Health Information Exchanges (HIEs) are being challenged by New York State and federal funders to transition to performance-based funding models instead of historical reimbursement-based models. The impact of this trend is manifesting itself in several significant ways.
1. HIE Consolidation
HealtheConnections in Syracuse is merging with HealthLink NY in the Binghamton/Hudson Valley area. Once completed, the merger will roughly double the size of HealtheConnections to include over 9,000 participating physicians from over 1,300 organizations across 3,300 locations in Central New York, the Southern Tier, and the Upper and Lower Hudson Valley. This merger will reduce the number of qualified entities––regional HIEs certified under the Statewide Health Information Network for New York (SHIN-NY)––to seven. Expect additional combinations, if not in 2019, soon thereafter
2. Data Aggregation and Value-Based Care Initiatives
Data analytics and reporting are important “next phase” use cases in HIE evolution. Two separate Comprehensive Primary Care (CPC) initiatives supported by the Center for Medicare & Medicaid Services (CMS) involving NYS HIEs in two regions began last year and continues in 2019. In addition to collecting CMS claims data, a key role of the HIE involves the collection of claims data from multiple private payors. HIEs are uniquely positioned to meet the requirements for data aggregation and to support reporting to and from providers, which is essential to the success of CPC and other value-based care initiatives.
3. Funding: Performance Incentives
In New York State especially, the focus for 2019 is on “bi-directional data” flow and data quality. While all hospitals and most practices in New York have joined an HIE, the majority of data exchange is to providers, including lab results, radiology, pharmacy data, etc. The flow of data from practices and, in some cases, hospitals, is less than optimal. While HIEs still receive funding for “core services,” an increasing percentage of each HIE’s funding will be based on meeting performance metrics relating to documented bi-directional data flow both to and from providers. HIEs from various regions in New York are actively reaching out to providers and their EMR vendors.
4. Cross-State Regional and National Data Sharing and Data Use
While data sharing within New York State continues to expand via the SHIN-NY, HIEs in New York have begun the process to connect with a regional Strategic Health Information Exchange Collaborative (SHIEC)-sponsored Patient Centered Data Home (PCDH). Each PCDH is organized regionally and represents the collaborative effort of participating HIEs to share data electronically, based on the recognition of the fact that patients often see health care providers in various states and regions serviced by different HIEs. In short, regional PCDHs facilitate data sharing among HIEs across state lines. The challenge is assuring compliance with all applicable state laws.
The HIEs in New York State are working with the NYS Department of Health to revise and clarify laws, regulations, and policies to loosen current limitations on patient data originating in New York for sharing across state lines.
Among the data-sharing initiatives facilitated by SHIEC-sponsored PCDHs are zip code-based alerts. For example, based on a patient’s zip code, a query initiated by the “away” HIE goes out to participating HIEs to see which HIE operates in that patient’s zip code. The “home” HIE responds and, depending on the level of HIE data sharing allowed under applicable state law and regulation and technological capability, the “home” HIE sends a reply with information relating to that patient. The “home” HIE may also alert the patient’s primary provider that their patient has presented for care in another state and may provide sufficient detail for the primary care physician for that patient and out-of-state emergency department to connect in real time, if needed.
These are just a few of exciting initiatives under way in 2019. More to come!
If you have questions regarding the content of this blog post, please contact Herb Glose, partner, at firstname.lastname@example.org or another member of the firm’s Health Care & Human Services Practice Area.