Across the U.S., health information exchange (HIE) leaders are continuing to search for ways to evolve their business models in an increasingly murky landscape. While many data exchange networks have traditionally created value for their members by being able to move data from one place to another for the purposes of treatment and care, some folks believe that this approach will eventually be insufficient to generate substantial revenue going forward.
One of these HIE leaders is Laura McCrary, executive director at the Kansas Health Information Network (KHIN), a Topeka, Kan.-based organization founded nearly a decade ago by the Kansas Medical Society and the Kansas Hospital Association. KHIN—which McCrary says is different from many exchanges in the nation in that it is a private exchange that serves all the healthcare providers in Kansas—currently has 97 percent of the state’s hospitals connected to the network and sharing data, and about 76 percent of all physician practices in the state sharing data. What’s more, all the state’s federally qualified health centers (FQHCs), and about 70 percent of community mental health centers are sharing data as well, McCrary notes.
KHIN—a parent company of a subsidiary it owns, KaMMCO Health Solutions, which runs exchanges in states other than Kansas—offers a wide variety of services for its members, and the HIE itself is the core product offering that everything else is built off of. But KHIN also provides analytics that aggregate HIE data into web-based dashboards that its provider members can use to look at their patient populations more broadly, says McCrary. The HIE, in a vacuum, “only allows you to look at one patient at a time, and it is important for providers to be able to see all their patients in an aggregate view so they can look at [elements such as] their quality metrics, which patients need more preventative care, and how many emergency department services they’re using,” she notes.
To this end, KHIN has recently engaged in research—along with healthcare solutions company Diameter Health—with the aim to demonstrate the value HIEs deliver by aggregating patient data across all healthcare providers into a longitudinal patient view. One way this goal is being met is by having the ability to compute quality measures for providers that encompass all locations where a patient gets care. Oftentimes, these measures are computed within a practice’s electronic health record (EHR) system, but as McCrary puts it, “that’s very limiting as far as the actual data that is taken into consideration, because patients oftentimes get their care in many different locations.”
She brings up an example of a breast cancer screening. “Most women don’t get this [service] at their primary care practice, but the primary care physician is [still] responsible to ensure that this patient has gotten her breast cancer screening, because if she doesn’t, the physician’s quality metrics will be reduced in terms of overall percentages, affecting his or her reimbursement.”
As such, one of the products that has been developed by KHIN and Diameter Health allows for the ability to compute quality measures across all the locations that a patient has received care at. “So then, you can really see how the physician is doing, even if the patient has gotten care in different parts of the state. That is an important and impressive product that has [been] developed, and it does have the ability to start to change the way people look at the quality of care, as well as change how physicians are reimbursed on quality measures,” McCrary contends.
According to KHIN officials, data gathered in the original 2016-2017 study validates the strategy promoted by MACRA and the Quality Payment Program to establish qualified clinical data registries as new organizations that compute quality measures across providers. “The study highlights the importance of using longitudinal patient data from providers to improve the accuracy and completeness of quality reporting. The research presents data from the KHIN health information exchange on primary care practices where more than 50,000 patients visited 214 separate care sites during the measurement period,” officials pointed out.
At the time the research was made public, McCrary noted, “The research findings indicate quality measure calculation is possible using interoperability standards to collect near real-time clinical data from disparate EHRs.” She added, “This is in stark contrast to the current model which computes quality measures from only the data in the provider’s EHR. Patients receive care from many different providers and this research suggests a more accurate assessment of the quality of care provided to a patient can be computed by using health information exchange data.”
Indeed, a follow-up report to that original research is in the works, and will be looking deeper into the issue, says McCrary. So, for instance, “If you are looking at a practice and its patients, [we’ll analyze] how that practice did on quality measures just using the data in the EHR versus how it did on the quality measures using the data across the HIE. And they are looking at that data across [about] 50 different practices, so there isn’t an anomaly there with just one or two.”
McCrary believes that this offering is exclusive to HIEs, since no other technology platform is able to provide a comprehensive data set for different providers across an extended period of time. And on top of that, she adds, “It’s near real-time data; not claims data. So the opportunity that we have is unique to HIEs and we think it’s important to capitalize on that. We do not believe that the movement of data from one place to another for purposes of treatment will continue to be a viable business model,” she attests.
Furthering this perspective, McCrary points to existing interoperability initiatives and frameworks such as Carequality and CommonWell, noting there are prohibitions against charging money for the movement of data for treatment—a concept that HIEs have focused their business models on in the past.
And with TEFCA (the Trusted Exchange Framework and Common Agreement)—the government’s mechanism to promote data exchange and interoperability in healthcare—looming, it remains unclear on what those prohibitions will look like in the future. But McCrary is nonetheless confident that HIEs will not be able to “actually generate significant revenue [by charging money to move data for treatment] like we have in the past.”
This is a big reason why, moving forward, data aggregation and the delivery of aggregated data to payers, accountable care organizations (ACOs) and other alternative payment models will continue to be a priority for KHIN, McCrary states. “We have worked with Diameter, and continue to do so, to build a product that allows all the data from the HIE to be compiled together into a normalized de-duplicated document called a C-CDA [consolidated-clinical document architecture], which can be made available to providers through our HIE, but also can be made available to payers, ACOs and others that need the historical data on patients,” she says.
But even once that historical data is provided to the payer, for example, a patient still might get care at another outside location the very next day,” McCrary offers. “So we are working to make sure that we have delivered the C-CDA and all the historical data, but we’re also in a position to deliver every single thing that happens thereafter. That’s what I call the ‘differential.’”