'Who's going to pay for it?'
The panel discussion titled “HIE: Is it real? Does it work?” at the recent AMDIS Physician-Computer Symposium offered an opportunity for HIE vendors Axolotl, ICA, Microsoft and McKesson to explain the value of health information exchanges to a roomful of CMIOs.
Both the audience and panel agreed that information can and must be shared, but opinions were more mixed as to whether HIEs as currently envisioned are the right way to do that. And who pays? Sustainability was in the major issue in the question-and-answer period that followed.
The answers are likely to change, but the same questions are lingering in hallways and hospital meeting rooms across the U.S.
Q: With regard to sustainability models, physicians and healthcare organizations may not necessarily be the winners in this, if it means we have to spend more money to take good care of patients. What have you seen that works and will continue to work?
A: This is going to evolve over time as the value proposition changes, the payors are waiting to find out what happens next. One of the problems is sort like an untold story: The traditional RHIOs have been the squeaky wheel, trying to figure out how to sustain something beyond traditional grants. They’ve struggled trying to find a business model. RHIOs like Wisconsin have found it because they found payors and employers willing to come to the table to make that proposition happen.
The statewide piece has confused everybody because the feds were going one direction with the Bush administration, then suddenly PPACA and ARRA [are] saying it’s fully the state’s responsibility. And they’re starting to build something anew. Still, there’s a bit of an untold story regarding how rapidly health systems are starting move in the direction of seeing the value of paying for it.
Q: Why is the HIE model different from capitation, CHINs, RHIOs and other forms of information exchange? What have we learned from all those failures?
A: The big difference between CHINs, RHIOs and what we’re doing now is interconnectivity. Before, having an exchange meant having to provide a virtual network and everything else, [which] was as costly or more costly than the solution itself. With the internet proliferation, the security associated with the internet, VPNs and the like, connectivity is the least expensive thing, so now you’re just providing the solution. And the solution now has much more value than it did before.
In the next years, physicians are going to drive what they want these HIEs to do, and create the value. That’s what the vendor community is going to be responsible for is meeting physician needs.
Q: Is there any evidence-based medicine, any research that shows that sharing this data actually improves care?
A: In a medium size metro area, looking up past clinical history for regional systems for ER visits, on the claims side, we’re looking at between $25 and $30 in savings per visit. When we look at data by surveying doctors, about 40 percent said have the data made a difference in their decision making, and the predominant effects were less labs, less x-rays, less medications. About 15 percent of the time, they order more because they have a better picture of the patient. But there’s not enough evidence out there yet – that’s Step 2 of the process, not Step 1.
Q: I have trouble even now countering the argument that somebody else should have to pay for this stuff. Is it really the time to push it this hard, if we have to pay for it as physicians?
A: We’ve seen in some of our communities when payors do recognize that it takes extra work for doctors to do this, and that it ultimately will benefit the payors, so they pay extra to doctors to incentivize them to do the right thing. That’s the model that’s needed. Enlightened payors are helping sponsor an HIE because they know it’s the only way to survive, is in a partnership with their physicians. And that’s what needs to happen. You need to get paid for that extra time.
And so the discussion continues…
Mary Stevens, editor
mstevens@trimedmedia.com
Both the audience and panel agreed that information can and must be shared, but opinions were more mixed as to whether HIEs as currently envisioned are the right way to do that. And who pays? Sustainability was in the major issue in the question-and-answer period that followed.
The answers are likely to change, but the same questions are lingering in hallways and hospital meeting rooms across the U.S.
Q: With regard to sustainability models, physicians and healthcare organizations may not necessarily be the winners in this, if it means we have to spend more money to take good care of patients. What have you seen that works and will continue to work?
A: This is going to evolve over time as the value proposition changes, the payors are waiting to find out what happens next. One of the problems is sort like an untold story: The traditional RHIOs have been the squeaky wheel, trying to figure out how to sustain something beyond traditional grants. They’ve struggled trying to find a business model. RHIOs like Wisconsin have found it because they found payors and employers willing to come to the table to make that proposition happen.
The statewide piece has confused everybody because the feds were going one direction with the Bush administration, then suddenly PPACA and ARRA [are] saying it’s fully the state’s responsibility. And they’re starting to build something anew. Still, there’s a bit of an untold story regarding how rapidly health systems are starting move in the direction of seeing the value of paying for it.
Q: Why is the HIE model different from capitation, CHINs, RHIOs and other forms of information exchange? What have we learned from all those failures?
A: The big difference between CHINs, RHIOs and what we’re doing now is interconnectivity. Before, having an exchange meant having to provide a virtual network and everything else, [which] was as costly or more costly than the solution itself. With the internet proliferation, the security associated with the internet, VPNs and the like, connectivity is the least expensive thing, so now you’re just providing the solution. And the solution now has much more value than it did before.
In the next years, physicians are going to drive what they want these HIEs to do, and create the value. That’s what the vendor community is going to be responsible for is meeting physician needs.
Q: Is there any evidence-based medicine, any research that shows that sharing this data actually improves care?
A: In a medium size metro area, looking up past clinical history for regional systems for ER visits, on the claims side, we’re looking at between $25 and $30 in savings per visit. When we look at data by surveying doctors, about 40 percent said have the data made a difference in their decision making, and the predominant effects were less labs, less x-rays, less medications. About 15 percent of the time, they order more because they have a better picture of the patient. But there’s not enough evidence out there yet – that’s Step 2 of the process, not Step 1.
Q: I have trouble even now countering the argument that somebody else should have to pay for this stuff. Is it really the time to push it this hard, if we have to pay for it as physicians?
A: We’ve seen in some of our communities when payors do recognize that it takes extra work for doctors to do this, and that it ultimately will benefit the payors, so they pay extra to doctors to incentivize them to do the right thing. That’s the model that’s needed. Enlightened payors are helping sponsor an HIE because they know it’s the only way to survive, is in a partnership with their physicians. And that’s what needs to happen. You need to get paid for that extra time.
And so the discussion continues…
Mary Stevens, editor
mstevens@trimedmedia.com