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GETTING PAYER BUY-IN
Three of the HIEs profiled in the NeHC report, Quality Health Network (Grand Junction, Colo.), Availity, and Rochester RHIO, drew much of their success from incorporating the payer community as a key stakeholder, leader, and revenue source from the beginning. These HIEs convinced payers of the benefits of the HIE's services in terms of cost savings achieved through reductions in services utilization, NeHC's CEO Kate Berry notes.
“Employers and health plans as purchasers of healthcare do see the value of health information exchange, and how that is going to lead to better quality and care coordination and more effective cost management because they are going to avoid duplicated tests and better manage the care so you have lower downstream costs,” Berry says.
Rochester RHIO had a unique start in that its original CEO, Lustick's predecessor, was from Exellus Bluecross Blueshield and saw HIE as a positive benefit to the community, and thus, played a leadership role from the beginning.
“In Rochester one of the things the RHIO has done is develop a really sophisticated system of metrics to enable them to both do their own quality improvement projects and demonstrate the value in the community in a very quantitative way,” Berry says. “But they also have that metric system in place so they can support specific quality improvement projects that the purchasers want them to do.”
Getting payer support isn't always easy. Ideally, HealthInfoNet (HIN), Maine's statewide HIE based in Portland, would like to get one-third of its total fees to come from payers, but there has been a lack of interest until recently. Executive Director Dev Culver says that his organization plans to get MaineCare, the state's Medicaid program, interested in the HIE by addressing a key issue in the state, high utilization of the emergency room (ER) for non-emergent reasons. HIN would develop a notification system to alert care managers to ER visits for one of 14 different diagnoses. The care managers would then provide the patient with education and recommend appropriate follow-up to avoid future ER visits.
THERE'S A REALLY INTERESTING AND SIGNIFICANT INTRODUCTION OF SOCIAL MEDIA WITHIN THE PHR AND THE OPPORTUNITY THAT CREATES FOR BUILDING GROUPS [OF PATIENTS] BY LIKE CONDITION OR INTRODUCING PRODUCT LINES THAT SUPPORT THESE TYPES OF CONDITIONS. - DEV CULVER
Lately, Culver says that conversations with other insurers have been promising. With accountable care organization (ACO) legislation looming, which could possibly create some competition, payers are looking for alternate ways to bring value to their customers. An idea for HIN to appeal to payers would be to offer them population analytics, showing their members in the context of predicted cost and outcome, all with the benefit of clinical data.
INNOVATIVE REVENUE STREAMS
Many of today's experienced HIEs are evolving their services beyond just clinical information exchange and creating value-added services to benefit stakeholders and build new revenue streams for the HIE. These new financial opportunities include many revenue generators, including analytics, ACO support services, and patient portals.
Rochester and HIN are both planning patient portals. Rochester's portal allows patients to submit informed consents online, upload advance directives like living wills, and request an audit of access to their EHR. Next steps include creating a PHR gateway that establishes two-way connectivity to the HIE from the patient's untethered personal health record (PHR), like Microsoft's HealthVault.
Culver says that HIN is finishing due diligence on its robust patient portal to be completed early next year. The same product is currently being used by McGill University Health Centre in Montreal. The portal will have significant functionality not only to allow patients access to their health information in easy-to-understand language, but also to permit them to self-document, which will then be coded into medical taxonomy so it can be used for interpretation purposes. “Then there's a really interesting and significant introduction of social media within the PHR and the opportunity that it creates for building groups [of patients] by like condition or introducing product lines that support these types of conditions,” he says. “[For example], there's a huge market that tries to support those people who are actually caregivers for Alzheimer's patients.”
