As healthcare costs continue to increase and patients demand more from their insurance coverage, there’s rising pressure to provide higher-quality care more efficiently than ever before. The expectations for healthcare payers to achieve the Triple Aim objectives—that is, better patient experiences and improved population health at lower costs—demand that we all become more resourceful in our approach to care.
It’s clear that health plans and hospital systems can’t achieve these ambitious goals alone. It requires collaboration—a bridge that health information exchanges (HIEs) are uniquely positioned to fill. HIEs connect healthcare providers, payers and community organizations by securely sharing patient information between separate facilities and disparate technology systems. HIEs streamline communication by giving healthcare stakeholders a full picture of each patient’s needs, equipping them to make well-informed decisions at the point of care.
In light of the many challenges facing healthcare today, now is the time to lean into HIEs as a vital community resource that can empower payers to better serve their members at both an individual and population-wide level—saving costs and improving quality throughout the entire system.
The power of connected data
The true value of HIEs is revealed in both patient experiences and outcomes, made possible through seamless data exchange that enhances care coordination. By connecting siloed systems that couldn’t otherwise share medical records, HIEs give providers access to patient information that is immediate, accurate and comprehensive.
One of the simplest yet most powerful examples of an HIE in action is in emergency situations when patients can’t communicate their medical history. The treating provider can access details like prior surgeries and medications through an HIE to get a real-time snapshot of the patient’s health status—enabling safe and appropriate treatment.
This streamlined data exchange reduces the need for duplicative tests, unnecessary procedures and potential drug interactions, which can increase costs and impact outcomes. By sharing information more efficiently, HIEs minimize wasted resources. Clinical staff spend less time chasing down medical records and more time focused on care, which directly benefits patients. Subsequently, payers spend less time requesting records from providers, facilitating more efficient quality reporting across the entire system.
Accurate health alerts
HIEs can immediately alert health plans, providers, states, counties and a wide array of other covered entities when a patient presents at the emergency room or checks into the hospital. These instant updates empower payers, providers and their community partners to coordinate care much more effectively as we try to close gaps in care. In addition to having up-to-date health records for individual patients, this data-driven connectivity enables better management of chronic diseases across populations.
Whether we’re assessing potential gaps in care, improving quality measures, supporting predictive models and risk adjustments, or responding to regulatory audits, we can gather much of the data we need through the HIE instead of chasing down providers or members to collect information. Payers are increasingly obligated to request medical records from providers to substantiate health claims and quality scores. HIEs can significantly lower this burden for both payers and providers, saving time and cost, while improving the quality of care and the accuracy of audit findings.
In fact, HIEs enable coordinated care that has been shown to reduce hospital admissions, emergency department visits, redundant lab tests and medication errors—contributing to lower costs, improved patient safety and higher quality outcomes.
Community connections
The value of HIEs transcends traditional healthcare services, especially in rural areas like western Colorado, where many residents live far away from services that are typically available in urban areas. Here, local clinics, providers, community-based organizations and human service agencies serve as vital lifelines to food security, housing support, behavioral health services, transportation and other valuable resources. Many of these organizations work in isolated communities, which increases the risk that patients fall through the cracks or face critical gaps in care.
HIEs link these organizations together with health systems, bridging the gaps between medical providers, social service agencies and other community-based organizations. These vital connections make it easier to refer patients who not only need medical care but also support for food, housing, transportation and other social drivers of health. By closing the loop to connect members with these services, HIEs help payers coordinate resources to avoid costlier healthcare utilization downstream.
The more providers and organizations that participate in the HIE, the more valuable it becomes as the network expands to encompass more data to inform important healthcare decisions. The more information that providers have access to, the better care they can provide.
No matter how big or powerful a single health system’s platform grows, it will never be as comprehensive as an inclusive community network. There’s immeasurable value in a robust data exchange where information can flow freely between platforms and organizations—replacing healthcare’s siloed systems with efficient communication and seamless collaboration. This includes a broad array of health-related social needs data that is often well beyond the scope of EHR platforms and system-affiliated providers. A connected, community-based HIE model will drive the future of value-based contracting strategies, where payers and providers treat people as whole individuals with needs that transcend a single system’s health record.
About Patrick Gordon
Patrick Gordon is the CEO of Rocky Mountain Health Plans, where he leads initiatives in payment reform, integrated care, and value-based purchasing. He is recognized for developing the PRIME Medicaid program, which enhances primary care and behavioral health integration. He is also a member of the Contexture board of directors.
