A recent study conducted by Humana Inc. (Louisville, Ky.) and the Wisconsin Health Information Exchange (WHIE), based in Mequon, Wis., has finally put a dollar amount—$29 per emergency department visit to be exact—on the savings that can be reaped from integrating health information exchange (HIE) within the clinical workflow.
The study, entitled “The Business Case for Payer Support of a Community-Based Health Information Exchange: A Humana Pilot Evaluating Its’ Effectiveness in Cost Control for Plan Members Seeking Emergency Department Care,” found definitive decreases in four of the top five emergency department-based procedures, including CT scans (41 percent), EKGs (4 percent), laboratory testing (9 percent), and diagnostic radiology (19 percent), when the WHIE database was queried by clinicians. This resulted in an average savings of $29 per emergency department (ED) visit.
“HIE in a broader context needs to become an all-community element where that coordination of care and potentially avoiding the ED visit in the first place, or avoiding inpatient admission from the ED, are additional value points, not only to the payer organizations like Humana, but to the providers, and to the patient,” says Kim Pemble, executive director of WHIE.
The study ran from December 2008 through March 2010, and examined 1,482 fully insured Humana members in Southeast Wisconsin who sought care at EDs at 10 Milwaukee hospitals. For the purposes of the study, Humana provided incentives to the WHIE to promote clinician queries for eligible Humana members, and have chosen not to state the exact incentive amount because it may compromise current or future stakeholders’ ability to adjust administrative costs for future obligations.
Hospital Adoption and Clinical Workflow
Currently, 23 hospitals are providing admitting data to WHIE, and one Federally Qualified Health Center (FQHC) is providing ambulatory clinic encounters to WHIE. One Medicaid managed care organization is providing member data (e.g. care manager assigned, contact detail, member specific messages) to WHIE, while Wisconsin Medicaid is providing encounter and pharmacy claim data to WHIE. In addition, a total of 44 hospitals—soon to be 51 later this month—and several ambulatory clinics are providing data for public health syndromic surveillance.
Part of WHIE’s success was that it makes querying the exchange easy and part of clinicians’ workflow. When a clinician logs on to the WHIE portal, they see a grid that shows how many times the queried patient has been seen by the clinician’s hospital, how many times the patient has been to all participating facilities, and how many of the visits were in the ED. “The success of these kinds of tools will be best realized when the workflow is tightly integrated,” says Pemble. Despite the presence of electronic health records (EHRs), many of the participating EDs still operate in a paper workflow. For these organizations, the exchange auto-generates a patient history report and sends it to the appropriate ED printer, so it can be seamlessly folded into the workflow. In the future, Pemble would like to provide a link to the exchange within the EHR system and is working with vendors to provide that integration.
Payer Support, Sustainability
WHIE is in the minority of HIEs nationwide that receive payer support. As last month’s sustainability report by the Washington, D.C.-based National eHealth Collaborative pointed out, only three of its 12 profiled HIEs (WHIE not among them) had payers as stakeholders. Funded by Wisconsin Department of Health Services, through a Medicaid Transformation Grant, WHIE received payer support from Humana and the Business Health Care Group (Franklin, Wis.) from the beginning of its formation in 2004.
Albert Tzeel, M.D., study author and National Medical Director, HumanaOne, says that getting involved with an exchange was a great opportunity to help keep his members healthy and became an early physician champion at Humana. “A lot of it is understanding what the potential is there, and you have to believe that this is really going to make a difference,” says Tzeel. “And even if it doesn’t necessarily make as big of a difference, it’s certainly right thing to do.” He has tried to get other health plans involved in WHIE, but many of them are still hesitant. With this study, he hopes that the cost savings will be enough to sway them to participate.
Albert Tzeel, M.D.
Even with payer support, WHIE hasn’t found a path to sustainability yet and is currently reviewing several models. “Here’s a pushback to the question that everyone keeps asking, if exchanges are sustainable,” Pemble says. “My question is, can we accomplish things we’re trying to do to have healthcare be sustainable without exchanges?”
Pemble says that the WHIE is a community asset that has streamlined fractured workflows. “Different payers and managed care organizations have historically sought to establish portals or connectivity with health systems to provide information back to those hospitals and help them be aware of what’s happening to their patients,” he says. “There are many of those, and suddenly the workflow for providers is very fragmented.”
The Humana/WHIE study provided no further analysis of how WHIE affected inpatient admissions or length of stays, but Pemble says there will be future studies to assess the benefit of HIE. One study that will be published soon by the Medical College of Wisconsin in Milwaukee surveyed physicians after using the exchange to get their feedback. WHIE also plans to do a follow-up to that study across all payers to shadow physicians during patient visits to gather quantitative data points like what tests were or weren’t ordered as a result of the exchange.