After a period of wait-and-see in the health information exchange (HIE) market when the American Reinvestment and Recovery/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act initially passed in 2009, meaningful use has since been pushing providers to adopt the EHR technology necessary to move forward to launch HIEs. Hospitals and health systems, as well as payers, are fueling HIE growth, building information backbones necessary to support care coordination and accountable care organization (ACO) development.

With the multitude of health IT responsibilities on providers’ plates now, it’s a tough decision as to whether an organization should build their own private HIE or link to a nearby public exchange, says Mark Allphin, senior research director, KLAS Research (Orem, Utah). Allphin reports that in a recent survey his consulting firm conducted, providers were in a 50/50 split on the choice, and the deciding factors were the amount of organizational resources the organization had and the maturity of the region’s public HIE. Carladenise Edwards, Ph.D., president and CEO, The BAE Company (Miami, Fla.), says that some primary considerations for assessing the value of a public HIE are access to greater legal protections for data breaches and access to data points and public health reporting inaccessible otherwise.


Mark Allphin

This year, public exchanges will be pushing out a thin layer of services including query and retrieval of patient information across their regions to connect competing organizations, while the private sector will be developing deeper services to virtually aggregate ambulatory providers for ACOs and advanced payment programs to effectively manage patient populations, says Kevin Carr, M.D., senior executive, Connected Health, Accenture (New York). “There’s a business model on the backend that says, ‘if I do this effectively, then I have a platform to help support my accountable care organization effectively, and I am going at risk on certain contracts so I need that technology platform to help run that business,’” says Carr. Some private exchanges will also be building public health gateways to share immunization information and enable public reporting.

Rise of the Private HIE
From 2010 to 2011, the number of live public HIEs rose from 37 to 67, while the number of live private HIEs more than tripled from 52 to 161 during that same time period, according to a July 2011 report from KLAS. Allphin sees the big growth in HIEs to stem from hospitals and independent delivery networks (IDNs). He says there is a great motivation to build networks between a hospital’s employed and non-employed physicians to strengthen care coordination. Afterwards, a private HIE has the option of connecting to a public HIE.

Allphin attributes the slow growth in the public sector to the time it takes to balance the strategic goals of all organizations involved, and the challenge of politics and user adoption. There’s also a sense in the industry, he says, that there’s some cause for concern that public HIEs won’t be able to find successful sustainability models and garner the participation of competing entities. Provider feedback from KLAS’ recent report said that some organizations wanted to connect with their public HIEs, but moved forward with their own HIE because public efforts had stalled.

Edwards recommends that taxpayers hold the federal government and states accountable for these public-funded HIEs to make sure they are indeed forming and improving the public health infrastructure, be it by building disease surveillance  mechanisms or immunization registries. She also believes that HIE vendors need to be held accountable by the industry and the regional extension centers (RECs) to create systems that interoperate at reasonable costs.

Payer-Driven Exchanges, Interfaces
Edwards sees a major trend this year for health plans and managed care entities to provide solutions to their providers and patients to help coordinate care. Carr says that payers are looking to add value beyond just paying claims, and to drive quality by starting clinically data enriched HIEs and care management programs, so more time can be spent on interventions, rather than collecting information from the patient.

Carr notes that the Pittsburgh-based Highmark, a Blue Cross Blue Shield company, is implementing an HIE to network community providers to help reduce costs “and also to help drive a platform to help make those providers in the community more successful in pay-for-value programs—so helping to mobilize that data so the healthcare system is operating as a fully-integrated system, as opposed to silos.”

Last year’s acquisitions of Axolotl (San Jose) and Medicity (Salt Lake City), by United Health Group’s Ingenix Division (Eden Prairie, Minn.) and Aetna (Hartford, Conn.), respectively, were certainly a bellwether in the industry for this trend. To this end, besides an enhanced clinical capabilities program and a private label health plan, Aetna’s population-specific collaboration for Medicare Advantage patients utilizes case management staff and programs, as well as actionable clinical data, analytics, and patient population reporting through provided technology run on the Medicity platform.