HIE Leaders Crack the Code on Indispensability

Feb. 12, 2018
At the SHIEC Conference in Indianapolis last week, all eyes were on the future, and a range of opportunities for health information exchanges to make themselves indispensable to payers, providers, and public health

It was excellent to attend the sessions at the third SHIEC Annual Conference last week in Indianapolis, sponsored by SHIEC, the Strategic Health Information Exchange Collaborative. At a time when some in U.S. healthcare are prematurely writing a collective obituary for HIEs, the reality behind the scenes is both brighter and far more complex than the announcements of HIEs forming and breaking apart.

And that complexity, and that nuance, were on full display at the SHIEC Annual Conference. On the one hand, no one attempted to gloss over the fact that HIEs face challenges going forward—challenges around funding, policy issues, and above all, sustainability. On the other hand, the leaders of numerous HIEs are developing strategies that are putting them on more and more solid ground.

One great example is the Nebraska Health Information Initiative, or NeHII. I was able to sit down with NEHII CEO Deb Bass during the conference, and hear about some of the great things her organization is doing. Under her leadership, NeHII has moved ahead to embed some of its capabilities into core, and even mandatory, state healthcare processes in the Cornhusker State. For example, as I noted, “Since January 1 of this year, all prescriptions for controlled substances in Nebraska have had to be logged into the state government-sponsored Nebraska Prescription Drug Monitoring Program (PDMP) database, which NeHII operates. And, beginning on January 1, 2018, all filled prescriptions will be required to be logged into that statewide PDMP database. Meanwhile, NeHII continues to move forward on numerous other fronts as well, particularly in terms of collaborations with payers and providers in the state.”

I asked Deb about all of this progress. As she noted of the PDMP initiative, “This will help prescribers know which of their prescriptions are ultimately filled, and which not. Our end goal is to address adverse medical events, including the opioid crisis. Look at the dollars associated with adverse medication events, in terms of extended hospital stays, readmissions, etc.,” she said. What’s more, she noted, this initiative speaks to the core of what HIEs can do. As Deb put it, “[W]e are that trusted community partner. We are the neutral convener. For the most part, the HIEs in SHIEC are non-profit collaboratives, and the mission for nearly all of us has to do with patient safety, increasing quality, and reducing costs. We’ve seen real-life stories of what’s happening to people, and it just makes us all the more dedicated towards those goals, with regard to improving the quality outcomes, the cost control, and the patient, family, and community experience of healthcare delivery.”

And that isn’t all: as Susan Beaton, R.N., M.S.N, vice president, provider services, care management, & risk, at BlueCross BlueShield of Nebraska, noted in her presentation as part of a session that brought together payer executives and HIE executives, she continues to be very excited by all the innovative work that her organization has been able to do collaboratively with Deb Bass and her colleagues at NeHII, and with local provider groups. “We at BlueCross BlueShield of Nebraska serve over 700,000 members—two of every three Nebraskans carry our card,” Beaton said during that session. “Physicians and payers working together to utilize NeHII-facilitated data helps provide a path forward” to improving patient/plan member health status and better managing costs, she said. “So it’s very important to participate in health information exchange. And it’s important to make sure we can help NeHII work smarter.”

Among other things, the BCBSNE folks and the NeHII folks are working, together also with provider leaders, to align on a smaller, more standardized group of quality metrics, to help providers to improve care management, and to enhance the use of data as a tool. As she told the audience, “The fact is that 300,000 of our 700,000 members are in patient-centered medical homes or ACOs”—accountable care organizations. “We want providers to work from harmonized sets of measures; we understand that they are very frustrated over having to work with so many different sets of quality measures.”

So right there, you have two very exciting areas that pioneering HIEs like NeHII are getting into: initiatives like the prescription drug monitoring program, and ones involving collaborating with health plans and providers to harmonize and reduce the volume of, quality outcomes measures that providers, especially physicians, have to report on and be incented around.

Meanwhile, two other fascinating areas that innovative HIEs are getting involved in are the collection and sharing of data around the social determinants of health, and, most commonly, providing alerts on transitions of care, something that is becoming very common now.

And what do all these elements have in common? They all involve HIEs making themselves indispensable, in some form or another, to payers, providers, public health agencies, and the healthcare-consuming public.

In a session devoted to the concept of the patient-centered data home (PCDH), and the National Patient-Centered Data Home Initiative, Melissa Kotrys, CEO of Health Current, a Phoenix-based HIE, noted that the patient-centered data home offers “standards-based, cost-effective, scalable data exchange, and links existing HIE systems together.” It also gives providers “comprehensive real-time patient information.” As Kotrys noted, the PCDH “answers three questions: the who, when, and where” of data collection and sharing. That means answering the following, she said: “First, where are my patients getting care? Then, when did my patients get care? What’s happening in my own region, and when patients are traveling? And who is the patient who got care?”

Furthermore, Kotrys told the audience, the PCDH concept “helps to resolve issues with identity across HIEs,” without requiring the development of a single, “universal” identifier. What’s more, she noted, the PCDH “preserves local governance and protects local stakeholders—it honors local data use policies.” And it “enhances data aggregations required for reporting for value-based programs.”

The potential for all of these capabilities, and for these implementations to support value-based healthcare, is tremendous; and the HIE leaders gathered in Indianapolis know it.

What’s more, the leaders of the successful HIEs, especially of the successful statewide HIEs, have been learning very quickly how to leverage the provision of all of these types of services into real sustainability.

And that is where the future lies in all of this. It is about HIEs finding ways to support the new, value-based, accountable, transparent healthcare system that is emerging, in ways that only HIEs can.

And while HIE leaders will continue to face a thicket of challenges going forward, what is clear is this: the really smart leaders of the really strategically developed and managed HIEs nationwide, are figuring this out. Will the intense challenges that face HIEs right now continue into the foreseeable future? Absolutely. But there’s no question that some of the smartest, savviest HIE leaders are figuring out that the secret to HIE sustainability lies in HIE indispensability, and are moving very quickly to skate to where the puck is going, on that front.

It will be fascinating to watch the HIE sector evolve forward in the coming year, and beyond. One thing is clear: for every challenge facing that sector, there is equal opportunity. The SHIEC Conference’s sessions and discussions demonstrated that reality in living color. I look forward to our publication covering he ongoing unfoldment of this important industry sector. It certainly will be a fascinating next few years in this area.

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