Slashing funds for HIE access may actually prove more costly

Missouri Gov. Jay Nixon last week vetoed a $500,000-line item from the state budget that would have funded data sharing between the state's department of social services and its health information exchange (HIE), Missouri Health Connection (MHC).

At the same time, new research reports that easy data sharing between New York City's immunization registry and clinicians' EHRs "significantly" improved the vaccination rates of children.

At first glance these two news items don't have much in common.

But they do; we're talking about Medicaid.

The New York study focused on children being treated at community clinics in the Bronx and northern Manhattan that are primarily insured by Medicaid. Most of the vaccines administered were paid for by the federal Vaccines for Children Program because the families can't pay for them themselves. One can just imagine the illnesses prevented by these immunizations, which included flu shots, the measles/mumps/rubella vaccine, tetanus, chicken pox and meningococcal vaccine. Since many of these immunizations are also required for school attendance, they have an even larger impact on these children. The study itself notes that this data exchange allows "scarce resources to be targeted" to those who need it.

Compare that to what happened in Missouri. The $500,000 would have enabled social services to connect long-term care and behavioral health providers to the HIE to help out Tier One safety net hospitals serving Medicaid patients. Nixon vetoed the funding on the grounds that it was unfair to exempt the long-term care and behavioral health providers from paying for HIE access.

I can see his point, in a way. Giving free access to only long-term care and behavioral health providers seems unfair to other providers who may also have trouble paying to participate in the HIE and would benefit from the assistance.

However, it seems short sighted. Providing long-term care and behavioral health providers with access to the HIE to help provide care coordination to Medicaid patients seems like a smart, practical idea. Preventing disease or treating it early is not only good medicine, it's less expensive. And EHRs alone can't seem to handle the integration of this data.

In addition, many physicians who treat primarily Medicaid patients can participate in the Meaningful Use program and receive incentive payments for adopting EHRs and electronically exchanging data. Long-term care and behavioral providers cannot.

Moreover, the New York clinics were able to obtain immunization information because they were lucky enough to be affiliated with a hospital with registry access. But many clinicians, especially safety net or ancillary providers, may not have that resource.

Perhaps the Missouri approach was less than ideal. Maybe the funding should have been earmarked for a broader array of providers, or a smaller amount of money used as a pilot to see if free access helps.

But a blanket veto? When it's clear that this data exchange improves care for Medicaid patients? Sounds penny wise but pound foolish.

I hope Missouri takes another look at how supporting data exchange can help treat patients in the Medicaid program. It's not only good for population health, it probably pays for itself in the long run. - Marla (@MarlaHirsch and @FierceHealthIT)

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