Virginia’s new data-sharing platform could be a peace offering in payer-provider battle to control ED utilization

Virginia has launched a single, statewide platform to connect 129 hospital emergency departments across the state, allowing physicians to access patient records and tap into the state’s prescription monitoring program.

In doing so, the state may have discovered one way to smooth over what has become an increasingly combative relationship between emergency physicians and payers over ED utilization.

Unveiled by Gov. Ralph Northam on Tuesday, Virginia’s Emergency Department Care Coordination program is a collaboration that stretches across providers, payers and state agencies aimed at controlling ED utilization costs and directing patients to the appropriate care provider.

“Near real-time, up-to-date information in an emergency department can assist healthcare providers in so many ways, from treating patients with chronic disease to knowing what medications to avoid prescribing to a patient with allergies,” Secretary of Health and Human Resources Daniel Carey, M.D., said in a statement. “When you have the right care and the right information in the right setting, you are able to make the best decision for the individual patient.”

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Salt Lake City-based Collective Medical is the technology partner that helped build the platform alongside the state’s health information exchange, ConnectVirginia. Collective Medical has launched similar programs in other states like Washington, but the willingness from the state’s prominent hospitals and emergency groups to collaborate with payers stands out, according to CEO Chris Klomp.

Anthem, which is currently facing a lawsuit from the American College of Emergency Physicians (ACEP) in Georgia over a recent shift in its ER claims policy, was among the first to be involved with the project, Klomp told FierceHealthcare.

“All the major payers the hospitals and their healthcare associations, plus several state agencies were all rallying to get behind this,” Klomp said. “It’s pretty extraordinary. And the pace with which its happened is pretty extraordinary.”

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Virginia began working on the EDCC program last year as part of legislation to redirect patients to the appropriate care setting as opposed to expensive EDs. In an April update (PDF) on the project, Debbie Condrey, the Virginia Department of Health’s chief information officer, said the program would reduce ED visits and decrease spending associated with high utilizers.

The total budget for the program for fiscal year 2018 is $3.9 million, which the federal government chipping in $3.5 million in HITECH Act funding.

The current rollout includes data from Medicaid Managed Care plans. The second phase of the program, scheduled to go live June 30, 2019, will build in information from the State Employee Health Plan along with Medicare and commercial plans. That rollout will also include downstream providers like primary care physicians, nursing homes and behavioral health providers.

In addition to helping providers better manage patients, care managers at the largest insurers will be able to use the data to preemptively divert unnecessary ED visits by offering lower cost services like telehealth visits or a same-day appointment at a nearby clinic. 

“The better version of just denying reimbursement for a patient is helping that patient not need to visit the ED in the first place,” Klomp said. “So, you’re not paying for a visit that didn’t need to happen.”