Chicken or the egg – the HIE or the ACO?

Oct. 1, 2011

Information Exchange


With financial, clinical and regulatory pressures increasing steadily, and the new and confounding acronyms appearing daily, many hospitals and health systems today are wondering where they should first put their focus – building a robust health information exchange (HIE) or preparing for an accountable care organization (ACO) or other payment reform model?

Each variety of HIE (statewide, regional or private/IDN) has different goals. Privately held HIEs are rooted in the desire to achieve clinical and operational excellence among physicians within a health system, while regional or statewide systems are focused on sharing patient information across providers in a geographic area. We all know that trying to connect these disparate systems can be challenging, and that linking into a larger network requires additional infrastructure investment. But rather than implementing a less robust system that will need to be replaced in two years, the inevitability of some kind of payment reform and shared risk model coming to a town near you means that healthcare organizations need to invest in an HIE that both enables meaningful use now and has the power to support collaborative care models later.

Regardless of whether the shared-risk model adopted in the area is an episode of care, bundled payment, full capitation or per-member per-month model, the functionality that is inherent in a robust, full-featured HIE will be a requirement for any successful ACO. Primary caregivers, specialty physicians, the hospitals, the health plans, employers – any group assuming risk for the healthcare of a set of patients – are going to need to be able to communicate efficiently and electronically about patients and their health data. Moreover, they need to be able to access key analytics on that data so that they can segment their riskiest patients and treat them in ways that make them healthier while controlling costs. They also need to enable real-time decision support and alerts to the caregivers with actionable intelligence to reduce gaps in care.

The reality is that HIEs can be up and running for years before any payment reform model is adopted or implemented, and those healthcare organizations that have HIE experience will be best positioned for the change. With the inevitable shift toward collaborative and accountable care on its way, there is no reason to wait. But providers need to make sure that the HIE system they select is flexible, scalable and “ACO ready,” avoiding the trap of implementing a less robust system to tide them over until the time comes. When ACOs take hold, the last thing organizations will want is to have to make a square HIE peg fit into a round ACO hole.

Both HIEs and ACOs are on the mind of every hospital C-level executive, and faced with these big changes, it can be extremely difficult to know where to start and how to prepare. But regardless of the ACO or collaborative care models that are adopted tomorrow, these systems need a fully functioning HIE today – one that will help them exchange information securely and operate more efficiently now, providing the data and analytics to support continued care and workflow improvements that will be core to models we adopt in the future.

Glenn Keet is president of Axolotl, part of OptumInsight (formally known as Ingenix).
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