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Top Three Ways Health Information Exchange Benefits Payers

Health information exchange could play a significant role in reducing overall healthcare spending among payers and providers.

By Vera Gruessner

When health payers and providers utilize health information exchange, they will make significant gains in reducing healthcare spending, reducing duplicative testing and services, and improving their use of preventive medical services, according to Dan Paoletti, CEO of Ohio Health Information Partnership at CliniSync. In an interview with, Paoletti discussed how the use of health information exchange could fill in typical gaps in care, improve care coordination, and emphasize preventive services.

Value-Based Care Reimbursement

“Having access to information really goes back to managing coordination of care,” Paoletti said. “One of the most important things related to that is preventative care because, ultimately, this is about trying to keep people healthy. That’s how we’re going to manage risk by making that pool of healthy people bigger and reducing overall costs of care through that.”

“Being able to fill in gaps of care and making sure that those responsible for coordinating care - whether these are primary care providers, patient-centered medical homes, or managed care coordinators - have all the information they need to help fundamentally change some behaviors and habits to get people healthier,” Paoletti pointed out. “It really is critical to get the information where it needs to be in order to fill in the gaps that exist today. That’s what we’re trying to do and that’s where we’re headed on a larger scale.”

Before the advancement of health information technology and the sharing of data between medical facilities, hospitals, and payers, the healthcare industry had remained fragmented with little coordination and difficulties with communication between multiple providers and payers. Preventive care was far from a common strategy within the healthcare industry, but has become a more typical way for doctors to improve the health of their patient base in recent decades.

While incorporating health IT tools and systems capable of health information exchange throughout a medical facility and between payers-providers does offer real solutions to the problem addressed, there are certain challenges that may occur when sharing medical data. For instance, the health information may not be up-to-date or a facility may lack the security protocols needed to ensure the privacy of patient data.

READ MORE: How Payers Could Improve Population Health Management with Tech

“We’re finding ourselves in a role to help facilitate the conversations, as everybody is trying to transition to value-based care and trying to create an environment where people feel comfortable coming together - the health plans and provider groups - to talk about what we need to do today and in the future,” Paoletti related. “We are moving information and notifications to care coordinators. Health plans especially Medicaid and managed care plans need access to better demographic data so they have information, phone numbers, and addresses to contact the patients.”

“A lot of times what they receive from Medicaid or the Medicare program is not up-to-date or accurate,” Paoletti claimed. “Being able to give the managed care coordinators more timely information so they know what’s going on with their covered lives is important. Also, we’re facilitating conversations about how the health plans and the care coordinators can work with the providers in the community, the same ones who may be setting up ACOs themselves. Instead of potentially getting in each other’s way, we facilitate  how best we can work together for the patient.”

Paoletti also discussed the need to do more to support bidirectional flow of information between payers and providers, which has often been a challenge in the past.

“It’s also important to talk about better bidirectional flow of information between two organizations and while we’re beginning to do that with some direct functionality and other technical capabilities, there’s a lot more that can be done in making sure everyone has the information they need to work together to coordinate care,” he stressed.

Rebecca Little, the Vice President of Business Development at Medicity, told some of the potential solutions that health information exchange brings to the problem of fragmented healthcare. Secure messaging and real-time data has brought more value to the medical industry.

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“One of the things that we’ve seen that has made a substantial difference is being able to use capabilities like secure messaging via DIRECT to connect together the folks involved,” Little explained. “In two high-level scenarios, as patients transition from one site of care to another as well as the ability to bring real-time information for a specific set of high-risk patients.”

“For example, we have been working collectively on a project with the Cleveland Clinic to use technology to connect to the scale in the patients’ home for congestive heart failure patients and then to use that capability to transmit the data from the scale as well as other clinical information to the care managers, whether they are Aetna care managers or those at the clinic,” noted Little. “That’s one place that we see value. The other place that we see value is to be able to bring notifications to the care managers for patient populations where risk is involved. Enabling organizations to know when their patients are in the emergency department to help direct them to a better or more appropriate site of care, or to engage quickly in follow-up.”

The solutions that health information exchange could bring whether through remote monitoring tools or real-time notifications of emergency room visits could all lead to a reduction in healthcare spending, greater use of preventive care, and fewer duplicative testing, explained Paoletti.

“I think what will result [from health information exchange] will be a reduction in spending both because ultimately, it will increase preventive care but also realistically we will have a reduction in tests and duplicative services because the information will be available,” Paoletti asserted. “It’s hard to put a dollar figure on that, but we think there’s some tremendous opportunities to that. We’re just in the very beginning of facilitating that type of benefit to the community.”

Little also mentioned how health information exchange would bring better physician decision-making around diagnostics and medical interventions.

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“There’s a lot of evidence that if the right person has the right information at the right time, they can make better decisions and choices around diagnostic testing if certain tests were performed previously and intervention as it relates specifically to emergency department overutilization. We see a lot of value there,” Little explained.

“The model will be very different over time. In many places across the country, hospitals see the benefits of those kinds of savings as they move into value-based and risk-based contracts,” she said. “Preventing duplicative testing, preventing admissions, and preventing emergency room utilization when unnecessary are all part of value-based care and data exchange could assist with these goals. It will be very interesting as we see the model beginning to shift more into risk-based contracting.”

In addition to these points, Paoletti provided some advice for why health payers and providers should transition to value-based care and implement health information exchange tools. There are three major ways that health information exchange reduces medical spending and eases administrative burdens: chasing data, care coordination, and filling in gaps in care.

“The number one thing is chasing data. The amount of money, time, and resources it takes for everyone, health plans and providers to chase data is a lot. The number one thing that we hope to solve through this is really be able to use the resources for more important things such as helping patients navigate the system and helping them be healthier,” he continued.

“The second thing it comes down to is coordination. This means not creating duplicative efforts around information. The final point is starting to fill in the gaps of care as well as promoting preventive care, health and wellness,” Paoletti concluded. “This means making sure patients are doing what they need to be doing to maintain a healthy lifestyle.”


Dig Deeper:

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How Healthcare Information Technology Boosts Member Engagement


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