04 Feb Burden for patient data exchange likely to fall on payers, patients
Milwaukee, Wis. – Forget hospitals and physicians – patients and health plans are more likely to shoulder the financial burden for development of health information exchanges, according to the former head of CalRHIO.
In an appearance before the annual meeting of the Wisconsin Health Information Exchange in Milwaukee, Don Holmquest told Wisconsin healthcare executives that because health plans (payers) and patients benefit most from such exchanges, they should be the focus of building a sustainable business model.
Holmquest, who now serves as an advisor to the California health information initiative, said hospitals will not be interested in supporting HIEs and RHIOs (regional health information exchanges) because the resulting efficiencies – fewer duplicate and unnecessary tests – would cut into their revenue. He said small physician and physician groups, which also have labs and imaging technology, probably can’t afford to provide financial support – especially if they are based in rural areas that lack broadband service.
Invoking the “Show Me the Money” line from the motion picture Jerry McGuire, Holmquest said technology is not the limiting issue for health information exchanges, money is. “It’s not privacy, it’s not security, it’s how do you get the money?” he stated. “And more importantly, from who?”
The most likely funding sources, he added, are patients and payers. The latter will respond in a mixed fashion, he predicted, as some will think it’s the right thing to do and others will drag their feet.
Stakeholder value
In emergency department settings, there are times when patients are unable to communicate with caregivers, and emergency rooms are the first target for health data exchanges because of the necessity of having patient information readily available for critical care.
With a regional patient data exchange, ED clinicians have access to historical patient data – including previous tests to avoid unnecessary duplication and to help control costs, medication history to avoid potentially harmful and costly drug interactions, and the results of visits to specialists for better care planning.
The challenges include protecting patient data in a secure system and making computer systems interoperable because even when information is stored on computers, it isn’t necessarily connected to computers in other healthcare facilities or systems.
WHIE Executive Director Kim Pemble said there are many value stakeholders, including patients, payers, and health systems. Pemble, the former CIO for SynergyHealth in West Bend, said HIE benefits health systems with “faster throughput” in emergency departments, higher patient satisfaction, and quality of care for patients coming through the EDs.
One sign that payers know they must play a supportive role is WHIE’s new partnership with Humana to provide emergency room clinicians with access to patient data. “That’s very exciting news,” Pemble said. “It is the first step. We hope other payers will join that model or similar models. By payers, I mean all payers, and that includes Medicare and Medicaid.”
In terms of outreach to stakeholders, Pemble said WHIE has an advisory board position reserved for a health plan representative, it has engaged payers in numerous conversations about what it is trying to do, and it has a patient advocacy position on its board.
“We’ve been fortunate to have the conduit for those communications from the early days,” he said.
Feedback from healthcare consumers has Pemble convinced that they will find value in health information exchanges, especially because they are an unknown to emergency care providers.
“They [consumers] realize that their retail store has more knowledge about their purchasing habits and where things were on the shelf and what they paid for them than their physicians know about their care, particularly when they go into the ED and they are not a familiar patient,” he noted.
Exchange rate
Thus far, WHIE has received funding from participating hospitals and government agencies such as the U.S. Centers for Medicare and Medicaid and the Wisconsin Department of Health Services.
The exchange reached a milestone in 2008 with the establishment of an Emergency Department [ED] Linking program. Thirteen hospitals now contribute data to the exchange, and eight emergency departments use the exchange for regular patient care.
In addition, Microsoft Health Solutions Group provides WHIE with its Amalga unified intelligence system to aggregate and share health data. Amalga captures data from the WHIE’s 13 hospitals, centralizes the data within the network while maintaining separate data structures for each delivery network.
The exchange would like to expand the number of participating organizations and expand the types of data available to contributors. Care providers have been reviewing where previous care was administered, plus past diagnoses and medication lists. The new data would include lab and imaging results and additional pharmacy information.
But will there be enough funding for even incremental expansion? That may depend on the federal stimulus bill, as both the House and Senate versions contain funding for the Office of the National Coordinator (ONC) for Health Information Technology.
Pemble said the WHIE project needs additional bridge money this calendar year, and he hopes the progress made so far will convince the federal government to provide funding for the next steps, including more stakeholder partnerships.
“We’re not asking for millions of dollars,” Pemble said. “All we’re asking for is a bridge from today to tomorrow.”
Payment mechanisms
Holmquest said there are two possible funding mechanisms for patient data exchange – charges based on use of ED services such as lab tests, imaging, and medications, or charging on per member, per month basis. Of the two, he said the per member, per month method would be easier.
Large medical groups have the scale to generate sufficient revenue, he noted. The California-based Kaiser Permanente, for example, has 10 million enrollees nationwide.
“Health plans think in terms of how much per member, per month,” he stated. “You can talk about paying $25 for this service delivered in an emergency room, but when you start talking about 50 cents per member, per month for all members, they know that’s a big amount.
“They often buy services for nickels and dimes per person, per month. You’ll have to get actuaries and very knowledgeable people to work through that, but it’s a much more convenient way to do it.”
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