California insurers are building a massive health information exchange (HIE), but so far only one healthcare system is interested in participating
Healthcare Big Data is big business. But it requires large databases with complete records of many patients, including their medical laboratory test results. That’s why two big California insurers would like to build such a data warehouse, however, hospitals and physicians are wary of feeding their patient data into an insurer-organized HIE. Why? Because he who holds data, holds power.
Thus, doctors in California don’t want to give that power to health insurers. Meanwhile, hospitals and health systems in the Golden State that operate accountable care organizations (ACOs) want to protect their own ability to serve patients.
The HIE that is struggling to collect the patient data it needs to be successful is the California Integrated Data Exchange (Cal INDEX). Founded in 2014, it is an independent not-for-profit organization that was created by Anthem Blue Cross and Blue Shield of California—the second and third largest insurers in the state. According to their statement, the two organizations intended to build a statewide health information exchange (HIE) based on electronic patient records that include clinical data from healthcare providers and health insurers.
By the end of 2014, Cal INDEX expected to be “providing physicians and nurses with secure, online access to approximately nine million health information records—or nearly one-fourth of the state’s population,” the statement declared.
Providers in California More Reticent than Ready for HIEs
Is it true that California’s hospitals and physicians are reticent to participate in the Cal INDEX HIE? If so, should pathologists and clinical laboratory managers in the Golden State be equally cautious as well?
Since lab data makes up 70% to 80% of the typical patient’s permanent health record, medical laboratories clearly have a stake in how these healthcare “Big Data” databases are put together and who controls access to the information.
Note also, that providers would have to pay to access the data in Cal INDEX of those individuals who are not their patients. Thus, if a person ended up in an ER—and that hospital had no prior healthcare data on that individual—the hospital would have to purchase that data from the Cal INDEX.
That’s why, who controls the data and how much providers must pay to access it, are just two of the difficulties Anthem and Blue Shield are having as they attempt to recruit more hospitals and health systems.
California Insurers Motivated to Reduce Expenses
By reducing duplicate clinical laboratory tests and imaging procedures, Cal INDEX expects to reduce provider medical expenses by 2% to 3%, according to the Modern Healthcare article.
“For a long time, payers were reasonably comfortable with the data they got via their claims, which is very structured. As payers have become more engaged in healthcare by helping to manage complex patients, their appetite for data has grown,” stated David Watson, CEO of Cal INDEX, in a Managed Care article.
Cal INDEX currently provides participating health professionals online access to about nine million health information records that cover three years of claims data. The database size at launch represented about 25% of the state’s 39 million population, as listed by the U.S. Census Bureau’s 2015 report.
“We’ve been doing outreach to payers and providers since mid-year last year. But our challenge is that we’re not closing on providers as quickly as we wanted to,” Watson stated in the Modern Healthcare article.
The only participating healthcare organization, Dignity Health (Dignity) of Sacramento, Calif., has 9,000 physicians and 59,000 employees. Dignity initially connected five Sacramento-area hospitals to Cal INDEX. Dignity plans to eventually involve all 32 of its California facilities, according to a statement.
“Our participation in Cal INDEX will give clinicians access to more comprehensive historical patient information, enhancing our ability to deliver high quality care in cost effective ways,” declared Lloyd Dean, Dignity Health’s President and CEO, in Becker’s Health IT and CIO Review.
Providers like Dignity Health pay a per member, per year fee to Cal INDEX. But the exchange leaders want to simplify and change the HIE’s pricing structure to a single fee-based model, noted Modern Healthcare.
Is There Hope for HIEs?
The future may brighten for private HIEs like Cal INDEX. About 72% of multi-provider networks and hospital systems said last year that they are considering private HIEs for standardized sharing of patient data, up from 33% in 2013, according to a Black Book Research statement.
Clinical laboratory data make up the largest portion of an insured patient’s record, which means it is a big target. As the developers of Cal INDEX pointed out, reducing duplicate and unnecessary medical lab tests is a goal that is high on its radar. So, it follows that the development of HIEs, albeit slow, deserves the attention of clinical laboratory executives.
—Donna Marie Pocius