The three year period in which the Office of the National Coordinator of Health IT (ONC) will fund the Beacon Community Program is coming to an end, and one Beacon is preparing for the “after-life.”
The Beacon Community Cooperative Agreement Program was enacted in 2010, with the ONC providing $250 million over three years to 17 selected communities across the country. The communities had already made “inroads” to develop secure, private, and accurate systems of EHR adoption and health information exchange (HIE). While each of the Beacons had separate goals, and received different amounts, they all aimed to increase health IT infrastructure and exchange.
In many cases, that has been achieved. At Healthcare Informatics, we have featured many of the Beacons and some of their innovative projects. In Colorado, leaders of the Colorado Beacon Consortium powerful analytics and health information exchange tools to support region-wide, physician practice-based population health tools, for the benefit of patients scattered across the Rocky Mountain west. The folks at Crescent City Beacon Community (CCBC) in New Orleans have used the power of EHRs to facilitate a metropolitan area-wide patient-centered model of care.
In San Diego, leaders of the Beacon Community have taken on a number of initiatives. They reduced readmissions rate by facilitating successful transitions between hospital and home, improved childhood immunization rates, increased the speed in which patients received cardiac care, and drew together a number of local health systems and providers to form a regional health information exchange (HIE).
The Mall of HIE
It’s the work from the latter HIE focused initiative that will continue long after the federal money dries up. To help kick-start the transition, Dan Chavez was brought on as the executive director of the not-for-profit entity of the San Diego Regional Health Information Exchange, an organization created to provide oversight of San Diego Beacon.
“The grant funding ends at the end of September. That provides us the start-up capital to start up the new organization and pay for the transition,” Chavez says. “Going forward, after October 1st, my anchor tenants, the major healthcare providers in San Diego, will pick up the costs of my budget based on their relative size determined by revenue on a contribution basis.”
Over time, Chavez plans to make HIE sustainable. By the start of 2016, he says, San Diego Regional Health Information Exchange will have a business model based on utilization and appropriate costs. This may be a price per record shared, price per physician, a subscription model, or something else.
“To be determined,” he says. “The point is to stand up the HIE in 2014 and 2015, have a good sense of the utilization—who is using it for what and where the values are— make that assessment and propose a new fee structure to the membership in 2016.”
Trust is the most important element to HIE success Chavez sees going forward. Since being brought on in March, Chavez has attempted to build a culture of trust within the HIE by hiring a security/privacy officer and working on vendor and provider relations.
For an HIE, Chavez says trust means keeping the major providers in San Diego happy and ensuring the smaller providers remain competitive. The big providers, he says, which include University of California (UC) San Diego Health System, Rady Children’s Hospital San Diego, Scripps Health, Sharp HealthCare, Kaiser Permanente San Diego, and a few others, are like the anchor tenants at a shopping mall.
“They (the anchor tenants) have to be happy with the mall because they pick up the vast majority of the fees of operating it. The smaller providers, they are your specialty stores and they all compete. And you know that you can buy shoes at the department shoe, the shoe store, or the athletic store. So you have to recognize that these people all compete, but you have to keep them happy and keep the traffic flowing,” Chavez says.
In healthcare, San Diego Regional Health Information Exchange was created (the lead grantee for the federal Beacon funds was UC San Diego) for the purpose of creating all these different providers happy and to ensure the exchange of data is flowing. Not only will Chavez and co. have to do this going forward, but it will have to do it with a small, 5-7 person staff.
The mindset of what the San Diego Regional Health Information Exchange has to become and what the San Diego Beacon was created to be are completely different. The Beacon, Chavez says, wasn’t chartered to be self-sustaining or sell services. To that point, on the HealthIT.Gov website, the key word under the Beacon Community description is demonstration. The programs are a demonstration. The San Diego Regional Health Information Exchange is a self-sustaining organization.
“I think the Beacons really wanted to show proof of concepts in terms of demonstration of value,” Chavez says. “We’re trying to make an impact at a community-level. My goals have to do with adoption and utilization. I’ve got to bring up the nodes of the network.” Getting providers in the community on board will expand the scope of patient data available in the HIE, he adds.