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VITL CEO on Health IT & Payer Reform at HFMA Forum

Health care reform in the U.S. is reshaping every facet of the system, most significantly how it is financed. The 2010 Affordable Care Act included provisions that expanded health insurance coverage for many Americans, will change how providers are reimbursed for treatment, and makes investments in health information technology that will increase efficiency and eventually lower health care costs.

Almost six years have passed since this legislation was enacted. During January 2016 the New Hampshire/Vermont chapter of the Healthcare Financial Management Association (HFMA) hosted a "status report" program entitled Innovative Payment Models in NH & VT: Lessons Learned and How We Move Forward. Panelists and speakers convened in New Hampshire to examine a range of payer models that are currently in place and the impact they are having.

VITL's President and CEO John K. Evans was invited to participate at this forum as part of a Vermont panel on How Do We Move the Ball Forward. He discussed health information technology's role in driving payment reform.

Along with John, five other leading health care executives participated on the Vermont panel:

  • Amy Cooper, executive director, Vermont HealthFirst
  • Tom Huebner, CEO of Rutland Regional Medical Center
  • Craig Jones M.D., executive director, Vermont Blueprint for Health
  • Norman Ward M.D., chief medical officer, OneCare Vermont
  • Joyce Gallimore, director, Community Health Accountable Care LLC

During the session John answered questions about the importance of data aggregation and health information exchange to drive the reformed payment system. Fee for services is moving to a capitated environment, which means a set amount of money is determined for each enrolled patient assigned to a provider, whether or not that person seeks care. A provider would then oversee the health outcomes for a group or population of patients over time. The goal for managing the health of a population of patients is to keep everyone as healthy as possible, and reduce the need for excessive or expensive treatments, tests, emergency room visits and hospitalizations. For Vermont the move to a capitated system includes the reliance on data-driven performance measures for clinical outcomes, in addition to financial outcomes.

As stated by the American Health Information Management Association, "Population health management (PMH) lowers costs by refocusing health care on not just the sick but also the well. What must be understood in this care model is what a healthy population looks like, how clinical risk is defined, how financial risk is measured, and what will be the metrics used to analyze how sick patients with chronic disease do and do not get sicker. PMH also tracks and trends inpatient, ambulatory and emergency department patients. For PMH to be effective, there is a critical need to focus on data and information that will power clinical decisions."

Health information exchange supports reform initiatives and population health management in several ways. Many HIEs started out by providing basic services like collecting and sending electronic laboratory results. Today, VITL, Vermont's health information exchange (VHIE), has over 700 connections (known as interfaces) in place to collect health data across a wide range of health care organizations.

VITL now has sufficiently robust data to support decision making at the point of care, and data aggregation capability to support the shift in using analytics for population health management purposes. Over the last 18 months VITL developed an infrastructure in parallel to the VHIE that allows it to work with providers on data quality. Ensuring data are complete, accurate and consistent is necessary to support clinical decisions, and data quality services are becoming a core part of VITL's work.

Another question answered during the panel discussion related to how provider processes that routinely use both an electronic health record (EHR) and secondary data sources like VITLAccess are built by VITL. Interface is the term used to describe the connections VITL builds from EHRs and other systems to connect them to the VHIE. In order for these systems to communicate better, VITL follows a set of standards developed by IHE International (Integrating the Health Enterprise), an initiative working to improve the way health care systems share information electronically.

IHE encourages the use of established interoperability standards such as HL7 or DICOM. They created a set of profiles--related to specific clinical needs that describe solutions to integration issues--that provide precise definitions of how to implement the standards for direct query of a health information exchange like the VHIE. Systems and interfaces developed in accordance with these interoperability standards communicate more efficiently.

VITLAccess is a web-based service developed by VITL that providers can log into and view patient data stored in the VHIE. If a patient agrees to share (by giving written consent) their medical information in the VHIE, then any of their other treating providers using the portal may view it as well. A team of specialists at VITL works with providers to set up best practices for integrating VITLAccess into a practice's workflow, so they know when and where use of the service is most appropriate.

Considering there has been a great deal of progress in health information exchange over the past 10 years, John was asked a question about why some providers shun health information exchange. Is it due to a lack of trust in the quality and completeness of data channeled from other providers, and are they right to be skeptical? The answer was yes, and no. Providers have always relied on data that has been transferred from one health care organization to another by fax, courier, telephone and other less technologic methods. The introduction of technology in the form of electronic health records hasn't necessarily made the data providers collect more consistent across the board.

VITL developed several strategies to improve the accuracy and consistency of health data being sent to the VHIE by:

  1. Working with providers directly. Examples include an initiative known as Blueprint Sprints, which pairs VITL eHealth specialists with patient centered medical home providers, to ensure that medical information from providers connected to the Vermont Blueprint for Health repository and VHIE meets data quality standards. VITL has also received funding to work with behavioral health providers on improved methods for collecting patient data.
  2. Through data management in the VHIE network such as establishing a Master Patient Index (MPI) and terminology services.
  3. Establishing dashboards back to the health care organization. Dashboards can supply metrics to help the organization track performance in key areas and identify areas for improvement.