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Public vs. Private HIEs (Part 2)

October 24, 2014
by Gabriel Perna
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Michael Matthews, CEO of MedVirginia

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. Less than half of HIEs 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 into 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 of this series on HIE is with Michael Matthews, CEO of MedVirginia, a regional HIE in central and eastern Virginia. The HIE has been operational since January of 2006 and was the first to connect to the Nationwide Health Information Network (NwHIN), the Department of Defense and Department of Veterans Affairs (VA), and the Social Security Administration through the NwHIN. The HIE has rolled out value-add services, such as results routing and encounter alerts, to create a model of sustainability. Matthews himself has been involved state initiatives as the CEO of ConnectVirginia and national initiatives through his work with the NwHIN and its evolution into Healtheway’s eHealth Exchange.

Below are excerpts from HCI’s conversation with Matthews:

How have you been successful with recruiting health systems?

We’ve worked with health systems in past and we know the challenges they are facing. We appreciate the pain points of health systems and physician practices. Our basic message to them is to achieve meaningful use they have ever-increasing requirements for interoperability. More importantly than that, it is one way to increase the ROI on those EHR investments, become more interactive, and have data that’s able to follow the patients as they go from provider to provider. Data needs to flow. The physicians now that they have EMRs, they are hungry for discrete data. The forces are lining up, whether it’s from a triple aim/population health perspective, the incentives of meaningful use, the technologies are advancing.

From that perspective, what struggles are public HIEs facing?

All the states appreciate the funding that came from the government to help with the rollout of their HIEs. But it’s a pretty dramatic cliff to drop off of that funding and many were not able to get their policy framework in place, build the required infrastructure, get stakeholders on board, and get a sustainable business plan in place in the span of 2.5 years. That’s a heavy lift for even the most nimble of state organizations. Any one of those activities would have taken two years. Well, all of that had to happen in two years. Most people ran out of daylight.

In this perspective, what has MedVirginia and ConnectVirginia done that others have not?

Fortunately, we had a lot of engagement with our health systems and providers in the Commonwealth and we had extraordinary leadership by the Commonwealth itself. Secretary of Heath and Human Resources in Virginia, Dr. Bill Hazel is chair of the ConnectVirginia board and is a great champion of HIE. The health systems rallied with a lot of support. They recognized the situation and came up with bridge funding to further develop our infrastructure as we’re building to moving to a more sustainable business model over the next few years. We couldn’t have done this without the health system and Commonwealth support.

It sounds like you had a lot of vision, making the HIE live in 2006. From what I can tell, not everyone has had the same kind of foresight to do this before HITECH was passed and money was doled out.

I think that’s true. There is certain subject matter expertise that goes with this. I’m big on the concept of a trust framework for health information exchange activities. I’ve been around Virginia for 21 years and understand what’s required to build trust and to use use that trust to support meaningful health information exchange. If there were not a foundation in place of some sort, there would have not been enough time to build up the HIE and be sustainable.  

Where do see your HIEs in terms of sustainability?

We’re very bullish on our future both as a regional HIE that’s doing a lot of connectivity at an individual provider level and as statewide HIE, moving the Commonwealth forward on interoperability. We’re bullish on the opportunities to bring value on the population health and accountable care side. I won’t say I ever rest easy…every day we show up trying to determine how we add value to our partners.That’s a challenge we accept.

Do you consider your HIEs to be private or public?

MedVirginia is a private HIE. We’ve received federal funding as one NwHIN trial implementation but it’s always been a private LLC.