CRISP’s Craig Behm Parses the Landscape Around the Future of HIEs

Jan. 12, 2023
Craig Behm, who late last year succeeded David Horrocks at the helm of the Columbia, Md.-based CRISP HIE, shares his vision or CRISP and his perspectives on the future of HIEs

Late last year, Craig Behm was officially named president and CEO of CRISP, which describes itself as “a regional health information exchange (HIE) serving Maryland, the District of Columbia, West Virginia, and the surrounding regions. A non-profit organization advised by a wide range of stakeholders who are responsible for healthcare throughout the region, CRISP has been formally designated as Maryland’s statewide health information exchange by the Maryland Health Care Commission. Health information exchange allows clinical information to move electronically among disparate health information systems.”

Behm’s appointment was announced in an Oct. 5 press release. It noted that “Behm, who has been instrumental in the success of HIE efforts throughout Maryland and the region, plans to expand partner and affiliate collaborations to advocate for local, industry-led solutions to interoperability and removal of public health obstacles. CRISP and its affiliate HIEs will continue to build on strong relationships with providers, Medicaid and health departments, community organizations and other HIEs.”

“Every affiliate should be an essential part of the healthcare continuum in their region, and we will continue to generate even more value over time by tapping our rich legacy of innovation and leadership across the data exchange industry,” Behm said in a statement contained in the press release.

At the same time that he was named president and CEO of CRISP, Behm was also named president and CEO of CRISP Shared Services, described on the organization’s website as “a non-profit support organization that provides technology infrastructure and other core services to Health Information Exchanges (HIEs) across the US. We are different than a vendor in that each of our Member HIEs participates in the governance of the organization.”

As the Oct. 5 press release noted, “Behm brings rich experience both in value-based payment reform and health information technology. He was the Executive Director of MedChi Network Services, a subsidiary of the Maryland state medical society, where he led the start-up of three Advance Payment Medicare Shared Savings Program Accountable Care Organizations. He then worked at a health information software, strategy and services company, and focused on the modernization efforts for Maryland’s unique all-payer hospital rate setting system. Those experiences proved essential as CRISP enabled the data and analytics aspects of the Centers for Medicare and Medicaid Innovation total cost of care demonstration model.”

Further, the press release noted, Behm “most recently served as Executive Director of CRISP, a key role in connecting healthcare providers and the Maryland Department of Health. He oversaw all statewide activities, including customer engagement, product implementation and reporting services. He was instrumental in passing key legislation during the past two Maryland legislative sessions, including a statute to create the first Health Data Utility in the nation.”

“I am fortunate to be taking the helm of such a wonderful organization with so many talented and dedicated staff. We are eager to explore new opportunities to advance health and wellness,” Behm said at that time. “Our stakeholders see our commitment to problem-solving through deep engagement around our region and across the country. This will continue to be the foundation of everything we do.”

The press release noted that “CRISP shares the technologies it develops with other HIEs nationwide through CRISP Shared Services. Critical projects in conjunction with other HIEs include: West Virginia Health Information Network (WVHIN) -- end of life registry reporting where patients submit one document to one place; and a number of initiatives with CRISP DC -- a consent tool developed with the Department of Health Care Finance for exchange of patients' behavioral health information; social determinants of health tools through the DC Community Resource Information Exchange (CoRIE) project; and encounter notifications that alert providers in real-time, flagging when their patients have been treated by emergency medical services to ensure appropriate follow-up treatment.”

And it noted that “Behm replaces David Horrocks, who was president and CEO of CRISP when it was created in 2009. Brandon Neiswender returns to his role as VP & Chief Strategy Officer after serving as acting CEO since February when Horrocks left to become CEO of the New York eHealth Collaborative.”

In early December, Behm spoke with Healthcare Innovation Editor-in-Chief Mark Hagland to discuss his vision for CRISP going forward in 2023, and his perspectives on the health information exchange phenomenon in the foreseeable future. Below are excerpts from that interview.

Coming into the CEO position, what are your biggest strategic goals, as we look forward into next year?

