At the SHIEC Annual Conference held this week at the Crowne Plaza Union Station Downtown Indianapolis, and sponsored by SHIEC, the Strategic Health Information Exchange Collaborative, leaders from a wide range of stakeholder groups led presentations and panel discussions that articulated why they’re collaborating with health information exchanges (HIEs) on a variety of emerging and ongoing initiatives, with the dominant theme that of community health enhancement.
On Wednesday morning, August 30, two panels in particular shed light on some of those collaborative efforts. First came “Linking Social Factors to Health and Community Information Exchanges: 2-1-1 Connects the Dots,” which was presented by John Ohanian, president and CEO of 2-1-1 San Diego, and William York, executive vice president of that organization. That panel was followed by “HIE Payer Use Cases,” in which the panelists were Susan Beaton, R.N., M.S.N., vice president, provider services, care management & risk, at BlueCross BlueShield of Nebraska (BCBSNE; Omaha); Michael Heidenreich, HIE program manager, at PacificSource Health Plans (Bend, Ore.), and Teresa Rivera, president and CEO, Utah Health Information Network (UHIN; San Diego).
As the first speaker on the payer panel, BCBSNE’s Beaton told the audience of HIE leaders that she continues to be very excited by all the innovative work that her organization has been able to do collaboratively with Deb Bass, CEO of the Nebraska Health Information Collaborative (NeHII), and her colleagues there, and with local provider groups.
“We at BlueCross BlueShield of Nebraska serve over 700,000 members—two of every three Nebraskans carry our card,” Beaton noted. “Physicians and payers working together to utilize NeHII-facilitated data helps provide a path forward” to improving patient/plan member health status and better managing costs, she said. “So it’s very important to participate in health information exchange. And it’s important to make sure we can help NeHII work smarter.”
The key strategic goals at BCBSNE, in the context of working with NeHII and with local providers? Aligning on quality metrics, working with providers to improve care management, enhancing the use of data as a tool, and improving community health status overall. With regard to the alignment on metrics, Beaton told the audience, “The fact is that 300,000 of our 700,000 members are in patient-centered medical homes or ACOs”—accountable care organizations. “We want providers to work from harmonized sets of measures; we understand that they are very frustrated over having to work with so many different sets of quality measures. So we’ve partnered with the Nebraska Medical Association to work on CPC+”—the federal Comprehensive Primary Care Plus patient-centered medical home model initiative—“in order to create the same metrics and measures for physicians.” More broadly, per leveraging available data, she said, “We actually send or case management nurses into clinics when they participate in ACOs and case management. We want to make sure our providers not only use the HIE but push their data into the HIE.” That’s exactly where NeHII fits in, she said. “Community betterment is the key. Physicians are our members’ most trusted resource. We are an advocate for them, and provide tools for them.”
In that regard, Beaton shared with the audience five key goals in their collaboration with NeHII and with providers. “First,” she said, “is reducing barriers. We’re so often seen as yet ‘one more thing to do.’ We want to reduce barriers” in order to ease practice burdens for physicians contracting with the insurer. Second, she said, is “whole-person care. How do you bring everything together? We have the claims data; physicians have the EMR data; the HIE has other data. How to bring that together?” That is both the challenge and opportunity, she noted. Third, she cited “connectivity of clinicians that ensures actionable and sharable data. Trying to figure out how we can deliver that information, even though it’s claims-based,” she said, remains an enormous challenge, but one that she and her colleagues are determined to overcome. “You often hear about providers having to wait 90 days to receive claims-based data. In fact, we’re able to work to deliver that claims information within 30 days on a care management platform, via a dashboard, to give physicians actionable information in as close to real time as possible.” Ultimately, she said, the goal is to improve on that 30-day timeframe, to bring clinicians closer to receiving claims-based data that can further enhance their ability to care for patients. Indeed, “adherence to care plans and medication programs” was the next major objective she cited; and the final one she referenced was “security and HIPAA compliance around data-sharing.”
Moving Ahead in the Pacific Northwest
In a very different corner of the country, things are moving forward as well. Michael Heidenreich, the HIE program manager at PacificSource Health Plans, began by sharing some background on his organization, not one of the better-known health plans. Based in Bend, Oregon, PacificSource has 272,000 members, and contracts with 46,000 providers in Oregon, Idaho, and Montana, with a dedication to a “high-touch model of service,” as he emphasized—which, among other things, means a focus on direction personal interaction over the phone and in person. For example, he noted, “We direct our customer service calls to a live person within 20 seconds.”
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