Despite connectivity and collaboration being key to the success of specialist provider organizations, health information exchange between provider organizations and health plans is possible but difficult. That was my big takeaway from the townhall session, Health Plan/Provider Data Exchange In Pay-For-Performance: A Town Hall Discussion On Meeting The Connectivity Challenge, at The 2019 OPEN MINDS Performance Management Institute.
In this session, we learned that there is a reason that less than half of provider organizations have health information exchange (HIE) capabilities (see The Dismal State Of Data Exchange and HIE 3.0?). The faculty – moderator OPEN MINDS Senior Associate Joseph P. Naughton-Travers and featuring Monica Collins, Senior Director, System Transformation, Magellan Behavioral Health of Pennsylvania; William Camp, MBA, Operations Compliance Manager, Tri-County Human Services; and Jaclyn O’Donnell, Executive Vice President, Credible Behavioral Health Software, outlined three key impediments to bringing HIE to scale: lack of a uniform behavioral health datasets, coordinating data exchange with multiple EHRs; and the cost to provider organizations of creating data exchange relationships with other providers and with health plans.
Lack of a uniform behavioral health dataset—From a tech standpoint, this is a major obstacle. Many organizations will have to navigate a market where everyone else either has a different electronic health record (EHR) system, or a unique data set, or both. Ms. O’Donnell noted:
We find that organizations are all different. The technology isn’t the hard part. Everyone has different connections and they define it all differently. It’s hard to build scale when you have a unique data set. Fast Healthcare Interoperability Resources (FHIR) would be a good step, not as a cure all but it’s a step.
Coordinating data exchange with multiple EHRs—This is a primary concern from the payer side. For many in the field, the dream is for two-way data exchange, so that both sides have the access to the data they need, when they need it. But the logical extension of this is to makes sure that multiple data sites can exchange information the same way. Ms. Collins commented on the challenge:
For me, working with provider organizations means we truly want to share two-way data, but it’s tough with different EHRs. It’s the cost of connecting those pieces. Then, with a smaller data set like scorecards, confidentiality becomes a barrier. The most important thing is that none of these barriers are necessarily a show stopper. For the most part we can share enough data to move things forward.
The cost to provider organizations of creating data exchange relationships with other providers and with health plans—From the provider organizations standpoint, this is a serious consideration. What are the dollars and how much time will it take to hammer out the negotiations and build the necessary trust? Furthermore, what is the cost of the tech to make these relationships work? Mr. Camp noted:
It must start at the provider organization level to get that data exchange started. And it must start at the chief executive officer level. From the provider organization side, we need to make it a top strategy, and then put the resources to it.
For more on HIE, check out these resources from the OPEN MINDS Industry Library:
- How Can We Improve Behavioral Health Data Exchange? The Challenges & The Opportunities Of HIE
- Without HIE, Participation In ACOs Is Limited
- HIE – In The Works In Los Angeles
- Stop Integrating Data & Start Liberating Data
- HIE Not Only Improves Efficiency – It Saves Lives
And be sure to mark your calendar for October 28-30, when we will host The 2019 OPEN MINDS Technology & Informatics Institute at the Loews Philadelphia Hotel. This year’s institute will focus on tech tools executive teams needs to move their organization from the concept of value-based reimbursement, to success in the new financial normal.