HealthcareITNews
Health information exchange helps medical group find success with value-based care
By: Bill Siwicki
Wes Combs is chief information officer at Holston Medical Group in Kingsport, Tennessee, which serves northeast Tennessee, southwest Virginia, and Charlotte, North Carolina. He’s also president of OnePartner Health Information Exchange, based in Duffield, Virginia.
The HIE was started by several doctors at Holston Medical Group as an investment to support and improve the doctor-patient relationship by making it easier for providers to see all instances of care for their patients, no matter where they were treated.
THE PROBLEM
“As a forward-looking and progressive healthcare organization, Holston Medical Group, one of the largest multi-specialty medical groups in the southeast, made the bet in 2012 that healthcare would make a transition toward value at a more accelerated rate than compared to the years prior,” Combs said.
The group is a company that saw the market for value-based care as an opportunity. However, in order to make the transition, the organization had to start thinking in the same terms as insurance companies, Combs explained. This required an approach to manage the highly complex patient population that consumes the majority of the avoidable healthcare dollars and how they can be addressed at alternative locations, he said.
“Holston Medical Group identified a data-driven approach as the answer to manage the risk these new payment models would bring,” Combs said. “At the time, in the Appalachia region, we had a failed Health Information Exchange and still used an outdated data transmission method – faxing.”
Understanding that this would not allow the group to be effective in the new model of care, it sought a vendor-agnostic solution that could be a safe place to aggregate and store patient data. This location had to be designed to efficiently keep patients’ records safe, protected and accessible for providers treating at the point of care.
PROPOSAL
“For any HIE or population health platform, the hardest part of the equation is the accessibility of data to the physician for treatment purposes when it matters the most – when the patient is sitting in front of the physician for an exam or checkup,” Combs explained.
“The reason is that this is the time when the physician has the ability to educate and inform the patient on care decisions that could potentially save their life or, time, frustration and money depending on the situation,” he said.
To leap the accessibility hurdle, OnePartner’s electronic health record agent removes physician barriers to review patient data in alternate systems, Combs stated.
“Some of these barriers, for example, require physicians to log-in to extra portals/systems and search patient records numerous times,” he explained. “It is made more difficult by the fact that the physician is also supposed to keep a running tally of quality and use measures in their head on each patient treated and somehow remember to use data from disparate systems to determine if the patient qualifies for the measure and has been screened properly in order to meet the measure.”
"The funding provided into the program allows value-focused organizations like Holston Medical Group to actually achieve savings on populations that otherwise would be considered healthy and funded or, compared under the benchmark."
An example of this challenge in practice can be illustrated by the review of external charts from an optometrist or ophthalmologist that might have performed a diabetic eye exam on a diabetic patient. If the physician can’t find a record, they are supposed to refer the patient for one of these exams. If the physician doesn’t do this, they are often penalized in the new payment model.
“The value of the OnePartner HIE is that it not only makes finding this information easier, but it also analyzes the data for the physicians, indicating at the point of care whether the patient does indeed need a particular screening and why,” he added.
MARKETPLACE
There are a great many healthcare information exchanges across the country that healthcare provider organizations can join.
MEETING THE CHALLENGE
In addition to improving accessibility of useful data for physicians, another factor in Holston Medical Group’s success moving toward value-based care comes from the ability to identify patients that are the highest risk or the sickest and reminding the physician to assess all current problems they are experiencing, Combs explained. These problems often are tied to hierarchical condition category codes.
