By Scott Afzal, President, Audacious Inquiry
Healthcare costs per capita in the United States are increasing at an alarming rate. Overall spending reached $3.8 trillion in 2019. Between $760-$935 billion of the overall cost of healthcare is attributed to waste, overtreatment, low-value care, and failure of care coordination.
As the healthcare system becomes more complex, payers, health systems, and providers are increasingly recognizing the important role that Health Information Organizations (HIOs) play in health data exchange – leading to more coordinated care, improved clinical outcomes, and reduction in the total cost of care.
Audacious Inquiry has partnered with HIOs across more than a dozen states for over a decade to develop successful and sustainable revenue models for health data exchanges at both the federal and state level. In the white paper “Improving Patient Outcomes and Driving Revenue in a New Era of Value-Based Care,” the company shares insight into the current state of HIO funding, how HIOs are driving value-based care, and successful examples of revenue models that support long-term HIO sustainability. Here are a few key takeaways.
Current State of HIO Funding
Currently, HIOs are facing funding pressure due to the recent expiration of funds offered by the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act. For context, a HITECH-eligible project costing $1 million would receive $900,000 from CMS, leaving a $100,000 difference to cover via funding from the State or other sources. By comparison, if that same project took place today, the State or other sources would now be responsible for $820,000—more than eight times the funding amount needed under HITECH. In order for HIOs to thrive in the post-HITECH era, they must adopt self-sustainable revenue models to survive.
Benefits HIOs Bring in Value-Based Care
As the healthcare industry moves away from fee-for-service towards value-based care, HIOs will play a critical role. HIOs provide managed care organizations with access to rich patient data sets and real-time information that support value-based care success. Examples of improved patient outcomes driven by HIO care coordination platforms include:
- Real-time alerting to help identify unnecessary emergency department visits
- Reduced gaps in care due to proactive follow-ups with patients during transitions of care
- 4.5 percent reduction in emergency department re-admissions within 30 days of discharge due to coordinated follow-ups from care managers
In an industry rife with barriers to patient data exchange, HIOs represent one of the few levers available to healthcare stakeholders looking to proactively drive targeted care interventions that support population health objectives. HIOs enable this by offering care teams a unified view into patient data factors culled from otherwise disparate systems. Ensuring the long-term viability of these organizations is vital to facilitating timely and accurate health data exchange for improved care coordination and enhanced interoperability.
Optimizing Successful Revenue Models
To ensure HIOs remain sustainable in the post-HITECH era, they must adapt revenue models that safeguard their financial stability. Subscription-based patient encounter notification services have enabled some HIOs to achieve a high degree of sustainability. Health plans and at-risk providers—both those participating in capitated or shared savings models and those operating under fee for service plus arrangements—are satisfied paying the fees associated with these services because of the instrumental role they play in driving increased revenues, cost savings, and improved outcomes.
Long-term sustainability models for HIOs do not have to be a one-size-fits-all solution, but instead can be tailored to meet the HIO’s technological needs, health initiatives, and regulatory parameters. There are several options available, all of which are detailed in the white paper “Improving Patient Outcomes and Driving Revenue in a New Era of Value-Based Care.”
Download the whitepaper today to learn more about leveraging HIOs to advance value-based care, improve quality, and enhance reporting and data analytics.
About the Author
Scott Afzal is the President of Audacious Inquiry and a Strategic Advisor for CRISP, a health information exchange serving Maryland, DC, and West Virginia. Across both roles, Scott establishes organizational growth strategies, delivery system reform initiatives, and technology solutions to support value-based payment models and connected communities.