How information is connecting all types of healthcare data to make a difference

By Bill Thornburg and Paul Lagasse

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

“Advanced Analytics models can be the linchpin to defining an HIE value proposition centered on improved patient outcomes.”

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 all stakeholders take better care of patients and reduce costs - by providing the evidence-based medicine (EBM) insights necessary to develop intervention programs, do community outreach, measure performance and compare providers.

The Ingenix HIE Gateway Model enables HIEs with administrative transactions 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 HIE Gateway Model yields solid returns to fund HIE operations by supporting administrative transactions. However, to fund, grow and achieve sustainability, HIEs will need to provide value beyond basic exchange. By offering Advanced Analytics services as a value-add service in addition to administrative transaction exchange services, HIEs can transform existing electronic information into useful, actionable data to improve outcomes and provide physicians with the tools needed to care 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, or if the patient is current on tests, and compliant with their medication," explains Paul Lagasse, Senior Director, Solution Architecture, Ingenix.

Advanced Analytics provides 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 healthcare resources, and assess physician care delivery within a network.

Using Advanced Analytics to help render HIEs sustainable is a win-win situation because in providing stakeholders with actionable information that improves care, HIEs are creating a service that has distinct market value.

For example, in our recently published white paper, Formula for Long-term HIE Sustainability, Better Healthcare. The HIE Gateway Model, Part II: Return Model for HIE Value-Add Advanced Analytics Solutions, we look at three common chronic conditions 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 in the model. By knowing which diabetics are not conforming to EBM guidelines, physicians can help bring a patient into compliance, savings millions and improving long-term health. This model demonstrates value and provides a basis for cost coverage necessary for an HIE to deliver value-add services.

Advanced Analytics Solutions can help providers demonstrate that they have achieved "meaningful use" of healthcare technology, compare outcomes and develop performance-based programs, 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.

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 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 Healthcare, The HIE Gateway Model, Part II: Return Model for HIE Value-Add Advanced Analytics Solutions.

Biography

Paul Lagasse is Senior Director, Solution Architecture for Ingenix. 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 is Vice President, Product Management, Health Management Solutions for Ingenix. 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 healthcare, datacenter operations, software development tools, computer peripherals and electronic publishing.