eHI Survey: HIEs Seeing More Demand for Merged Clinical, Claims Data

May 17, 2019
Strong interest in social determinants of health data, but standards lacking

In its annual survey of health information exchange executives, the eHealth Initiative (eHI) found that HIEs are reporting significant increases in demand from payers for more access to clinical data. Forty percent of HIE leaders also said they are likely to adapt care coordination tools in the next few years.

Fifty-three U.S. based organizations in 35 states completed the survey this year. Achieving financial sustainability has long been a challenge for HIEs. For instance, in eHI’s 2005 survey, 84 percent of HIEs considered developing a sustainable business model a very difficult or moderately difficult challenge. Yet in 2019, only 32 percent of respondents listed long-term sustainability and financial viability as a top priority in the next two years. Increased financial viability could be attributable to a number of factors, eHI noted. “As HIEs have grown to scale, they have established themselves in their communities and are demonstrating clear value. In addition, the number of HIEs in the U.S. has decreased in the last two decades due to changing economic conditions, consolidation, and market forces.”

The majority of respondents (67 percent) report that they have seen a significant or very significant increase in demand from payers for more access to clinical data, and 84 percent of respondents believe the services they are providing to payers are valuable. Among larger HIEs (between 3 million and 10 million members), 38 percent of respondents have adopted an all-payer claims database and 16 percent are likely or very likely to do so in the next two years.

On May 16, eHI held a panel session to discuss some of the trends the survey identified.

Joe O'Hara, director of clinical innovation for Horizon Blue Cross Blue Shield of New Jersey, described his organization’s efforts to meld clinical and claims data. In its own private data exchange platform, it now has seven large health systems contributing EHR data. He said Horizon has been involved in value-based payment programs for seven years, working with hundreds of clinical partners. “The message we heard from providers is that they need access to better, more comprehensive data, such as discharge reports from hospital,” he said. Horizon had provided that information via monthly flat file or Excel spreadsheets, but those were not current enough. They wanted near-real-time data from EHRs to complement its encounter-based data. Creating a more comprehensive patient record and sharing that information is the primary goal.

O’Hara said the more complete data also supports quality measurement and reporting initiatives, but data quality can be an issue. Data in EHRs is entered to support care, and the clinicians tend to know where to look to find it, he said, but it is often not in the structured fields that make for easy export. “There isn’t any commonality across organizations about how data is stored and how it is output.”

Katie Sendze, director of client operations and programs for HealthInfoNet, the statewide HIE in Maine, noted that her organization has a strong relationship with Medicaid in terms of integrating claims and clinical data to close care gaps. Members also leverage real-time clinical data such as ADTs and acute care utilization information about which members are receiving care now, and performing care management work flows based on that information. But the HIE is not currently receiving claims data from commercial insurers or Medicare, she said.  

The eHI survey respondents said that social determinants of health (SDOH) data offers promise for addressing socio-economic issues that impact a patient’s health, but they said a lack of consensus on standards for capturing and representing SDOH data creates barriers to its collection and use, as does navigating legal parameters for cross-sector information sharing. Overall, 52 percent of respondents experience difficulty in exchanging SDOH data.

Sendze said Maine has joined the SIREN Gravity project, a national effort focused on creating data standards using HL7 for social determinants areas such as housing and transportation. “We are just at the beginning of working on this,” she said. “Most data is not standardized in ways you can look at it at population levels. It is in Excel files or on paper. Our approach is to look at what data structures exist that can get aggregated at a statewide level so that other states could learn from it, too.”

Mike Sims, chief financial officer of the statewide Delaware Health Information Network, said that last year the DHIN launched an all-payer claims database to combine clinical and claims data. “The biggest benefit we are seeing is the ability to provide a more complete historical record. Although it gets records from all hospitals and labs in the state, it still has lots of holes in the longitudinal record from other physician office visits that don’t make it into the HIE. “Getting claims data is going to make our service more valuable,” Sims said. He said eventually the more complete record will allow payers to combine clinical and financial data to identify which provider organizations are doing the best job.

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