Providing near-real-time notice when patients visit the emergency room might be more useful and cost-effective initially than a full-fledged health information exchange, according to a case study presented by the Agency for Healthcare Research and Quality.
The Indiana Health Information Exchange (IHIE), one of the nation's largest, provides health plans and Medicare-chartered accountable care organizations with alerts within 24 hours when a member visits the emergency room or is admitted to the hospital. In a pilot test of near real-time collection of admission, discharge, transfer (ADT) messages, a managed health plan was able to reduce non-urgent emergency department visits, replacing them with lower cost primary care visits--saving money while providing more coordinated care.
For instance, by using data from the ADT project showing significant "leakage" to non-network facilities, it's helping health plans and ACOs to understand why members go out of network for care and to address issues such as insufficient specialists or facilities in certain areas.
Among its lessons learned from this ADT project is that program leaders should avoid the "build-it-and-they-will-come" approach. Author Curt Sellke, the IHIE's vice president of analytics, advocates soliciting feedback from potential users to find out how information from multiple data sources could be collected, analyzed, combined, and transmitted in ways that would be useful to them.
It takes work to sell hospitals that might compete with each other on the benefits of cooperation, but those benefits can include avoiding Medicare penalties for readmissions and the potential to better manage the health of the member population.
Client organizations have to see the value of the data provided by the program, so monitoring and sharing information about reduced ED visits and cost savings is important, Sellke writes.
"There must be a laser focus on the value proposition and sustainability of each service that HIEs are providing," Keith Kelly, IHIE vice president of professional services, told FierceHealthIT in its eBook "Key Lessons in Health Information Exchange."
IHIE has made predictive analytics software available to ACOs and hospitals across the state and spun off a for-profit subsidiary aimed at monetizing software licensed from the Regenstrief Institute for use outside the Hoosier State.
To learn more:
- find the case study