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HIE, ACO Partners Both Have Rural Focus

November 14, 2013
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Inland Empire HIE providing BI, reporting services for National Rural ACO

In October, I wrote something about health information exchanges finding a niche as accountable care platforms. For instance, using its private HIE infrastructure called KeyHIE, Geisinger Health System is working on care coordination and patient activation. That includes working with home health and long-term-health providers.

Yesterday, I heard another great partnership described as an HIE becomes an ACO quality reporting platform. Richard Swafford, executive director of the Inland Empire Health Information Exchange (IEHIE) in rural California, spoke to a National eHealth Collaborative online meeting about his nonprofit group’s innovative partnership with the National Rural ACO.

NRACO is forming a national network of rural healthcare providers that hope to benefit collectively from the Medicare Shared Savings Program. Members of the network are hoping to achieve savings through care coordination and healthcare technologies. IEHIE is providing the members HIE services as well as quality reporting capabilities.

NRACO is based in rural Northern California, and IEHIE serves 11 counties in rural California, making up about a third of the state in terms of geography.

Unlike most HIES, IEHIE was launched with no federal or state funds and is a sustainable, fee-based organization.

IEHIE already supported a number of the rural communities targeted by the ACO, Swafford noted. “The union of these two groups made sense,” he said.

So far, 10 communities in California, Michigan, Oklahoma and Indiana have signed up and 57 letters of intent are in process.

(If an NRACO participant already has a local HIE it uses, it can take advantage of the analytics and reporting services of IEHIE without having to use its HIE service, although it would have to work with its HEI provider to get the data into IEHIE’s data warehouse.)

NRACO and IEHIE both received data analytics development grants from the state of California. They decided to pool their resources and work together using the Orion Health business intelligence platform to begin the build-out of the clinical measure reporting tools.

Although it was quite a challenge, Swafford said, IEHIE worked with Orion on developing 25 reports in the BI tool by the end of 2013.

So why ACO and HIE together?

 “If you look at the programs coming out of CMS, all of them fundamentally require the exchange of patient health information across many providers, and HIE is a natural fit,” Swafford said. “That becomes obvious when we ask how do we capture what we need to measure quality.”

While most ACO data is extracted from claims, the real-time clinical data is simply not available without direct access to the providers’ EHR, he added. HIEs facilitate this connectivity either through query/response or a data repository.

Another benefit, he said, is that the ACO reporting tools appear in same portal that physicians use. “There is no need to bounce out to separate a tool or reporting environment,” he explained. There is a single clinical environment they can use to do reporting and tracking. “I am not sure it would work if they had to use three or four portals.”

And the relationship with NRACO will allow IEHIE to become more sustainable as it charges a flat fee per community that joins. Rural communities not only gain the benefit of cost sharing through the ACO, Swafford said, but all the advantages of an HIE to improve patient care.

“One thing we are looking to do is expand the HIE to provide population management capabilities," he added, "so we can go beyond just tracking clinical and claims data, but allow providers to track patient populations from within the HIE.”

This will be an interesting partnership to watch. We’ll check back next year to see how these rural communities are faring.