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Coordinated Care Oklahoma Will Exit HIE Market, Citing a Large Payer Mandating Providers Work with Competing HIE

January 19, 2017
by Heather Landi
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Board chairman Roger Neal said the decision to dissolve the organization was driven by a large, unnamed health insurer mandating its contracted providers work with another HIE
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In a public statement posted to its website this week, Coordinated Care Oklahoma (CCO), a health information exchange (HIE) based in Norman, Okla., announced that the organization will exit the HIE market, effective June 30, 2017.

In the statement, Roger Neal, chairman of the board for CCO, said that the “landscape has changed,” and said the board’s decision to dissolve the organization was driven by a large, unnamed health insurer mandating its contracted providers work with another HIE.

Essentially, Neal said in the official statement that “the best thing for Oklahoma was for CCO to exit the HIE market to help decrease the cost of healthcare as it pertains to HIE service within the state.”

In the official statement, CCO officials said the CCO board met January 5, 2017 and agreed on plans to dissolve CCO and voted unanimously to dissolve the organization effective June 30, 2017, “in the interest of our state, providers, health systems and patients.”

“It was a tough decision,” Neal said in a statement. “Our board members, support personnel, and founding organizations have a lot of blood, sweat, and tears in CCO. We’ve been able to accomplish a lot of great things for our patients, providers, and hospitals; but the landscape has changed.”

Further, Neal wrote, “Our board recognizes that one of the largest payers in Oklahoma has mandated its contracted providers must submit data to another HIE platform for their use in value-based contracting programs. That decision creates a hardship on many of Oklahoma’s providers and hospitals and has resulted in duplicative HIE costs for many who were members of CCO.”

During an interview with Healthcare Informatics Editor-in-Chief Mark Hagland at RSNA in October, CCO chief administrative officer Brian Yeaman, M.D. said CCO evolved from SmartNet into an HIE in 2014 and its members include more than 65 hospitals and 250-plus clinics, as well as approximately 100 post-acute care facilities. The HIE covers 5 million patients across facilities in five states with a transaction volume of over 2 million inbound ADTs and CCDs a month.

CCO officials also wrote in the statement, “CCO leaders believe the power of healthcare is in its data. Cost burdens associated with reimbursement cuts, and existing limitations on data-sharing options essentially mean that health systems in Oklahoma would pay two HIE fees— expenditures the CCO Board feels are untenable and unsustainable.”

Additionally, Neal said in the official statement that “while CCO has tried numerous times to discuss options with the payer for providing the data needed for these programs, we to date have no meeting to discuss our participation.

He continued, “As well, our understanding is that no connection or option outside direct data submission would give CCO’s participants the opportunity to continue in the payer’s value-based programs. With the growing rate at which Oklahoma providers and hospitals are having reimbursements cut, we felt the best thing for Oklahoma was for CCO to exit the HIE market to help decrease the cost of healthcare as it pertains to HIE service within the state.”

It has been noted throughout the healthcare industry that many HIE organizations have been struggling in the wake of the loss of most federal and state funding in the past two years and there is a strong need for operating HIEs to prove strong market value in order to be sustainable.

The official statement from CCO officials went on to state, “However, the CCO board does believe the public service and connections CCO has to providers at the point of care is a critical service and that data sharing and the seamless transition of care for patients should ultimately be free amongst provider-to-provider exchange and provider-to-payer exchange for reimbursement. During the next several weeks, CCO will contact all of its members and will provide assurance these critical public services — such as sharing of data — shall persist for our member organizations.”

 

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