HIEs save payers big bucks

A study of emergency-department visits conducted by Humana in the Milwaukee area shows that payers can save money if EDs have access to community health information exchanges (HIEs).

When ED clinicians queried patients' encounter histories in the Wisconsin Health Information Exchange (WHIE), the patients' visits cost Humana $29 less, on average, than did visits by patients whose doctors did not have the benefit of that information, the study found. Much of the savings came from a reduction in redundant testing.

The study, which ran from 2008 to 2010, involved 1,482 fully insured Humana members who sought care at 10 Milwaukee hospitals. The test group consisted of patients for whom the WHIE database was consulted during at least two ED visits; the database was not consulted for those in the control group, who also made at least two ED visits.

The researchers analyzed Humana's claims data to determine the ED costs for patients in each group. They found there were significant decreases in costs in four of five of the top ED-based procedures, including CT scans, EKGs, laboratory testing, and radiology, when ED physicians consulted the WHIE database.

An earlier study by the Medical College of Wisconsin showed that ED physicians using the WHIE data altered their workup or treatment 42 percent of the time, noted the Humana researchers. Moreover, the clinicians spent 42 percent less time gathering data than did those without access to the HIE data. And the time to the disposition decision decreased 50 percent of the time. 

"We plan to continue the collaboration between Humana and the WHIE; our study demonstrated that we gained an economic value," the study authors concluded. "We found that as payers invest in HIEs, they receive a positive financial return on their investment. Although these cost-savings realized by the health plan may be used in a number of ways, one option allows health plans to invest in HIE funding, thereby improving HIE sustainability." 

To learn more:
- see the study in American Drug & Health Benefits
- read the Healthcare IT News article