On Jan. 10, a major development took place in the health information exchange (HIE) world, when two California HIE organizations announced a merger. At a telephonic/live press conference held both at the Sir Francis Drake Hotel in downtown San Francisco and via telephone, several California healthcare leaders announced that the San Francisco-based California Integrated Data Exchange (Cal INDEX) and the San Bernardino-based Inland Empire Health Information Exchange (IEHIE) announced a planned merger that will create one of the nation’s most comprehensive not-for-profit HIEs.
It was announced that Claudia Williams, former White House technology senior advisor, will lead the new organization as CEO, effective February 1, 2017. The merger, subject to regulatory approvals, is expected to be completed in the first quarter of 2017 and will operate as a tax-exempt public benefit corporation under a new name.
And, according to a press release published at the same time as the press conference was taking place, “The new HIE will combine the 11.7 million claims records from Cal INDEX founding members Blue Shield of California and Anthem Blue Cross with the 5 million clinical patient records of IEHIE and its 150 participating partners. HIEs help improve the quality of the patient experience, support collaboration and coordination and improve efficiencies by making it easier for doctors, hospitals and other care providers to securely review, analyze and share medical information across the healthcare system.”
The press release quoted Bradley Gilbert, M.D., chairman of the IEHIE Board of Directors, as stating that “The creation of this new statewide health information exchange by IEHIE and Cal INDEX is an important milestone in transforming California’s healthcare system into a coordinated system that delivers higher quality and more efficient care to all Californians." And Mark Savage, chairman of the Cal INDEX Board of Directors and director of health information technology policy and programs for the National Partnership for Women & Families, added: “Claudia is the ideal candidate to lead this new entity. She is a strategic and transformational leader with national experience managing and scaling health information exchanges. With Claudia, California’s statewide HIE gets the rare combination of breadth and depth.”
Further, added Dr. Gilbert, “Claudia’s track record of developing strategic partnerships with technology, provider, consumer and health plan leaders will be invaluable as Cal INDEX and Inland Empire HIE add new partners and bring value to providers and patients throughout the state.”
“I’m thrilled by the opportunity to lead the new organization and collaborate with our partners to improve patient care for all Californians,” Williams said. “Our goal is to deliver compelling products and services that support California’s hospitals, providers and patients in their efforts to improve care coordination, reduce inefficiencies, address gaps in care and enhance patient experience.”
Meanwhile, at the outset of the press conference, Savage said, “The merger of Cal INDEX and the Inland Empire HIE today will create one of the nation’s most comprehensive health information exchanges, with 16 million patient records, and 150 providers from the outset. Inland HIE,” he said, “provides essential infrastructure, synthesizing the longitudinal patient record that patients and providers need. This represents an important milestone for California healthcare.” He continued to note that the merger will require the approval of the California Attorney General, and also that it will operate under a new name, one yet to be determined. “We expect to complete the merger this quarter,” he added.
“What I think is exciting about this merger is the combined strength” of the two organizations, Gilbert said. “Cal INDEX brings leveraged support from five health plans in the state, and brings that connection. Inland Empire brings real local and regional collaboration and experience around HIE. So we’ve got the operational experience, and that local and regional experience. An HIE is only as good as the amount of data and the participants involved,” he added. “We’d like to think that healthcare truly is local. But having that statewide, functional HIE will make a big difference.”
Williams, the new CEO, said, “I’m delighted to be here today. As I sat at my desk in [Washington] D.C. last week, I was thinking about what we’re trying to create, and it really is making connections. On the national level, both payment and policy initiatives, with that policy agenda, there could be no better place in terms of actually guiding change than here in California, where partners bring a scale, a commitment, and an operational excellence to this work. I’m delighted.”
Paul Markovich, president and CEO of the San Francisco-based Blue Shield of California, said, “I’m thrilled” by this merger. “One of the major distinguishing features of this new non-profit is our commitment to an open platform,” he said. “That will facilitate the development and use of some wonderful technology and applications. This, combined with a broad representation that Brad mentioned, of hospitals, physicians, and health plans, will also allow these technology solutions to be used across one broad platform.”
In response to a question from a reporter on how this new development would be helpful to Blue Shield of California, Markovich said, “Our mission is to ensure that all Californians have access to high-quality care at a low price. And we can’t do that unless we enter the digital age. And that means getting all the patient records onto a digital platform. Right now, it’s still very difficult to leverage data when information is still highly fragmented. So for us, it is absolutely critical to fulfilling our mission.”
Asked a follow-up question regarding how much funding will be available to the new organization, as well as how much data has been shared to date, Markovich said, “I don’t have that number in front of me. But the new entity will literally have tens of millions of dollars available to it. We have integrated data at Cal INDEX. There is some data there and at Inland Empire HIE.”
Then, asked a question about the challenges that have faced both Cal INDEX and many regional and statewide HIEs across the U.S. in the past few years, and how this new entity might overcome such challenges, Markovich said, “I think the key is really showing the value proposition for the providers. For example, we have every single hospital in the Inland Empire signed up; and the vast majority are now exchanging data. That means working with the physician groups, the health plans, and showing the value proposition, and showing them the data, that in fact the data is very available to them. Really, the key is that providers have to believe that this will help them better take care of patients.”
Asked about the organization’s fee structure for sending and receiving data, Markovich said, “We’ll have to work that out. But all the organizations that participate will contribute something.” The HIE leaders also confirmed that five health plans, 43 hospitals, 30 medical groups, and numerous other patient care organizations and providers, will be involved. The five plans are Blue Shield of California, Blue Cross of California, Inland Empire Health Plan, and Health Plan of San Joaquin, and Health Partnership Health, the last two of which are both MediCal (California’s Medicaid) managed care plans.
The leaders of the contributing organizations expressed optimism going forward, in the Tuesday press conference. Things have not always proceeded optimally at Cal HIE. As Modern Healthcare reported in March, “Anthem and Blue Shield of California—the second- and third-largest insurers in the state, respectively, after Kaiser Permanente—teamed up in 2014 to establish Cal Index. Their goal is to create a complete, longitudinal health record for every California resident. But they still need the buy-in from state health systems, which must be willing to share their data and pay a fee to access data from others.” At the time of that article’s publication (March 5), only one large health system had joined the HIE and begun to move towards go-live. Since then also, senior executives have left the organization.
