NJ / DV HIMSS Fall Conference 2012

Can HIEs Really Achieve Financial Sustainability: A Case Study and Discussion of Transformational Approaches and Unique Partnerships

William Gillespie dove into a case study about Pennsylvania’s HIE execution as an example for financial stability:

• Multiple private health insurers covers 78% of the population (16% of this is medicaid and medicare the rest)
• 84% of hospitals have less than 300 beds
• 47% have less than 100 beds
• 3000 physicians in small 1-2 practices in 2300 rural areas

After these statistics, he proposed a question to the audience, “What is the next step to take?” What are we going to do to start building an HIE that is not only successful at transmitting information between physicians, but a sustainable one?

To start, a plan requires buy-in from everyone involved.

1. Articulate high level model - “Are we going to exchange immunization records? Are we going to perform analytics?”A plan needs to be established in accordance with the laws and practices already in place.
2. Collect market research - Every market is very different. There needs to be an investigation into the state-specific legal system and how health care providers large and small operate in it before stakeholders can be engaged and buy into the HIE. This research not only gives insight on how the HIE should operate, but how to show ROI to the potential participants.
3. Engage stakeholders - William emphasized this point: without the active participation of everyone involved in the system from payers to providers there won’t be enough entities to make the HIE worthwhile.
4. Come to general consensus on the plan - Without agreement from all parties, you could potentially have the best plan only for disagreements to crop up because not all parties were able to present their needs in an organized manner.

The Prescription for Pennsylvania (http://www.thefutureofnursing.org/resource/detail/prescription-pennsylvania) that included allocating $17 million for a state-level HIE initiative started in 2007. William described how the great number of small practices in PA led to the fairly quick adoption to participate in the HIE.

Camella Brown stepped in to talk about the national presence of HIEs and how we can sustain them. “Grants are wonderful, how do we sustain an HIE though after it runs out?”

1. There are 250 HIEs nationally, but only 18 are currently financially self-sustaining
2. $8 billion has been spent on providers for HIEs
3. $19 billion was allocated
4. $750 billion is wasted in the healthcare industry through unnecessary tests and prescriptions

Knowing these statistics, we can see that there should be a huge ROI by fixing the waste problem. Yet if the HIEs are not successfully planning and executing as they should be, they will fail to save. So Camella discussed various success strategies of HIEs she has had communication with.

• Payers, physicians, and hospitals must all be on board. By starting with claims you can get everyone to pay their share for the services provided.
• The driver of sustainability is physician adoption. Most HIEs only ever attain 20-30% while the most successful ones create 75% or higher adoption. In order to gain adoption an HIE must give physicians what they want: exchange and move data. The ability to look up data is less useful to that audience because they have no time to do that. In fact the doctor doesn’t even have to know they’re on an electronic system as long as someone at the point of care is familiar and trained with the technology to manage it.
• In one area there were a number of institutions that had 84% of the population’s patient data. The creation of another institution was impossible simply because the system could not sustain another one, so creating an HIE allowed for ease of communication.

Camella asked the audience, “How do we have a dialogue that can respond to healthcare transformation?” She then showed an infographic detailing the drivers of change and enablers of change. The concept is that there are healthcare needs and technological enablers, and as long as the enablers stay ahead of the needs of healthcare we can continue to make progress without wasting time implementing proprietary solutions. For example: if we have tools embedded in workflow and have predictive modeling and forecasting based on data collected from population based reporting we can reach Triple Aim goals for measurable improvements. (http://www.ihi.org/offerings/initiatives/tripleaim/pages/default.aspx)

Their presentation closed with Camella saying, “We have 95% of the data, but the only thing we’re doing with it is clinical messaging!”