I’ve started to talk about success in terms of being a health data utility rather than a health information exchange. In my opinion, the local HIEs should be the one-stop shop for health data on behalf of the state, with the broadest goal being to build efficiency throughout the healthcare system by having a single pipe among data submitters and receivers, and providing a one-stop shop for anyone needing to work with them. If I’m a state health department, maybe I should go to the health data utility to obtain aggregate data for public health purposes; or to support state welfare agencies, with regard to the needs of children; and so on. And the visual model for this is a flywheel, where the more data you have in the infrastructure, the more useful it will be for everybody. My favorite example is immunizations. At first, during the COVID-19 pandemic, the goal was to determine immunization rates for COVID. And we said, we should also reach out to physicians so they can do proactive outreach to patients and populations, especially underserved ones. And we said to the state, we have a better MMPI, why don’t we support you? So it’s three, four, five times more powerful than it would have had been otherwise.

There was much talk of using public health data for biosurveillance purposes when we were living through the depth of the pandemic. Has that sense of urgency been lost since then?

I think it’s very important to fight the next battle, not the last battle; that’s one of the things I learned from David [Horrocks]. And I honestly don’t want to be talking about COVID anymore. But what many HIEs, including ours, did, proved the need for this robust public health data infrastructure. And we were working with the Baltimore Public Schools, and realized there were all sorts of public health things we could do with them, related to access, attendance, etc. I think we need to act quickly to describe the value of health data utilities, so that the vision is out there.

What are the biggest challenges that you and your colleagues are facing right now?

When I work with our partner states, I try to describe success in two different ways. One is around depth: It’s important that public health data utilities do multiple things, support work around multiple issues, including around the social determinants of health, for example. The natural challenge becomes policy. I think we have a model for an independent non-profit controlling data governance based on what its stakeholders say. And even in states where we have a lot of depth, we’re often starting conversations over and over again with directors of different departments. The other element of success is breadth: we need to have more health data utilities across the country. We want states to have local control and assets, and then to be able to share more broadly. So in that context, the biggest challenge has to do with the sustainability. There needs to be some combination of funders to keep the utility operating, and then all data should be completely free to anyone who’s allowed to have it. And we’re funded through a combination of participant fees, the health department and federal Medicaid dollars, in Maryland. And that creates the opportunity for researchers, and so on.

Funding remains a huge issue for HIEs overall, though, correct?

It does. We always first remind ourselves, we don’t exist for the sake of existing. And those places that simply stood up HIEs because the grant funding was available, were the first to drop. And the culture that David built—we are not competing with the commoditized data products or federal standards or for-profit vendors. We’re working with eHealth Exchange as our QHIN… And my opinion is if you’re fighting to stop more efficient point-to-point data transfer mechanisms, you’ve already lost. It’s more efficient to have sharers authenticated once and then data passed forward. It’s still hard; we’re looking to drive value.

What does the landscape look like for you and your colleagues in the HIE world, over the next few years?

We’re going to be spending a lot of time establishing that depth. I need each of my affiliate HIEs to move well along the maturity curve of HIE development. We need to keep building their credibility, data connectivity and services in their states. So a lot of time will be spent supporting data use agreements, etc. I’m going to be leaning more into the policy discussions, in order to describe what we think will work. And obviously, health equity issues were always around, but have really been highlighted through COVID. And I think health data utilities, even in something as simple as race and ethnicity data, have a role to play. We’re probably the best sources for that data. So, working with stakeholders. And finally, we’re seeing social determinants of health and community-based organizations as the new frontier of health data exchange. And the risk is that the data becomes siloed or controlled through quirks that platforms and vendors develop, rather than letting the data flow interoperably from the start. So when it comes to things like referral platforms… I think it’s a mistake for states to mandate specific platforms, but instead encourage interoperably. And this is self-serving, but the successful HIEs are ethe right platforms for that interoperability.

Is there anything you’d like to add?

I’ll double down on my excitement for health data utilities. The technical capabilities have become so robust; and many stakeholders simply don’t understand what we can do now, so they need to get creative in their asks.

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