Stakeholder Buy-in and Local Health Information Exchange Activities: Implications for Quality Reporting & Pay-for-Performance (P4P)

Slide Presentation from the AHRQ 2008 Annual Conference

On September 9, 2008, Joy Grossman, Kathryn Kushner Santoro, and Elizabeth November made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (260 KB).

Slide 1

Stakeholder Buy-in & Local Health Information Exchange Activities: Implications for Quality Reporting & Pay-for-Performance (P4P)

Joy Grossman, Kathryn Kushner Santoro, and Elizabeth November

AHRQ Annual Conference 2008, 9/9/08

Slide 2

Health Information Exchanges (HIE) Vision vs. Reality

• Vision:
  • Support patient-centered comprehensive medical records for treatment.
  • Leverage clinical data repository (CDR) for secondary uses, e.g. quality reporting and improvement and P4P.
• Reality:
  • Few operational HIEs; no comprehensive CDRs.
• Limited research on role of stakeholder participation in HIEs.

Slide 3

Research Questions

• How does stakeholder participation vary across HIEs?
• What are the facilitators of and barriers to stakeholder participation?
• How are HIEs structured to gain stakeholder participation?
• How do stakeholder preferences affect the HIE role in quality initiatives?

Slide 4

Qualitative Research Design

• Selected four local HIEs:
  • IHIE and HealthBridge—Mature HIEs with active data exchange; hospital-sponsored.
  • CareSpark and Tampa Bay RHIO [regional health information organization]—Newer HIEs in planning/development stage; started by multi-stakeholder community groups.
• 76 discussions held with broad range of stakeholders, including participants and non-participants, from 2/07-8/07.

Slide 5

Consistent Concerns Across HIEs About Sharing Data

• Health care providers and health plans view patient data as key strategic asset:
  • Fear losing competitive advantage by relinquishing data.
  • Concerns about potential data misuse.
  • Concerns about patient privacy and security.

Slide 6

Differing HIE Strategies to Engage Stakeholders

• In IHIE and HealthBridge, major hospital systems agreed to collaborate rather than compete on HIE, providing HIEs with critical mass of data.
• Hospitals willing to pay for clinical messaging, which replaces hospital results delivery to physicians.
• HIEs designed to address hospital competitive concerns:
  • With clinical messaging, unlike clinical data repository, providers retain control of data.
  • Legal agreements limit data use, e.g. provider performance measurement not permitted.
  • Governance structure allows hospitals to control any changes to HIE.

Slide 7

Newer HIEs Struggle with Broader Coalitions

• CareSpark and Tampa Bay RHIO had plans to develop clinical data repository that aggregates patient data.
• No critical mass of stakeholders willing to provide data or funding.
• Struggling to identify initial services and financing models that stakeholders will support.

Slide 8

Minimal Role for Employers and Health Plans Across HIEs

• Employers are catalysts but few provide financial support:
  • Clinical messaging viewed as provider business cost.
• Health plans have reduced participation over time:
  • Local plan mergers with national companies.
  • Concerns about loss of competitive advantage and data misuse.
  • Development of potentially competing data-sharing products.

Slide 9

Quality Efforts in Four HIEs

IHIE rolling out Quality Health First (QHF)

• Participants include Anthem and local plans, others in discussion; Medicare/Medicaid.
• Combining claims with some clinical data.
• Start with Primary Care Physicians (PCPs), add specialists, hospitals.
• Physician and patient reports go to physicians and plans:
  • Changed data use agreements to allow comparison of physicians but can't be made public.
• Plans pay per-member per-month (PMPM) fees; start-up grants from other sources.

Slide 10

Quality Efforts in Four HIEs (continued)

• HealthBridge developing plans for clinical data repository to support quality reporting/P4P:
  • Would need to change data use agreements for both purposes.
• CareSpark and TampaBay RHIO planning quality measurement to track health outcomes but not actively considering provider performance measurement.

Slide 11

HIE Role in Quality Initiatives Challenging

• Stakeholders felt HIEs, as central data conduit, could address shortcomings of existing quality programs:
  • Combine clinical and claims data for all patients.
  • Reduce administrative burden.
  • Facilitate development of common measures and get physician buy-in.
  • Attract employers and plans to provide data and funding.
• However, more complex/costly clinical data repository needed to aggregate patient data for quality measurement.

Slide 12

Provider Views on HIE Role in Quality Initiatives

• Provider competitive concerns heightened with clinical data repository:
  • In IHIE and HealthBridge, requires renegotiating data use agreements, etc.
• Providers wary of health plans using data for price negotiation/network selection.
• Concerns that smaller physician practices resistant to P4P might not join HIEs.

Slide 13

Employer and Plan Views on HIE Role in Quality Initiatives

• Employers:
  • Mixed views about provider performance measurement/P4P.
  • No widespread interest in funding quality activities.
• Plans:
  • Value access to clinical data.
  • Potentially willing to pay fee for quality reports.
  • Concerns about losing competitive advantage by sharing data and standardizing P4P programs.
  • Moving to statewide or national information technology (IT) and P4P strategies.

Slide 14

Discussion

• Barriers that caused community health information networks (CHINs) to fail in 1990s still exist:
  • Health data treated as business assets over which health care organizations exert property rights.
  • Few incentives/substantial disincentives to share data.
  • No stakeholders consistently willing to pay for CDRs.
• HIEs must balance evolving business relationships with maintaining stakeholder participation.
• Will "niche" data exchanges compete with or support community-wide HIEs?
• Will HIEs be widespread enough to support quality reporting/P4P?

Slide 15

Funding Acknowledgement

• Project funded by AHRQ.
• Study report: Joy M. Grossman, Kathryn L. Kushner, Elizabeth A. November, "Creating Sustainable Local Health Information Exchanges: Can Barriers to Stakeholder Participation be Overcome?", Research Brief No. 2, HSC and NIHCM, February 2008, http://www.hschange.org/CONTENT/970/

Current as of January 2009

Internet Citation:

Stakeholder Buy-in & Local Health Information Exchange Activities: Implications for Quality Reporting & P4P. Slide Presentation from the AHRQ 2008 Annual Conference (Text Version). January 2009. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/about/annualmtg08/090908slides/Grossman.htm