Getty Images
How Health Information Exchanges Boost Value-Based Care
As providers look toward value-based care delivery, health information exchanges (HIEs) can support care coordination and population health management.
Health information exchanges (HIEs) are well-situated to help healthcare organizations achieve the triple aim of value-based care—improving population health management strategies, providing better care for individuals, and reducing healthcare costs.
Value-based care is a form of reimbursement that ties payments for care delivery to the quality of care provided and rewards providers for efficiency and effectiveness. This form of payment has emerged as an alternative and potential replacement for the fee-for-service reimbursement model, which pays providers for services delivered based on bill charges or annual fee schedules.
Value-based care models center on patient outcomes and how well healthcare providers can improve care quality, compared to the traditional fee-for-service model, which pays providers based on the volume of services they deliver.
While value-based care can improve overall patient outcomes, hospitals assume more risk than traditional fee-for-service models. This increased risk has led many hospitals and health systems to leverage health IT and join HIEs to manage care to maximize the potential for success.
Support Population Health Initiatives
HIE allows providers to share patient medical information through a secure exchange network that is EHR-agnostic, meaning that healthcare providers can share information from different EHR systems.
A more complete picture of the patient population can help providers better coordinate care. Identifying gaps in care and working to close them can help hospitals improve the quality of care they deliver— staple in value-based care.
HEALTHeLINK, the HIE for Western New York, worked on 83 different projects in 2021 focused on improving data sharing, according to the HEALTHeLINK 2021 Report to the Community.
"HEALTHeLINK continues to support Western New York hospitals and provider organizations through its core services, including results delivery, alert notifications, patient record lookup, and patient encounter data to improve quality of care," Anthony J. Billittier IV, MD, FACEP, chair of HEALTHeLINK Board of Directors, wrote in the report.
The report noted that in 2021, participating HIE providers utilized patient record lookup more than 6.5 million times to access a consenting patient's EHR data instantly.
Additionally, the HIE delivered more than 950,000 clinical results, such as lab tests and radiology reports and images, to providers monthly. Officials said that this marks a 10 percent increase over 2020.
"Understanding the unique role HIE has within our local healthcare structure, HEALTHeLINK is working to deliver data needed for value-based care, social determinants of health, and population health initiatives," said Billittier, who also serves as executive vice president and chief medical officer of Independent Health.
The HIE saw increased utilization of its community population health tool, HEALTHeOUTCOMES, which leverages HIE data and claims data from Highmark Blue Cross Blue Shield of Western New York, Independent Health, and Univera Healthcare.
"We are very excited about our expanding population health program and technology," noted Daniel Porreca, executive director of HEALTHeLINK. "HEALTHeOUTCOMES supports quality measure calculations and has been utilized for Comprehensive Primary Care Plus (CPC+) and other quality improvement programs between payer and provider organizations."
Boost Care Coordination
Joining an HIE can help healthcare organizations succeed in value-based reimbursement models by boosting care coordination.
An op-ed published in the Journal of AHIMA notes that HIEs support care coordination by providing clinicians with up-to-date patient health data in real-time, which can prevent excess hospital admissions and readmissions.
When a provider sees a new patient, the patient often arrives with incomplete clinical information.
However, being part of an HIE allows providers to easily access a patient's clinical data from across the care continuum.
Providers can also generate and monitor a worklist of seriously ill patients seen regularly by multiple providers (like cancer patients and transplant patients) through the HIE to track their care.
Additionally, viewing diagnostic tests in the HIE helps eliminate redundancy and lower patient discomfort and healthcare costs.
"Within a day in the life, HIEs enhance providers' ability to deliver proactive care rather than just reactive care," the op-ed authors explained.
Brian Dixon, PhD, MPA, director of public health informatics at Regenstrief Institute and the Indiana University Richard M. Fairbanks School of Public Health, presented how HIE can support care coordination at the HIMSS 2022 Global Conference.
Primary care providers often don't have access to information about the care their patients receive outside of their office, especially if patients seek care in a different health system.
