Many types of proactive alerts can be created as well for care managers and providers to manage their patients more effectively.  So for an exchange with this fluidity of data, the state established that all the data is going in “no questions asked” to the HIE but the patient or the member has to authorize who gets to see it. And the way traditionally that’s has worked in New York state is for the individual to go to a provider at a point of registration and make a consent decision does this provider organization have the ability to access my data.