HIE use financially benefits payers and providers

Participating in a health information exchange (HIE) can produce net financial gains for both providers and payers, according to a new study published in the Journal of the American Medical Informatics Association.

The researchers, from the University of Wisconsin-Madison, studied 4,639 emergency department (ED) encounters in three large EDs in Milwaukee over a 12-month period to see if the data access available through an HIE would prevent unrequired hospitalizations, reduce duplicate tests and prevent ED visits.

They concluded that accessing patient data of others via the HIE created "net gains" both for providers and payers; reducing unrequired hospitalizations and avoiding repeat ED visits were responsible for more than 70 percent of the savings.

The study noted that payers enjoyed greater financial benefits in decreased reimbursements due to reductions in tests, hospitalizations and ED visits. However, providers also saw a seemingly counterintuitive financial benefit. While they received less compensation for seeing fewer commercial fee-for-service patients, the loss was offset by reduced expenditures on a much larger group of Medicare and Medicaid patients, where reimbursements are considerably lower.

"HIE participation yielded financial benefits to all agents by enabling better care for patients who are high-volume users of the ED," the authors said.

The study also looked at how the subscription pricing structure for accessing the HIE's data could affect its sustainability. The researchers suggested that a flat annual fee may be preferable, but that was based on the unique study population, meaning more research was necessary. They also recommended that "[i]nstitutions considering participation in an HIE should examine how the cost of additional services, such as case management, could affect the financial bottom line," they wrote.

Other studies have found that the sharing of data via an HIE and other methods can reduce unneeded repeat tests and overuse in EDs, as well as enable patients to be treated in other, less expensive settings, providing better care and reducing costs.

To learn more:
- here's the abstract
- read the full report (.pdf)

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