Several years ago, the State of Montana used HITECH Act funding to begin creating a statewide health information exchange called HealthShare Montana, but that effort eventually faltered. Now the state has redoubled its efforts to create the Big Sky Care Connect HIE, which will expand on a pilot effort already under way in Billings.
In a recent interview, Jean Branscum, CEO of the Montana Medical Association (MMA) in Helena, described the parallel efforts in Billings and at the state level.
She said that in 2015 an advisory group that Gov. Steve Bullock had put together to look at healthcare reform, behavioral health and innovation. asked the MMA to re-invigorate the conversation in regard to health information system in Montana. “They saw that for us to move forward as a state in terms of how we provide services, we needed data. We all lacked data. As that was happening, we realized this pilot was happening in Billings. We used the same consultant for both efforts.”
In the Billings Alliance project, three health systems were approached by Blue Cross Blue Shield and they all had an interest in exchanging information. “They talked about what is best for the community rather than just what is best for their individual institutions,” Branscum said. “They have been working to put together the infrastructure for health information exchange, always with the intent that they would love to see that technology expand statewide.” The Billings group worked with an Oklahoma-based vendor called Verinovum, which powers Oklahoma's MyHealth HIE. They started with clinical use cases. One was high-utilizers of the health system and how to approach those individuals differently through care coordination.
“They are at the point where they are exchanging data, but still working on putting the provider portal up,” she said. “They expect having that rolled out by October.”
Meanwhile, in 2016 David Kendrick, M.D., with the MyHealth HIE in Oklahoma, led an advisory group doing a feasibility study for HIE in Montana, which determined there was a feasible business case. “They looked at the move from fee for service to value-based models,” Branscum said. “They saw the potential for providers to not only understanding their risk, but also how they can identify gaps in care and places to save money by avoiding duplicate tests. Alerts and population health management also are critical.”
A group of champions met in December 2017 and went through the process of forming Big Sky Care Connect, which is a new nonprofit organization formed in 2018 to advance statewide HIE. A full formal governing board will start to meet in October. The state Medicaid agency also is part of the organization and governance.
The goal is to have a business plan completed by the end of January 2019 so that providers who wanted to join could begin expanding out from the Billings pilot by next July or August.
Were there lessons learned from HealthShare Montana’s lack of sustainability? Branscum said one lesson learned is that all the key stakeholders need to be at the table. “HealthShare started with decision makers, but the most active people really didn’t decide things for their organizations,” she said. “Our governing board will be CEOs who can make decisions for their organizations. The governing board is very strong.”