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.”
With regard to health information exchange, Heidenreich told the audience that health information exchange is a central element in his organization’s strategy to improve the health status of the communities in which the health plan operates. A key goal, he said, is the collection of social-determinants-of-health data, for that purpose. “PacificSource was selected for a CMS Innovation grant called Accountable Health communities (AHC), which will survey our Medicare and Medicaid populations in Oregon,” he added, referencing the Center for Medicare and Medicaid Innovation (CMMI) within the federal Centers for Medicare and Medicaid Services (CMS). Meanwhile, he added, “A similar pilot is getting underway in one of two Medicaid regions in Oregon,” citing a planned spring 2018 launch for that initiative.
Heidenreich noted that, in both cases, there are opportunities to improve processes around screening and provider referrals, and to improve the navigation services offered to health plan members. As for working with health information exchanges, he said, “There’s a nice opportunity to take that data and use it. We’ve been talking with the Reliance eHealth Collaborative, to get the data into their database,” he said, referring to the Medford, Ore.-based HIE, with which Heidenreich and his colleagues have been discussing collaborative efforts.
What’s more, he added, collaboration with HIE partners could prove valuable along other dimensions as well. “We also see the ability to identify some markers in the clinical data, and trying to use natural language processing to trigger [social determinant and other types of] data capture,” including through appropriate access to behavioral healthcare and substance abuse data.
“Within the next 24 months, we’re trying to become live with Reliance,” Heidenreich noted. “We want to encourage that the consent [for data release] actually come through us. That means probably working with behavioral health partners and making sure the consent is going to the payer, so we can alert for care coordination. And we’d like to use the CCDA for analytic purposes. Right now in Oregon,” he added, “we have a Medicaid quality incentive around metrics for hypertension, diabetes, clinical depression and follow-up and cigarette smoking prevalence.”
In all this, Heidenreich, data coming into plans can be “problematic, and,” he added, that data “requires validation to make sure the reporting is accurate. We find that the data can be a little bit off and wrong,” he added, emphasizing that he and his colleagues want to ensure the highest level of data accuracy possible in pursuing these initiatives.
Meanwhile, Heidenreich told the audience, “We are making use of an analytic model that leverages claims data, some demographic data points, and a 12-month history” of plan members, through a solutions provider. Where he and his colleagues would like to get, within the next 18 months, he said, is a “future readmissions prediction model based on existing data, plus timely clinical transactions.” And, he said, he and his colleagues would like to be able to leverage social determinants data from clinic notes, using capabilities provided by the Reliance eHealth Collaborative capability, to help inform care management, as well as to receive alerts at the health plan, and to have the HIE alerting providers, as appropriate, to changes in status of plan members/patients.
Connecting Social Service Agencies through HIE
Ohanian and York, from 2-1-1 San Diego, a social services organization in San Diego, shared some background on what 2-1-1 organizations are, and on their organization’s expanding portfolio and initiatives. As York noted, the attacks of September 11, 2001 spurred the creation of 2-1-1 organizations, which make use of the telephone number “211” as a non-emergency number that can connect residents of particular communities with needed social services. “In 2001, the necessity for 2-1-1 being available, post-disaster, became very evident,” he said. “And as a result, over 200 emergency lines opened up in New York after 9/11. Having a single place too call was deemed important. So 2-1-1 lines were set up across the country. Fifty percent of those lines were run by United Way; the other 50 percent are standalone non-profits. We’ve created a variety of programs in San Diego. We’re working across the country for 100-percent coverage,” with “over 90 percent now” already, he noted.
What makes 2-1-1 organizations so valuable to their communities? “We’re trusted, non-profit, confidential, and stigma-free, and we operate a 24/7 service, with a 3-digit dialing code that’s easy to remember,” York said. Meanwhile, 2-1-1 San Diego is an organization that services 400,000 contacts and connections per year, and is engaged with more than 1,200 service provider organizations. It provides services in over 200 languages, via tele-interpreters, with English, Spanish and Cantonese the main internal languages available. And it prides itself on a customer satisfaction level of 92 percent, and a 98-percent referral accuracy.
Among the overall types of programs that 2-1-1 San Diego offers: food insecurity benefits and enrollment (in coordination with SNAP, Medicaid, and CoveredCalifornia programs); Courage to Call, a clinical intervention program for veterans; health navigation programs to help resident access health insurance and discharge planning, etc.; and a strong role in disaster and fire response services.
“Providers are trying to get a grasp on the social determinants of health,” York noted. “And I’ve noticed, with many of the HIEs, you layer on different services, like privacy/security aspects and identity management. So where does the social service data belong? That can be another partnership.” What is exceptionally important, he said, is “connecting the dots to create a social snapshot of a client’s situation, and matching that with a database of social service providers and referrals,” York said; and that means “connecting with a local provider and a community information exchange, and figuring out what kinds of information can be shared. Social service providers are already doing that work, and we’re already experts in connecting the dots around social services,” he said. In that regard, going forward, it will be important for organizations like 2-1-1 San Diego to collaborate with HIEs in order to help provide coordination across various environments, including for healthcare providers.
Ohanian and York were joined by Daniel Chavez, executive director of San Diego’s HealthConnect, and a 2-1-1 San Diego Board Member, in sharing perspectives on the partnership in San Diego as a model for merging social and health data and leveraging existing community infrastructures. Ohanian and York detailed what 2-1-1 organizations are, and on their organization’s expanding portfolio and initiatives.
Right now, Ohanian said, 2-1-1 San Diego’s Community Information Exchange is linked to San Diego’s HIE called San Diego Health Connect reminding health care professionals there is additional social factors and individual client information available in the Community Information Exchange. Future client data integration and referral pathways are under development.
Meanwhile, Ohanian and York agreed, health information exchange will become increasingly important in connecting traditional healthcare providers with social service providers like the 2-1-1 organizations.
And all of those participating in both panels agreed that the kinds of social-determinants data that HIEs can appropriate share, when combined with traditional healthcare data, can accelerate the work that all the different types of organizations are engaging in, in order to improve the health status not only of individuals, but of entire communities.