Benefits of Health Information Exchanges for Value-Based Care
An increasing number of healthcare providers and organizations are using health information exchanges (HIE) to not only exchange medical information but to also support value-based care. This practice is growing among healthcare providers because the need for quality data is growing and the HIE benefits aligned to these needs are significant. Below, we discuss several ways stakeholders can leverage HIEs to succeed in their value-based programs.
Benefits for Providers
Independent provider clinics may not have data that is fully reflective of a patient’s health and activity, particularly if he or she is seeking care from multiple facilities. HIEs offer alerts and notifications about admissions and discharges from hospitals and post-acute settings as well as other services to help providers see the patient’s activity across the care continuum. These capabilities also help providers align to CMS’ new Interoperability and Patient Access Final Rule.
Providers and groups participate in several value-based programs, like bundled payments, shared risk and capitation, as well as quality incentive programs, like Merit-based Incentive Payment System (MIPS), a system for value-based reimbursement designed to promote the ongoing improvement of clinical activities, and Alternative Payment Models (APMs), a payment approach that gives incentive payments for providing high-quality, cost-efficient care. HIEs directly support providers with these programs by providing quality measurement, dashboards, reports, care gaps, automated measure submissions and other resources to help reduce the burden and set them up for success with their value contract goals.
Benefits for Health Systems
Health systems and Accountable Care Organizations (ACOs) also have limited views of patient activity, which is overcome by comprehensive utilization data and the associated alerts offered by HIEs.
In addition, systems and ACOs are held to performance standards as delineated within their value contracts. Because of this, performing well on cost and quality metrics is of the upmost importance. HIEs offer the ability to reduce the reporting burden by being a CMS Qualified Registry (QR) or a Qualified Clinical Data Registry (QCDR). This includes alignment with CMS new APM Performance Pathway that is moving to requiring MIPS eligible clinicians and Medicare Shared Savings Program ACOs to report through a QR or QCDR. HIEs can also provide NCQA validated logic for electronic clinical quality measures (eCQMs) and HEDIS® measures to support the monitoring and improvement of the measures, in addition to other analytics like readmissions, high utilizer reports, condition registries, risk stratification and more.
Benefits for Public and State Health Organizations
With the current COVID-19 pandemic, public and state health organizations can leverage HIEs to better support citizens by tracking real-time insights for things like bed management, testing and vaccinations, high-risk populations, personal protective equipment, social distancing, case management and social mapping. With this renewed focus, HIEs are continuing to refine their value propositions in this space to address the persistent data obstacles and better track the variables that positively impact the health of communities.
Benefits for Payers
HIEs, particularly those that utilized electronic clinical quality measures (eCQM) certification in the past, helped relieve administrative burdens on payers by saving time and money. With NCQA’s emerging Data Aggregator Validation (DAV) program, HIEs will now be able to provide validated data (rather than just measures) to health plans as standard supplemental data for HEDIS® – eliminating the burden of primary source verification and making DAV-validated HIEs a go-to partner for HEDIS success. This is in addition to HIEs that provide near real-time clinical analytics and risk stratification to support outreach, care management and quality improvement initiatives.
It’s clear to see that HIEs offer several benefits for stakeholders. In addition to facilitating coordinated patient care, HIEs help healthcare providers and member organizations reduce duplicative treatments and avoid costly mistakes, which in turn equates to better quality care—and in today’s value-based care model, that’s worth everything.
To learn more about the benefits of HIEs, download our white paper:
The Indispensable Value of Health Information Exchanges.
About KPI Ninja
KPI Ninja is a data analytics company that helps healthcare organizations accelerate their quality, safety, and financial goals with a unique combination of software and service. We are differentiated by our signature mix of technology, performance management consulting and healthcare expertise. We don’t merely offer software solutions but work shoulder to shoulder with clients to help them draw on the power of analytics and continuous improvement methodologies to become more efficient. In harmony with our data-centered ethos, we truly believe that our success is strongly co-related with yours.