As health information exchanges (HIEs) evolve, they will need to adapt to changing approaches to reimbursement, according to a newly released report from the HIMSS State Advisory Roundtable. The group -- comprised of experts and advocates from state and federal governments, regional extension centers, HIEs and other key areas -- seeks to target health IT issues that transcend state boundaries, thereby enabling states to advance their health IT programs.
Along with adjusting to new reimbursement patterns, HIEs will need to reshape their business models to facilitate coordination of care, the group reported.
The roundtable's inaugural report, titled "States Will Transform Healthcare through Health IT and HIE Organizations," was published at the HIMSS Government Health IT Conference and Exhibition in Washington, D.C., earlier this week.
Two of the roundtable's members are former Vermont Gov. Jim Douglas and former Wyoming Gov. Jim Geringer. In a blog post on the Government Health IT website, they wrote that, with many states still finding themselves "far behind where they were economically when the recession started 4.5 years ago," a key way "to address the economic challenges of many state budgets is to encourage our states to invest in health information technology."
There will be challenges along that road, especially with regard to funding, infrastructure, sustainability and, most notably, a healthcare industry that's in the throes of reinventing the very basis of its business model -- steering away from fee-for-service and toward value-based care.
Other challenges faced by the states include a surge in Medicaid patients – with some states anticipating a more than 50 percent increase in enrollees – and pitfalls with regard to patient engagement. "Putting data in the hands of patients should be a major component in both enabling transparency and driving responsibility of the individual’s and family’s health," according to the report. "This is a challenge due to the complete lack of transparency between the caregiver, the payer and the patient today."
Even in light of such challenges, HIEs hold big potential, the report argues.
"Almost all states have large contracts in place for a more extensive build that is just getting underway now," the report points out. "Stage 2 Meaningful Use will drive much more rapid development but that is no guarantee of success of state-run HIEs. There has always been a concern about state-run HIEs being able to compete with private options that are emerging as the market organizes.
Indeed, there are big questions about many exchanges' sustainability.
"With few exceptions, such as Rhode Island and Vermont, the state-level HIE business model is almost completely void of private investment, leveraging mostly state and federal funds for development and implementation activities," according to the report. "Most models that have found success to date are based on driving efficiencies to providers in a fee-for-service model."
But as that model fades in favor of value-based care, "the sustainability model for HIEs also must change," the report argues.
"This will likely come in the form of leveraging HIEs for care coordination, telehealth visits and quality and payment analytics. Therefore, the business of state HIEs will likely need to shift from 'facilitator of sharing' to 'data aggregator and analyzer' in order to build a sustainable business plan. The challenge will be to provide a basis for comparison across private providers."
In their blog post, governors Douglas and Geringer offered other advice:
- States should leverage their HIEs and other IT infrastructure in "new and innovative ways," such as closer partnerships between state governmental entities, regional extension centers, Beacon Communities and professional trade associations.
- Health IT "transcends political lines" and should be a top legislative priority, regardless of which party is in power, to maintain its forward momentum.
- States should "facilitate, engage and educate patients and consumers with the delivery of their healthcare services and promote overall increase in health literacy."
- Health IT should be foundational to healthcare reform.
- As reform drives the shift from "fee-for-service to pay-for-quality models," state-level HIEs, to remain sustainable, will need to rethink their approach, from “health information exchange” to “healthcare coordination facilitation."
- Better coordination is needed between and among federal and state health agencies to make sure state-level HIEs are aligned with funding sources to ensure success.
Access the HIMSS State Adivsory Roundtable's report here.