Much of the recent discussion around making interoperability a widespread success has shifted from technical standards and capabilities to business dynamics.
In its August report, Principles and Strategy for Accelerating Health Information Exchange and Advancing Interoperability, the Department of Health & Human Services puts it front and center: “Both providers and their vendors do not yet have a business imperative to electronically share person-level health information across providers and settings of care that exceeds the cost of doing so.”
And in the eHealth Initiative’s most recent survey of more than 100 established HIEs, “developing a sustainable business model” and “competitive positioning in the marketplace” outweighed “addressing technical barriers” as their top challenges.
This is all good news in terms of consensus that transport and content standards — from Direct to C-CDA to SOAP — are becoming accepted and integrated into health IT systems and that the level playing field of certified EHRs is the gateway to data exchange on that technical level.
These established regional and state HIEs have provided evidence in recent months that they are thriving through expanded exchange capabilities…announcing connections across state borders, with fire departments and EMS services, and even mental health facilities. Missouri Health Connection, for example (7,000 physicians, 62 hospitals and 350 clinics), says its ability to process 250,000 electronic transactions per day, including CCDs, is successful because of its ability to connect with certified EHRs that meet the requirements of meaningful use.
But what of the business model — for health IT systems or provider groups — to complete the portfolio on interoperability?
Embracing the ROI of Data Exchange
Competition will always ensue around innovation, usability and other proprietary aspects as it does in other industries. So, stopping short of framing EHRs and data exchange as commodities, how can providers — and EHR suppliers for that matter — embrace the return on investment of data exchange?
In the Principles and Strategy document (co-authored by HHS, ONC and CMS), a strategy by the world’s largest payer is proposing a carrot-and-stick approach over time: “A natural lifecycle of incentives followed by payment adjustments and conditions of participation in Medicare and Medicaid programs as HIE becomes an established enabler of patient-centered care delivery.” The document further states that this is an evolution from “incentive and reward structures to ultimately considering HIE a standard business practice for providers.”
CMS has already begun this path — certainly on the heels of meaningful use — by filling gaps such as enabling states to utilize Medicaid Federal Medical Assistance Percentages funding (FMAP) at a 90/10 matching level to support HIE.
And a broader message was sent within the new CMS Physician Fee Schedule proposal offering a complex chronic care management fee, but conditioned on the ability to electronically exchange a summary of care record with other providers to facilitate care transitions.
A Growing Business Case
Along with ACO, PCMH and many similar programs, the business case for incentives and payment based on a level of interoperability is growing. And no other motivation may outweigh the bipartisan U.S. House Energy & Commerce Committee proposal to overhaul fee-for-for-service (FFS) into a payment program also scored via care coordination.
But let’s look further, knowing that a good business model is planned around opportunity. The healthcare consulting firm Sg2, for example, predicts a three-percent decline in hospital admissions throughout the next five years, countered by a 17-percent growth in hospital outpatient services. That spells a need for more interoperability. Likewise, the Congressional Budget Office has lowered projections for future Medicare spending in part due to 70,000 fewer admissions in 2012.
Among other healthcare delivery models, a Rand Corp study found that consumers seeking care at drugstore clinics rose from 1.5 to nearly 6 million visits just from 2007 to 2009. This demonstrates another need for expanded interoperability on multiple levels, as these widespread and accessible clinics seek data exchange within their networks and to the external primary care physicians the store chains point out are still needed by their walk-in customers.
With ever-improved data exchange standards and consensus — and ever-increasing incentive programs — providers should come to understand that implementing data exchange offers a defined ROI. On the health IT side, offering integration over interfaces and exchange points matching data sets with the addition of analysis creates desirable solutions. And I would expect that collaborations such as the CommonWell Health Alliance send providers the message that the greater good of population health and sustainability are in the business plans of the supply side as health IT strives to solve common issues such as patient consent models that can streamline provider exchange. Put simply, sharing is caring!
The Bottom Line: Quality
So taken together, what’s the bottom-line business model — or, as HHS puts it, the business imperative — for interoperability?
Quality performance.
Quality is the key to incentives and future payments, penalty avoidance, better outcomes, patient volumes, patient satisfaction and being a desired care provider within ACOs as well as emerging payment and care delivery programs.
Interoperability is the means to that end.