Inland Empire Health Plan, based in Rancho Cucamonga, is a not-for-profit health insurer that covers 1.25 million members in Southern California, primarily in Riverside and San Bernardino Counties, in the eastern part of the vast Los Angeles Basin metroplex, and with additional members in Palm Springs, the high desert, and other areas.
The health plan’s membership includes 1.2 million MediCal members—MediCal is California’s uniquely named Medicaid program—and 23,000 dual-eligibles—that is, individuals who are eligible both for the Medicare program and the MediCal (Medicaid) program.
A lot is happening at Inland Empire Health Plan these days, and much activity is being led by its CEO, Bradley Gilbert, M.D. Dr. Gilbert, who practiced as a board-certified general preventive medicine and public health specialist before joining the health plan 20 years ago, joined the organization as medical director and CMO, and was promoted to CEO nine years ago. Gilbert has led numerous advances at the health plan, including in the context of the health plan’s support for health information exchange (HIE). It is in that context that Gilbert serves as chairman of the board of the San Bernardino-based Inland Empire HIE (IEHIE).
And it is in that context that Gilbert was one of the leaders participating in the January 10 announcement of the planned merger of IEHIE and the San Francisco-based California Integrated Data Exchange (Cal INDEX). Gilbert and others spoke at a press conference held simultaneously at the Sir Francis Drake Hotel in downtown San Francisco, and via telephone. The merger, once approved by federal authorities, is expected to create one of the nation’s most comprehensive not-for-profit HIEs.
It was announced that Claudia Williams, former White House technology senior advisor, will lead the new organization as CEO, effective February 1, 2017. The merger, subject to regulatory approvals, is expected to be completed in the first quarter of 2017 and will operate as a tax-exempt public benefit corporation under a new name.
And, according to a press release published at the same time as the press conference was taking place, “The new HIE will combine the 11.7 million claims records from Cal INDEX founding members Blue Shield of California and Anthem Blue Cross with the 5 million clinical patient records of IEHIE and its 150 participating partners. HIEs help improve the quality of the patient experience, support collaboration and coordination and improve efficiencies by making it easier for doctors, hospitals and other care providers to securely review, analyze and share medical information across the healthcare system.”
And the press release quoted Dr. Gilbert as stating that “The creation of this new statewide health information exchange by IEHIE and Cal INDEX is an important milestone in transforming California’s healthcare system into a coordinated system that delivers higher quality and more efficient care to all Californians.”
Two days after the press conference, Dr. Gilbert spoke with Healthcare Informatics Editor-in-Chief Mark Hagland regarding all these developments. Below are excerpts from that interview.
Based on your experiences, what do you believe are the biggest challenges in evolving HIEs forward these days, and in sustaining them in the current operating environment—one in which many HIEs have been failing?
I believe that the biggest single challenge is getting the participants involved in HIEs. At Inland Empire Health Plan, we already have good access to pharmacy data and claims data—but the claims data is older data. In that regard, the key is getting the hospitals and medical groups involved; they have clinical data that is more timely. The IEHIE has been pretty successful—we have every single hospital in the Inland Empire either actively participating in the HIE, or contracted to participate. We’ve got multiple medical groups participating as well. So the key is getting the data, and the second is the financial model that makes it self-sustaining; we’ve doing both.
Bradley Gilbert, M.D.
It’s not just the medical elements, it’s the social determinants of health and other factors that have to be considered, in order to engage in effective care management, correct?
Yes, it’s not just the medical elements at all. It’s the behavioral elements, too; and also housing, food, transportation, everything. Having done this for 20 years, and having spent my medical career caring for this population—if we can take care of dual-eligible and disabled MediCal members, we can take care of everyone.
And getting a handle on all of those factors is especially important for the Medicaid/MediCal population, especially the disabled Medicaid/MediCal population, and the dual-eligible population, correct?
Yes, I agree, it’s even more important to make sure that we can get current, up-to-date data on members of certain populations, because many of our members really are very transient and are moving around a lot. It is a more transient and fragmented population. That’s why we’re so engaged—why I’m the chairman of the board of IEHIE, why we support it financially, because it holds so much potential for our population.
What are the key practical challenges facing HIE leaders in this context?
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