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Posted: February 17th, 2022

The role of health information exchanges in value-based payment models

The role of health information exchanges in value-based payment models

Health information exchanges (HIEs) are networks that enable the secure sharing of health data among different health care providers, such as hospitals, clinics, pharmacies, laboratories, and public health agencies. HIEs can facilitate the coordination of care, improve the quality and safety of care, and reduce the costs of care by avoiding duplication and errors. HIEs can also support the transition to value-based payment models, which are forms of reimbursement that link payments to the outcomes and efficiency of care delivery, rather than the volume of services provided.

Value-based payment models aim to achieve the triple aim of health care: improving the health of populations, enhancing the experience of care for individuals, and reducing the per capita cost of health care. Some examples of value-based payment models are accountable care organizations (ACOs), bundled payments, pay-for-performance, and shared savings. These models require providers to assume more financial risk and accountability for the quality and cost of care they deliver to a defined population of patients.

HIEs can help providers succeed in value-based payment models by providing them with timely, accurate, and comprehensive information about their patients’ health status, needs, preferences, and utilization of services. HIEs can also enable providers to access clinical decision support tools, such as guidelines, alerts, reminders, and order sets, that can help them deliver evidence-based and appropriate care. Moreover, HIEs can facilitate the measurement and reporting of quality and performance indicators, which are essential for evaluating the effectiveness and efficiency of care delivery and determining the payments or incentives for providers.

Some examples of how HIEs can boost value-based care are:

– HIEs can help providers identify gaps in care and close them by sending alerts or notifications when a patient is due for a preventive service, such as a screening test or a vaccination, or when a patient has a chronic condition that requires regular monitoring or management.
– HIEs can help providers avoid unnecessary or duplicative tests or procedures by allowing them to access the results of previous tests or procedures performed by other providers, such as lab tests, radiology reports, or medication histories.
– HIEs can help providers reduce hospital readmissions and emergency department visits by enabling them to follow up with patients after discharge or referral, coordinate post-acute care services, and monitor patients’ conditions remotely.
– HIEs can help providers improve patient engagement and satisfaction by empowering them to access their own health records online, communicate with their providers electronically, and participate in shared decision making.

According to a report by EHRIntelligence , HIEs have been shown to improve clinical outcomes, such as reducing mortality rates, hospitalizations, length of stay, adverse drug events, and infections. HIEs have also been shown to generate cost savings, such as reducing spending on lab tests, radiology exams, medications, and administrative tasks.

However, there are also some challenges and barriers that hinder the adoption and use of HIEs by providers. These include technical issues, such as interoperability problems among different electronic health record (EHR) systems; legal issues, such as privacy and security concerns and consent requirements; financial issues,
such as lack of sustainable funding sources and business models; organizational issues,
such as lack of leadership support and stakeholder engagement; and behavioral issues,
such as lack of trust and awareness among providers and patients.

To overcome these challenges and barriers, some strategies that have been proposed or implemented are:

– Developing common standards and policies for data exchange among different EHR systems
– Implementing robust encryption and authentication mechanisms to protect data privacy and security
– Educating providers and patients about the benefits and risks of HIE participation
– Incentivizing providers to join HIE networks through financial rewards or penalties
– Aligning HIE goals with value-based payment model objectives
– Creating governance structures that involve diverse stakeholders in decision making
– Evaluating the impact of HIE on quality improvement and cost reduction

In conclusion, HIEs are valuable tools that can support the transformation to value-based payment models by enhancing the availability and usability of health data for providers. HIEs can help providers improve the quality and safety of care delivery,
reduce the costs of care delivery,
and achieve better outcomes for their patients.

Bibliography

: How Health Information Exchanges Boost Value-Based Care – EHRIntelligence
: Health information exchanges, interoperability crucial in change to value-based payments | Healthcare Finance News
: Value-Based Health Care Payment Models | Deloitte US

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