Rocky Mountain High: How CORHIO is Changing the HIE Narrative (Part 1 of 2)
In the past several months, multiple studies—one by researchers from the University of Arizona, Weill Cornell Medical College, and the Indiana University School of Public Health, published in Health Affairs, and one from the Santa Monica, Calif.-based research organization RAND Corporation—determined that it was too early to draw conclusions from health information exchanges (HIEs) in the U.S., given that there really hasn’t been much evaluation yet on their effects.
These reports, coupled with the fact that a number of statewide HIEs are close to shutting down, if they haven’t already done so, has led to a nationwide perception that as currently constituted, health information exchanges are not sustainable, and are “doomed.” In Colorado, however, the Denver-based Colorado Regional Health Information Organization (CORHIO) is doing its best to change that perception, and the results are speaking for themselves.
On Feb. 6, CORHIO’s leaders announced that their organization had seen the number of participating healthcare users in its network grow by 111 percent, and the amount of data available in the network grow by 118 percent, in the past year. That marks the third consecutive year of triple-digit growth rates for the organization, which now encompasses 5,705 active providers/users, 47 connected hospitals, and with more than 223 million clinical messages having been sent. Last month, HCI Editor-in-Chief spoke with CORHIO’s chief financial and strategy officer, Brian Braun, about the keys to CORHIO’s success amidst its recent growth. As a two-part extension to that piece, HCI Associate Editor Rajiv Leventhal spoke with CORHIO’s CEO, Morgan Honea, about how the state of Colorado has become a model for data exchange success as well as the national perception on HIEs. Below are excerpts from Part 1 of the interview with Honea.
What’s going in Colorado, related to value-based care?
There are so many different things going on in the state. You have Medicaid expansion in Colorado, a state-based health insurance exchange, a very active and progressive Medicaid program that’s been implemented, a fair number of Medicare accountable care programs, and a state innovation model grant that was just received. So there are a tremendous number of programs overall in the state that recognize the value of HIE and are constantly pushing us to evolve and translate our services into the different needs of those different programs. Our success has been largely around the hospital systems, but this year we’re rounding that out into more towards ambulatory and other ancillary provider networks going forward. That means more continuity of care document (CCD) exchange with office-based clinicians. We’re also doing a lot of work with groups who want to do population health and analytics. We’re moving a large part of the state into greater integration of services and more progressive payment systems.
Morgan Honea
What makes the state successful with these types of programs?
One of largest things is that we’re deeply purple. Politically, we focus on compromise and figuring out solutions. If you look at healthcare reform activities going on here, in most cases the state has taken opportunities where they felt it was appropriate to leverage federal programs, and sculpted them so they fit problems that they see. In general, we have a wildly collaborative nature in Colorado. On any given day, we can have multiple different systems or provider networks that see themselves as competitors but can come together because they see the value to the patient. It’s a great political environment and sense of collaboration. There is also a great policy community that is very active in translating challenges into policy solutions rather than the other way around. We benefit from having a strong economic environment where businesses are healthy as well. People don’t think it matters, but citizens having jobs and housing, with a strong education system, is really important.
What are CORHIO’s main challenges?
Really what I just said is a pro and a con. It’s an exciting place to be, and also exhausting. We struggle a bit with just being able to manage the amount of change that’s going on and how we do what we’re doing deliberately. General industry bandwidth and capacity for change is a challenge right now. The payment system lagging behind cost of technology and the expectations that are growing on different provider groups—whether that’s hospital, behavioral health groups, ambulatory, whomever—is a big challenge. We see a large number of practices becoming patient-centered medical homes (PCMHs), and these various designations require additional reporting, with more scrutiny towards quality metrics, without reimbursement mechanisms that support the cost of those efforts. The general capacity to manage change and the conflict between the cost of expectations versus a payment system that hasn’t followed quickly behind are the greatest challenges.
Nationwide, people are questioning the potential benefits of HIEs. What are your thoughts on that?
There are obviously a lot of successes and failures, just like with anything else. Nationally, there have been HIEs that have not been successful off the ground in building their networks and have thus dissolved. Here in Colorado, we see undeniable value in the HIE. There are very tangible benefits of having HIE where that point of care was dramatically changed because of it. I read [these] reports, and you have to be objective—there have been failures. But there have also been successes. We don’t have the national studies that have quantified the value of HIE, and we don’t talk at all about the benefit to patients who have received services and better proof of care because of the HIE. There are a number of stories already from our clients serving their patients where health outcomes were changed dramatically because of the HIE functionality.
Can you share any of these examples?
[From Christine Baker, CORHIO’s director of communications]: One customer of ours that runs a smaller sized hospital and ambulatory clinics wrote us an email 24 hours after they became connected to our network giving two examples of patient encounters where the HIE made a huge impact in care delivery. One patient avoided a transfer to another hospital in the area because what was thought to be a more serious condition requiring a higher level of care was actually pretty minor based on data synthesized in the HIE (recent test results performed by other providers in the community). This saved the patient from having to go through a stressful transfer and the payer from additional unneeded tests, procedures and hospital days (it likely would have been in excess of $25,000 for that one patient).
In the other patient example, a surgeon was readying to amputate a patient’s leg due to what was believed to be a serious and urgent medical condition, however after the HIE information was reviewed, it was determined that an amputation was not needed to treat the patient’s condition and the surgery was averted. Had that patient come in to the hospital one day prior, he or she would not have both legs today. To think that happened within 24-hour period and with only one of our locations (we have thousands of connected providers and hundreds of locations), it shows how remarkable HIE technology can be in terms of both cost and quality.
Would you be open to CORHIO being part of a larger study on HIEs?
Our HIE has not been “studied” in terms of success and failure. Our model has been one that sets us apart, sets us up for sustainability and business success. Most of the talk about failure nationally has been because many of these organizations are going out of business. We have had conversations with the Brookings Institution [Washington D.C.], which has recently done some reports on HIE and the value propositions of users in New York. We could work with them for research to support changing that national dialogue. We have been subjects of a lot of different conversations, but just in terms of the breadth of our network. But we are actively discussing what would be the right type of study to show the effectiveness of HIEs.
[Baker]: Many HIEs, including CORHIO, would love to participate in definitive research on the topic, but the challenge is budget/money. To have a well-executed, respectable study performed the cost will range between $150,000 and $300,000. Trying to find someone to pay for that research is a challenge. All of the revenue CORHIO generates goes straight into the technology and manpower that enables secure information exchange, so there is nothing remaining to pay for a study such as this. I think most HIEs are in the same boat as us when it comes to financing operations.
Part 2 of this interview will take a look at the role of the federal government, if vendors are keeping up with provider demands, and Honea’s advice for those who aren’t moving as quickly with data exchange efforts.
