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HIE Sustainability Secrets

October 25, 2011
by Jennifer Prestigiacomo
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NeHC Report Shares HIE Success Stories of Alternate Revenue Streams and Payer Buy-In

EXECUTIVE SUMMARY

Getting effective stakeholder engagement, including that of payers, and creating innovative value-added services that provide alternate revenue streams beyond basic subscription services, are just a couple of the common traits of the flourishing health information exchanges profiled in the sustainability report released in August by the National eHealth Collaborative.

How can health information exchanges (HIEs) ensure that they will have the financial viability to be around for the long haul? A recent report by the Washington, D.C.-based National eHealth Collaborative (NeHC) can provide some guidance.

The report, “Secrets of HIE Success Revealed: Lessons from the Leaders,” provides case studies on 12 successful, sustainable HIEs nationwide. The HIEs represent a diverse group of organizations, including for-profit entities, non-profit entities, and a government agency. NeHC CEO Kate Berry said in a Healthcare Informatics podcast (/article/podcast-sustainability-tips-hies) in August that the organizations were chosen based on their innovative strategies and business models, the value and impact they are having in their respective communities, their maturity in achieving sustainability and the geographic diversity among them.

COMMON TRAITS OF SUCCESS

Of all the HIEs profiled in the NeHC report, one of the commonalities they share is effective stakeholder engagement. Rochester RHIO, which is based in Rochester, N.Y. and serves 13 counties, illustrates this concept well, as it was founded in 2006 not only with a $4.4 million state grant, but $1.9 million in funding from local businesses, hospitals, and payers. Its user mix is as diverse as its board, and includes hospitals, physician practices, home care, long-term care, and behavioral health settings. “The major theme in our implementation was that we realized one of the values is to have as much information as possible; the other is to have as many people using it as possible,” says Marty Lustick, M.D., Rochester RHIO board member, and senior vice president and corporate medical director at Excellus BlueCross BlueShield. “You need both of those at the same time in order for people to gain confidence that there's value in it.”

Kate Berry
Kate Berry

Jill Eisenstein, Rochester RHIO's associate director, adds that to get these other healthcare entities involved in the RHIO, the barriers for adoption have to be very low. To that end, Rochester RHIO provides a virtual health record portal that only requires the healthcare organization to have Internet, rather than a full EHR, to access patient information.

Dev Culver
Dev Culver

Enlisting business leader support early on, says Lustick, is extremely important for the viability of any exchange. He notes that Rochester RHIO received both financial support and personal involvement in the board from business leadership. “Inevitably in this process when you're doing something this big and this new, there are times when there is ambivalence from the point of view of any particular healthcare stakeholder about how this is going to improve its position competitively,” he says. “The business leaders play a major role in keeping everybody focused on the community as a whole.”

Berry says being a trusted entity is a prime goal among HIEs, and hard work has to be done to build trust among stakeholders and maintain a reputation as a reliable, neutral entity that values protecting patient information and the interests of its participants above all else. Jacksonville Fla.-based Availity, which is a commercial for-profit that serves nearly 20 states with its multi-payer web portal that provides physicians with real-time access to patient information such as eligibility, benefits, and claim status, is the only profiled exchange of its kind that was borne from payers. It owes its vaunted status to starting with a small set of transactions and focusing on core strengths. In 2001 two health plans, Blue Cross and Blue Shield of Florida and Humana, agreed on guiding principles to gain value in finding billing efficiencies in providers' offices, while giving customers a common look, feel, and user experience.

Availity also exemplifies another core trait of a successful HIE, which is moving beyond sheer information exchange to operating on strong business directives and value-add services. “One of biggest challenges has always been, how do you create a sustainable model that will live beyond the grant money,” says Russ Thomas, COO and president, Availity. “We on the other hand went at it from solving today's problems in the physician office, which was inefficiencies in the way with which they interacted with health plans.” Thomas says that Availity has been profitable since 2004, and he owes that in large part to only exploring opportunities that have a business model behind them.

“We believe we're in a good position to leverage the existing network we have, which is 200,000-plus physicians and more than a billion transactions over our network, to be a part of that next generation of health information,” Thomas says.

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