With TEFCA Looming, HIE Leaders Discuss Changing Business Models

April 9, 2018
Regional health information exchanges are not an endangered species. That was the message from a panel of HIE leaders at the 2018 State Healthcare IT Connect Summit in Baltimore last week.

Regional health information exchanges are not an endangered species. That was the message from a panel of HIE leaders at the 2018 State Healthcare IT Connect Summit in Baltimore last week.

Panel moderator Carol Robinson, a principal at Portland, Ore.-based consulting firm CedarBridge Group LLC and former State Health IT coordinator in Oregon, asked the leaders for their impressions of the “elephant in the room” — the potential impact of the draft TEFCA (Trusted Exchange Framework and Common Agreement) proposal, as well as a host of other topics.  

Michael Matthews, who serves as both chief strategy officer for CedarBridge and president and board chair of The Sequoia Project, said he was heartened by the fact that the TEFCA framework plans to build on existing initiatives, “so that what works continues to work, but a number of strategic objectives needed to be accelerated. Does TEFCA mean that the business models of regional HIEs need to change? My belief is they needed to change anyway,” he said. The expansion of stakeholders and use cases requires a fresh look at business models, he said. He said he is optimistic TEFCA will be a “B12 shot” for the sector.

“I don’t think HIEs are going to go away,” said Tim Pletcher, executive director of the Michigan Health Information Network Shared Services. TEFCA is ambitious in terms of what it has been asked to achieve, he added, and one of the biggest risks he sees in all the noise around something that could be transformative in the long term is that people could start dismissing the good work already being done.

Pletcher noted that the draft TEFCA was silent on particular functions or use cases. He mentioned a few potential examples: a national ADT (Admit-Discharge-Transfer) notification infrastructure. “It would be a technically easy thing to do, but from a governance perspective, a fine place for TEFCA to cut its teeth. I also think immunizations is a nice, safe use case for data sharing that would make sense to try to do nationally. It could be a great national learning opportunity and encompass everything we have been working on.”

Teresa Rivera, president and CEO of the Utah Health Information Network and vice chair of the Strategic Health Information Exchange Collaborative (SHIEC), said TEFCA would build on the work SHIEC members have done on the "patient-centered data home" model that allows data to follow the patient. Referring to HIE business models, she agreed with Matthews that HIEs have to do more than transport data. “We go beyond that and provide valuable services to public health and to Medicaid state agencies in caring for citizens,” she said. Local HIEs have spent years building trust, she noted. “Interoperability moves at the speed of trust. That is the advantage we bring. We work with local communities and know what issue is important at the local level.”

Payers Leveraging Market Power

Robinson turned the conversation to recent developments in which private payers are starting to require participation in HIEs as part of their managed care contracts. (For instance, Blue Shield of California has announced that beginning this year it will require providers in its contracts to participate in Manifest MedEx.)

The health plans have come to recognize the value of HIE and are trying to catch up, said Dan Chavez, CEO of San Diego Health Connect. “We have white space in California. Half our state is not covered by HIE, so we need to work with health plans. But a mandate doesn’t lead to trust,” he added.  The payers will have to be patient because it takes years to work through the process of building trust, he said.

Pletcher told a story about how payers helped push providers to share ADT messages throughout Michigan. Hospitals and health systems recognized it was a good thing to do, but several backed away from the process. “That was shocking. They did it for competitive reasons,” he said. MiHIN convinced Blue Cross to use an existing incentive program to motivate hospitals and physicians to participate in ADT sharing.

“In less than 9 months we had 93 percent of hospitals participating because the CFOs called the CIOs and said 'I don’t care about Epic or your other priorities. The deadline is coming and you will send them.' That worked quickly!”

New Priorities

San Diego Health Connect has made progress to connect the emergency medical services to the HIE and it is focusing on how to collect and aggregate social determinants, Chavez said.  “We have to involve the entire ecosystem. We are doing that in San Diego with a community information exchange. Our next big thing is to tie that into the HIE in an integrated way.”

Rivera said UHIN is using 90/10 funding from CMS to work on two projects. One involves the sickest children in Utah who see many providers. “The 90/10 allows us to connect those providers, who may not have qualified for Meaningful Use, to the HIE to share data. Another allows providers to connect to the controlled substance database.