Solving the challenge of transforming to a value-based system

Health Information Exchanges, or HIEs, are essentially hubs for the sharing of clinical and administrative data across the boundaries of healthcare organisations, data centres, and the healthcare community. HIEs have proven to have significant long term benefits not just for care facilitators but also for the patients themselves. Numerous studies have gone into exploring the potential for HIEs to positively impact the delivery of quality healthcare. 

The benefits of HIE systems are many, and evident across many different groups. Patients are likely to experience significant improvements in their quality of care and security around their healthcare record. Facilitators benefit from improved lines of communication among providers, which can lead to decreased health care costs; this in turn can greatly boost efficiency and effectiveness of treatment and care delivered. With improved communication and data sharing, researchers and government organisations can gain improved access to public health data. This enables informed decision making about population health needs and the tracking of important data and patterns. This is just a small snapshot of some of the ways various groups benefit from centralised data repositories and HIEs, but some of these long term benefits are worth unpacking.

1. Improved access to data and patient health information (PHI). Convenient access to PHI in real time, at the point of care, has immense benefits to improving the overall quality of patient care. Providers and clinicians benefit from improved data access and can make more informed decisions about diagnostics and treatment plans. At the same time, they’re also feeding back critical information into the system for others to make use of later. Anonymised PHI can also be indispensable for healthcare and population health researchers.

2. Improved population health and healthcare outcomes. All of the above has measurable benefits on the health and wellbeing of patients. Not only do they benefit from more informed healthcare providers, they can also enjoy the long-term social benefits of better access to patient health statistics which will help local and state governments make better decisions about public health legislation and funding. This in turns facilitates “fence-at-the-top-of-the-cliff” types of preventative care models which can then influence best practise guidelines and care delivery models.

3. Secure and convenient inter-organisational collaboration. HIEs are enabling providers to communicate and share information in a secure fashion that not only benefits the patients, but also the care team as well. Building care around the patient rather than the more often decontextualised individual consultations, can lower costs associated with patient care, reduce clinical workloads and greatly improve long term population health outcomes. HIEs have also highlighted some issues around standardisation of medical data that have warranted addressing and the development of improved ways to reliably and securely exchange information between systems.

The concept of an HIE has been around in some form for over 30 years. They were initially built from the idea that a patient’s longitudinal record could, and should, eventually become available for reference at the point of care. The goal was primarily for using aggregated clinical data to improve current healthcare models, which by extension would improve patient outcomes. Since then we’ve discovered many ways to make use of these patient data repositories. However, despite the many evident benefits, HIEs are still not universally adopted or utilised. HIE initiatives are continuing to leverage information and analytics to improve decisions around care planning and treatments. Now we want to update continuously in real time any changes to an individual’s health record, in order to increase uptake of the HIE model across the globe.

In Canada, Alberta has a solid example of a successful HIE implementation called Alberta Netcare, which has been in production since March 2006. Results taken in June 2016 showed there are 51,000 users, including approximately 5,000 concurrent users at any given time, servicing a population of over 4.1 million people. On average, 1.9 million patient records are accessed per month via the HIE.

Alberta Netcare helps to solve the issues of a healthcare system moving from episodic care and fee-for-service reimbursement to a value-based reimbursement system. Previously Alberta had physicians treating sickness and symptoms, which failed to manage the overall health of patients and populations. Providers know that managing population health proactively is a superior approach to reactively treating symptoms and sickness, but there is little to no understanding of risk management across populations, no incentive to care, and no agreement on the distribution of services across healthcare systems.

However, as payment and delivery models are changing, so do risks. Under a fee-for-service system, providers bear little risk because in ordinary cases, their care and treatment activities will be reimbursed. Their main data-related activity is to record patient encounters in enough detail to justify the services that are billed. Under a value-based reimbursement system, providers’ compensation is not directly linked to services provided, so they take on the risk of determining the most cost-effective methods of keeping their patients healthy. A richer set of tools is required to help providers focus on identifying patients that need care – either as a preventive measure or because their health is trending negatively.

It is well understood in the healthcare industry that value-based reimbursement systems bring many health outcome benefits, but there remain many complex obstacles that make meaningful change difficult and uncertain. While complex, the problem can be summarised as: “lack of shared information, insights, and plans that prevent collaboration, coordination, communication, and effective care delivery.”

Alberta Netcare is a solid example of a healthcare system that has already encountered the challenges of transforming to a value-based reimbursement system and has executed changes that have resulted in measurable improvements in their population’s health. Download the white paper to learn more about this successful HIE.