For instance, patients can go to the hospital and get released, and their PCP would have no idea, leaving patients to reach out to their provider on their own for critical follow-up care.
According to a survey of PCPs, physicians are notified less than half the time about patient hospitalizations, potentially putting their patients' safety at risk.
"Especially after a major event such as a hospitalization, patients need to discuss recovery plans, changes in medication and other important details with their primary care provider," Dixon noted in a press release.
"But often, as patients get back in their normal routine, they forget to follow up with their doctor, or they are feeling better and assume they don't need to, which is risky, especially for older adults," he added.
Dixon recently conducted a study that found HIE-based alerts sent to primary care providers boosted the primary care team's follow-up rate in the Department of Veterans Affairs (VA) health system.
Compared to usual care, veterans whose primary care team received notification of non-VA acute care encounters were four times more likely to have phone contact within seven days, and two times more likely to have an in-person visit within 30 days.
"The alerts prompted the care teams to be more proactive in closing the care coordination loop, and patients feel more valued when the provider reaches out to them," said Dixon.
Reduce Healthcare Cost
By delivering on population health initiatives and supporting care coordination, HIEs can help healthcare organizations cut downstream costs.
A 2018 systematic review of studies of health information exchanges found evidence the exchanges reduced the cost of healthcare.
The new findings “represent progress in reaching the national goals of better-quality care, improved population health, and lower costs,” Nir Menachemi, a professor in the Indiana University Richard M. Fairbanks School of Public Health at IUPUI and the study’s lead investigator, said in a public statement at the time of the announcement.
Benefits from the review include fewer duplicated procedures, reduced imaging, lower costs, and improved patient safety.
“Up until this point, the promise of health information exchanges to improve care and reduce costs has been theoretical,” said Menachemi, who also serves as chair of the school’s Department of Health Policy and Management. “We now have reasonably strong evidence that there are benefits to using health information exchanges.”
HIE membership can also help healthcare organizations hit cost-saving goals by sharing technology and promoting innovation. Joining a health information exchange comes with a membership fee, for lack of better term, and for smaller organizations that cost can be prohibitive. Through innovative HIE programs, that cost can be divided among healthcare organizations.
In 2021, Alaska's statewide HIE, healtheConnect Alaska, joined CRISP Shared Services, a collaborative of the Maryland statewide HIE and the HIE in Washington DC.
CRISP Shared Services presents data in a master patient index with multiple lives in it for each state's HIE, allowing the organizations to share technology costs.
"Geographically, on the surface, it doesn't look like it makes sense," Laura Young, executive director of healtheConnect Alaska, said in a May interview with EHRIntelligence.
However, while Alaska is not likely to share patients with HIEs located in the continental US, healtheConnect Alaska shares similar values and technology with CRISP Shared Services, Young explained.
"The CRISP Shared Services group has some similar technologies, so it meant that we didn't have to do a complete migration to a whole other technology platform," she continued. "We can maintain a lot of the things that we've already built. For us, it was really about how we could be the least disruptive in terms of any changes that we made."
CRISP Shared Services presents data in a master patient index with multiple lives in it for each state's HIE, allowing the organizations to share technology costs.
Young also explained that healtheConnect will benefit from the consortium from an innovation standpoint.
"Health information exchanges have been going on over 10 years now and we're all finding that we have some common problems to solve," said Young. "The idea behind it is to come together to share technology ideas, resources, and best practices around health information exchange."
As the digital health transformation continues, HIE membership could help healthcare providers reach their value-based care goals.
There are many models and business approaches emerging to support HIE, including regional, local, or state nonprofit or government-sponsored exchange networks and exchange options offered by EHR vendors.
Healthcare organizations looking to join an HIE should first determine which service providers are available to them keeping in mind the mission and goals of their organization, according to ONC.
Stakeholders should gather information on the sustainability of the HIE, internal requirements of participating in the HIE, and which forms of exchange the HIE supports, ONC officials noted.
