2. Community HIEs support strong performance.
Community HIEs give providers a critical line of site into the care needs of complex patients, thereby boosting a practices' ability to enhance health outcomes at a reduced cost. For example, patients often neglect to share information that could be important to determining next steps in care, such as a visit to the emergency department (ED) with complaints of chest pain.
However, when practices access a community HIE, they can build automatic notifications into their certified electronic health record (EHR) that alerts physicians to a patient's recent care interactions. So, in a few clicks, a physician could be alerted to a recent visit by the patient to an ED or urgent care facility. With this information, a physician can drill deeper and explore the reasons for the visit, such as complications related to a patient's chronic condition. Ensuing conversations could then lead to improved health outcomes and patient satisfaction while reducing costs.
Community HIEs also enable physicians and nurses to keep value parameters top of mind. Pay-for-value parameters change from year to year, and it's difficult—if not near impossible— for clinicians to keep up with multiple value-based contracts. Community HIEs like RHIO help teams follow protocols for patients under value-based performance contracts at the point of care.
RHIO Alerts at the point of care also inform physicians and care managers when patients haven't filled recent prescriptions, which can prevent medical issues, especially with chronic care patients and those who require financial assistance.
Holston Medical Group (HMG), a regional medical group that serves 200,000 patients in northeast
Tennessee and southwest Virginia, has achieved substantial success under value-based performance contracts since joining the only functioning, bidirectional, common medical record system in the state of
Tennessee. Since, 2012, access to a community HIE has positioned HMG to:
- Increase pay-for-value payments by 44 percent, with more than $13 million in value-based revenue annually
- Increase fee-for-service payments by 7 percent.
- Significantly reduce readmissions with decreases of 7 -12 percent by payer.
- Decrease ED visits with an ED utilization rate that is 25 percent better than other providers.
3. Community HIEs inform service line innovations
Community HIEs can point to trends in hospital admissions and ED visits. This data identifies the need to add a
specialty service line to the practice, such as pulmonary care, if data shows that admissions increased for a COPD patient, for example. The data also supports the decision to add after-hours appointments for specific patient populations. For example, a pediatric clinic helps parents avoid ED visits for common conditions such as earaches, or for patients who have trouble stabilizing chronic conditions.
Innovations such as these not only boost revenue for physician practices, but also reduce overall healthcare costs—an area of concern, not just for CMS, but also for consumers, employers and health plans. Today, U.S. health care spending accounts for nearly 18 percent of our nation's gross domestic product with medical costs expected to increase by six percent this year. A recent study found that if all U.S. physicians were part of an HIE, Medicare could save $63 million annually on procedures.
4. Community HIEs support data-informed revenue enhancement
Community HIEs help practices improve quality of care at a reduced cost. They also demonstrate a strong potential to offer practices opportunities to increase revenue, like supporting compliance measures with TCM billing requirements.
As practices face decreased federal and commercial reimbursement, exploring the potential to enhance both quality of care and revenue with the support of a community HIE, like Rochester RHIO, is an important step toward protecting a physician practice's long-term financial health.
