Information is the lifeblood of health care

Even though health information exchange (HIE) promises to reduce health care costs, improve efficiency, and enhance quality of care, few organizations have been able to achieve long-term sustainability.

“Advanced Analytics Solutions can provide information to physicians about recommended tests, if the patient is current on tests, and compliant with their medication—all at the point of care.”
-Paul Lagasse, Senior Director, Solution Architecture, Ingenix

To deliver on those promises, HIEs need a business model that can demonstrate a solid return on investment and financial stability. Advanced Analytics models can be the linchpin to defining an HIE value proposition centered on improved patient outcomes.

With Advanced Analytics Solutions, HIEs can help providers, hospitals, payers, employers, governments, and additional stakeholders take better care of patients and reduce costs-by providing the evidence-based medicine (EBM) insights necessary to develop intervention programs, conduct community outreach, measure performance, and compare providers. HIEs can then establish a fee for Advanced Analytics services based on the value derived from the analytics for their community.

The Ingenix HIE Gateway Model enables HIEs with administrative transaction exchange capabilities to capture the revenue typically associated with administrative exchange into a funding stream for the HIE to support the build-out of the clinical exchange infrastructure. The HIE Gateway Model supports sustainability because it eliminates redundant data exchange services for administrative transaction services and reduces fees paid by physicians.

"The use of administrative and clinical transactions together makes the system more efficient and provides a single point of data aggregation so analytics can be applied efficiently and effectively from the start," according to Kepa Zubeldia, M.D., Senior Vice President, Interoperability Technologies, Ingenix.  

The HIE Gateway Model yields solid returns to fund HIE operations by supporting administrative transactions such as HIPAA transactions. However, to fund, grow, and achieve sustainability, HIEs will need to provide value beyond basic exchange. By offering Advanced Analytics as a value-add service, HIEs can transform existing electronic information into useful, actionable data to improve outcomes and provide physicians with more useful tools to employ when caring for their patients within that HIE community.

Advanced Analytics Solutions capture raw data from disparate sources and databases and transform those data into information and insight that can be used to assist the clinical team in making informed choices at the point of care. "Advanced Analytics services can provide information to physicians about recommended tests, if the patient is current on tests, and compliant with their medication," explains Paul Lagasse, Senior Director, Solution Architecture, Ingenix.

Advanced Analytics Solutions provide care management professionals with transparent predictive modeling, EBM, and tailored clinical and business rules to identify, stratify, and assess patients' health status. This information and insight enables physicians and clinical teams to identify gaps in care, support and design new programs, initiate new interventions, understand patients' comprehensive use of health care resources, and assess physician care delivery within a network.

Using Advanced Analytics services to help render HIEs sustainable is a win-win situation for both stakeholders and HIEs, because in providing stakeholders with actionable information that improves care, HIEs are creating a service that has distinct market value. Other health care organizations are showing solid returns from the use of analytics for care measurement, care gap analysis, disease management programs, and related activities. Combining a successful fee-based information exchange with the powerful value-added analytics capabilities will result in HIEs that can sustain themselves over time and provide significant strides toward more informed decision making at the point of care.

Advanced Analytics as a value-add service can provide ongoing value to stakeholders and an additional revenue stream to HIEs, helping them to achieve long-term sustainability. "Value derived from analytics is worth paying for," Zubeldia said. "The payments are quickly offset by healthier patients and better outcomes."

For example, in our recently published white paper, Formula for Long-term HIE Sustainability, Better Health Care. The HIE Gateway Model, Part II: Return Model for HIE Value-Add Advanced Analytics Solutions, we look at three common chronic conditions (Coronary artery disease (CAD), congestive heart failure (CHF), and diabetes) and show that for diabetes alone, the total potential saved if all gaps in care are closed could mean upwards of $12 million in savings for the community used in the model. By knowing which diabetics are not conforming to EBM guidelines, physicians could take proactive steps to help bring a patient into compliance, savings millions and ensuring better, long-term health. The model shows a total potential of $12,577,120 saved if all gaps are closed in the CAD example. This model can be used to demonstrate value to the HIE community and provide a basis for cost coverage necessary for an HIE to deliver value-add services.

"The Ingenix Advanced Analytics Model demonstrates how a quite low close rate on EBM gaps in care can cover the costs of analytics, which every HIE will be able to attain," according to the developer of the model, Bill Thornburg, Vice President, Product Management, Health Management Solutions, Ingenix.

Advanced Analytics services can also provide specific value to providers because they can help providers demonstrate that they have achieved or exceeded "meaningful use" of health care technology under ARRA provisions that incent physicians to install and use electronic health records (EHRs). HIE analytics can help physicians compare outcomes and develop performance-based programs or new models for compensation, improve patient and beneficiary outcomes using population-based programs, lower costs by targeting treatment to the highest-risk populations, identify public health concerns to contain and stop the spread of contagious disease, and develop concrete data as a source for discussion regarding cost variations for specific treatments.

Advanced Analytics services help HIEs and all health care stakeholders use existing data to improve patient health outcomes and cut health care costs. Ingenix provides industry-leading EBM-based tools and episodic groupers that enable analytical insight. The Ingenix Advanced Analytics "tool box" includes proven, sophisticated analytics tools that allow HIEs to deliver valuable information to employers, hospitals, and payers.

"One HMO used Advanced Analytics Solutions to target the specific HEDIS quality measures they needed to improve their pay-for-performance scores," Lagasse said. "In the process, they identified gaps in care and developed tools to improve those scores."

Advanced Analytics Solutions delivers actionable insight that leads to improved outcomes and lower costs-the keys to sustainability.

Learn more about the HIE Gateway Model at www.ingenix.com/hie.

Download our new white paper, Formula for Long-term HIE Sustainability, Better Health Care, The HIE Gateway Model, Part II: Return Model for HIE Value-Add Advanced Analytics Solutions.

Biographies

Paul Lagasse, Sc.D.

Senior Director, Solution Architecture, Ingenix

Paul Lagasse is a subject matter expert in the Ingenix Health Management Solutions group. Using a variety of analytic tools to collect, analyze, assess, and report on data from multiple sources, he helps clients develop comprehensive solutions to identify actionable opportunities for improvement in both quality and utilization. 

Bill Thornburg, M.B.A.

Vice President, Product Management, Health Management Solutions, Ingenix

Bill Thornburg leads the product development for the Health Management Solutions business at Ingenix. He has over 20 years of experience in software product development, management and marketing, including commercialization of software products for health care, datacenter operations, software development tools, computer peripherals, and electronic publishing.

Kepa Zubeldia, M.D.

Senior Vice President, Interoperability Technologies, Ingenix, and Sr. Ingenix Fellow

Dr. Kepa Zubeldia creates strategies for the industry's next generation of health care information exchange. Zubeldia helped establish the nation's first commercial provider of HIPAA EDI compliance testing and certification services and led the development of pioneering health care transaction management, connectivity and information exchange technologies.