What’s more, the HIE is identifying patients who are “habitual utilizers of services,” such as one patient who Combs recalls was admitted 28 times in the last 12 months. “All of a sudden, the whole [care] team is now engaged to call patients and make sure they have their medications and home care. We are throwing all the resources we can to keep them out of the hospital setting. The HIE is doing this for us; it fills in gaps, and identifies a lot of people that need identifying,” he says.
“There is No Easy Button in Healthcare”
In the end, while Combs understands that many HIEs across the country are struggling, he believes that hard work and determination could help overcome the challenges. “There is no easy button in healthcare. You only get out of the HIE what you are willing to put into it. If you are willing to integrate and get your data in there, and get the rest of your community participating, that is step one,” he says.
But even more than that, he continues, physicians must also be willing to change their processes to take advantage of that data. “If you understand value-based medicine and the economics of healthcare, regarding insurance, risk identification and stratification, it doesn’t take any time for an HIE to give a return on investment in value-based contracting—if you are starting to go at risk.”
To this point, Combs notes that with an estimated twice as many patients coming into the system over the next 10 years—but without twice the number of doctors or twice the amount of money that Medicare can spend—there is a great need to identify the risk of each patient and keep the high-risk ones out of the hospital.
“Our HIE tells us the risk level of the patient and that goes straight to our value-based contracts. We have made more money since we started using the HIE then it ever would cost us in our contracts,” he attests. “So if you’re not figuring out how to execute on the value side and get payouts for either doing reporting or going at risk, then you will be declining in your fee schedule. We look at healthcare in general, and we see that there isn’t a choice—we have to go to value, and HIEs are [helping] with that.”
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