Statewide health information exchanges (HIEs) are adjusting their pricing models as they identify new services to offer member organizations and as they experience shifts in government and grant funding support.
As funding sources that helped with startup go away, HIE leaders are building new partnerships and finding new sources of revenue. Speaking at a July 12 webinar put on by the Office of the National Coordinator for Health IT, Deb Bass, executive director of the Nebraska Health Information Initiative, described a new pricing structure at NeHII.
Here is its early pricing model:
• Providers paid $20 per month to view data.
• Hospitals paid a monthly license fee based on bed size.
• Long-term and post-acute care providers paid $500 per month.
• Payers paid $25,000 annual fee plus $2 per member per month.
• There was a state legislative appropriation of $500,000 in 2014, which increased to $1 million annually in 2015.
The bed size tiers had grown from the original five tiers to eight, Bass said, and participants were asking for a more tangible, customized method to determine participation fees for hospitals. NEHII formed a workgroup to develop a new pricing model and a future value-added services strategy. The pricing model was finalized in January 2017.
Bass said the new pricing model created a more equitable manner to allocate costs based on a facility’s potential use of the HIE, and was not intended as a method to increase revenue. “It increased revenues less than 2 percent annually,” she noted. Hospital license fees had remained unchanged since NeHII’s go-live in 2009, although large health systems paid a three-year sustainability surcharge from 2013 to 2015 and all other health systems paid a two-year sustainability surcharge in 2014 and 2015. Five hospitals are paying slightly higher participation fees but less than with sustainability charge.
One key change is that the new scheme eliminates fees for licensed healthcare professionals to have access to the data. (If an ambulatory clinic becomes a data provider there will be a $500-per-month participation fee.) Instead, the cost of the exchange is shared evenly between payers and hospitals (with the State of Nebraska considered a payer.) The new pricing model has a phased three-year implementation schedule to allow for ease of transition.
The new model gradually eliminates the site licensed-bed model for hospitals and moves to payment based on adjusted discharge figures.
In the new pricing model, insurers pay a $25,000 annual fee plus the per-member per-month fee, with a sliding scale based upon number of covered lives
Here are some quick statistics about NeHII:
• Number of lives: 3,427,738
• Percentage of Nebraska hospital beds connected: 66%
• Percentage of critical access hospital beds connected: 53%
• Number of results in the system >157,595,989
• Percentage of patient opt-outs: 2.3%
• Number of HIE users: 9,358
The pricing model shift coincided with deployment of a new cloud-based technology platform.
New features include patient event subscription, public health reporting and ADT alert notification. “The most beneficial feature has been readmission reporting,” Bass said. “More than 35 hospitals in the state are using it to drive down readmissions. That has tremendous return on investment.”
NeHII has also gone live with prescription drug monitoring program functionality. It also is exploring moving beyond the query model to other value-added services. It just went live in the exchange of data with other states via the Patient-Centered Data Home model.
Other next steps Bass mentioned:
• Participate in eHealth Exchange to connect with federal agencies.
• Expand on connections with state registries.
• Obtain Meaningful Use certification for the PDMP as a specialized public health registry, so providers can use it for attestation.
• Offer supporting services and connections to LTPACs.
• Finalize a Community Care Plan to support the Medicaid managed care organizations.
• Develop a quality reporting strategy to support MACRA and MIPS via NeHII through HIO Shared Services.
That should be enough to keep NeHII busy for the rest of 2017 and 2018!