In all the fuss about RHIOs, a few cynics have been quietly pointing out that as things stand in healthcare, there's no real incentives for plans and providers to make their data interoperable. And where there's no incentives for something to happen, it probably won't. So do RHIOs have a business model? No, at least according to an HHS-funded study by Avalere Health. Not one of the featured RHIO or HIE projects had, in their words, "established a sustainable business or financial model." And then there's the thorny issue of whether everyone can agree to use standards, especially a standard that someone else is using and they are not. "Some states are also struggling to gather providers and other commercial organizations' agreement on technology standards and win over their long-term support." Back in the mid-1990s, the CHIN movement had similar impetus and fell apart over incentives. Now the technology is more much advanced--no one had heard of the Internet then--but there are still few incentives to promote interoperability. Don't believe me; Brailer said as much when I saw him talk two years ago.
The incentives that prevent interoperability can and should be changed if we want to use that Medicare carrot/stick. But that would mean Congress taking on a litany of providers, payers and vendors. How Medicare dollars are used to impact change is where the real RHIO rubber will meet the road. - Matthew