Payer Role Comes to Light in HIE Discussion at iHT2 Health IT Summit in San Francisco

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Analytics will help transform the way organizations exchange data across the care community.

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HIEs help coordinate care upfront, and then ACOs provide deep data analytics to further inform -- possibly in real time -- providers to help them deliver better care and control costs.

Panelists describing the future of health information exchanges (HIEs) at the Institute for Health Technology Transformation’s Health IT Summit March 23 in San Francisco told attendees to watch for developments from a source some may not have previously considered: payers.

Moderator Wendy Johnson, healthcare group publisher at FierceHealth IT, asked the panel about the prospect of large volumes of data feeding into HIEs from various sources across the care continuum: “How can that data be useful on the back end?”

Arieh Rosenbaum, director of medical informatics at the California Pacific Medical Center and co-chair of the San Francisco Health Information Exchange, noted that HIEs commoditize data by creating a community exchange for all stakeholders. From there, on the back end, HIEs serve as enablers for accountable care organizations (ACOs) to compete on the value they provide to patients and their ability to control costs.

“This is especially important in a fragmented community like San Francisco where there may be many different providers who are part of an ACO but on different platforms,” said Dr. Rosenbaum. “HIEs help coordinate care upfront, and then ACOs provide deep data analytics to further inform -- possibly in real time -- providers to help them deliver better care and control costs.”

Greg Walton, chief information officer at El Camino Hospital, added, “One of the phrases I like to use about ACOs is that they are affordable care organizations. They are going to have to become affordable through the use of analytics.”

Walton pointed out that large companies are moving into the healthcare sector from the insurance sector based on their knowledge of analytics.

“That’s one way we’ll start getting at the issue of data volume. These companies will bring in some tools that we would love to have in the provider space,” he continued.

Bob Rogers, PhD, chief scientist at Apixio, commented, “Clinical information is going to be the key commodity, and information systems will have to do a lot of the heavy lifting so that providers can spend time with patients rather than searching for pieces of data in an electronic scavenger hunt. So it’s really about informatics.”

From the panel-session audience, Tony Linares, MD, regional vice president and medical director for Anthem Blue Cross, said his company is helping providers with exchange directly from Anthem’s enterprise data warehouse and an overlay of laboratory data. “We can download directly through a portal to the provider’s EMR back end,” said Dr. Linares. “Providers get a clinical care summary similar to a continuity of care record in terms of labs, problem lists and medications.”

In addition, Anthem applies an analytics engine, acquired from Resolution Health, to provide its clients with point-of-care decision support. The provider can click on a desktop icon to get member histories.

Dick Thompson, executive director of the Quality Health Network, said he sees on the horizon a continued merging of clinical and administrative data.

“I have this dream: As a patient, you walk into the care environment of your choice, and they know who you are. They’ve done a good job of identifying you. They know what your insurance coverage is, and what you have left on your co-pay and deductibles. They know your major problems,” Thompson explained. “At that point, they help you understand what medications you’re on. And then perhaps they suggest that you get an MRI or some other procedure. Before you leave, they tell you the top three places nearby that can perform that function for you and at what price. When you’re ready to leave, you have a fully adjudicated claim. You hand them your credit card and you’re done.”

“We can do this,” Thompson observed, “but it’s going to take a collaborative effort to merge all these kinds of data streams.”

Dr. Rosenbaum concluded, “The merging of clinical and payer claims data will be very important. The analytics that the payers will bring to the table will really transform the way we exchange data, analyze it and then use it to improve care.”

By Frank Irving

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