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Public vs. Private HIE (Part 4)

November 7, 2014
by Gabriel Perna
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Erick Maddox

Health information exchanges (HIEs) are at a crossroads in 2014. A recent survey revealed that most HIEs are struggling with the financial costs of interoperability as well as building a sustainable operational model. Fewer than half of HIE leaders surveyed by the eHealth Exchange said that dues or fees were their greatest source of funding. Forty-nine percent of all HIEs surveyed said they were sustainable.

The end of federal funding of state-designated HIEs has shifted the landscape. Many public HIEs have been forced to shut down or dramatically shift gears, while others have succeeded in connecting major healthcare providers within and even across state lines. Meanwhile, some are turning to private HIEs for data exchange.

Healthcare Informatics Senior Editor Gabriel Perna spoke with four leading HIE executives –in both public and private organizations – who shared their thoughts on the challenges of running an HIE, the advantages of being public or private, where they’ve succeeded, and where they see the market headed.

Part 1 of this four-part series was an interview with Doug Dietzman, executive director at Great Lakes Health Connect

Part 2 was with Michael Matthews, CEO of MedVirginia, a regional HIE in central and eastern Virginia.

Part 3 was with Dan Paoletti, CEO of the Ohio Health Information Partnership (OHIP), which operates the statewide Clinisync HIE.

Part 4 is with Erick Maddox, HIT Manager at HealthInsight, which is a nonprofit organization that operates HealtHIE Nevada, a private statewide HIE. HealtHIE Nevada started up in 2010 and has experienced growth from the time it received its startup capital from community stakeholders. It includes most of the large healthcare delivery systems in Nevada, various primary and specialty medical care groups as well as independent physicians, major laboratory systems, imaging centers, and three payers. HealthInsight’s background as a quality improvement organization (QIO)/regional extension center (REC) was a huge leg up in growing the HIE.

Below are excerpts from the interview.

How have you been able to recruit hospitals and providers?

We had a lot of relationships with those facilities originally. We are not starting from scratch. We’re not trying to prove why they should listen to us. We have the relationships in place through our QIO work and the REC work, or through any other number of collaborative organizations we work with. That’s helped significantly. If we don’t have a history and can’t leverage a relationship, someone we work with typically does and can walk in the door with us and help us make the case. It’s a small state. We all know each other. It’s easy to run into the same people you’ve been running into for the last 10 years of your career on a regular basis. That helps in the process.

How were we able to get them to go? To say we have them all, it’s all there, and it’s working…it makes it sound simple. It’s been a fight and a struggle. We’ve worked hard at it and it’s taken four years. Only recently did we receive the agreements for the last urban acute-care hospital we needed in the state. We’re still working to get rural and critical access hospitals. There are other challenges there.

It’s leveraging those relationships, looking at the data sets. In some cases facilities or doctors will say they will participate, but they need to know they’ll get the data from a certain hospital or lab. It’s following the referral patterns and following the business relationships that already exist in the community and bringing on those in clusters. Rather than, just saying we’ll bring doctors using a certain EMR. I can bring on every doctor using PracticeFusion, for instance, but that doesn’t mean the data will be used correctly. We need our data providers. We start with a few key ones and start building out their referral networks from that point.

What is your sustainability model?

I’ve been asked this before and I’m never quite sure how to describe the sustainability model. It’s all subscription-based. We take the approach that everyone pays to play. Everyone. I got pushback early on. I went to some lab systems and they were surprised we wanted to charge them. It took a little, not tons, of working through the argument. Everyone that integrates and participates with the HIE has skin in the game. They’re paying towards sustainability. That fee-for-service rate is distributed in a very specific way, in what our community stakeholders believe, reflects value proposition in the system. For instance, of all the money required that operate us, 50 percent is coming from payers. They pay at a rate of 21 cents per member per month. After that, hospitals are next in line, then physician offices, and those lab systems…they have one of the smallest fractions. Everyone pays into it but their burden of sustaining the HIE ties it back to who is accruing and compounding the benefit of the existence and function of the information.

How do you justify those fees?