Could HIEs save Medicare billions each year?

October 24, 2017 Teri Thomas

Researchers say they can.

Health Information Exchanges, or HIEs, are hubs for sharing clinical and administrative data across the boundaries of healthcare organizations and the healthcare community. Unfortunately, many were put in place without experienced leadership and without sustainable business models, frequently leading to business failure and erosion of faith in the HIE model. That’s terribly unfortunate because, when run well, HIEs can actually provide significant benefits for patient care.

In an article for FierceHealthcare, written by Evan Sweeney, new research from the Universities of Notre Dame and California San Francisco present clear value of HIEs, including the potential to save Medicare billions of dollars every year. Researchers analyzed Medicare spending over a seven-year period and found areas with an HIE had a significantly lower average spend per beneficiary, per year. With the sheer number of Medicare beneficiaries out there, this adds up very fast.

The Medicare study also indicates that the longer an HIE has been implemented, the more effective it is at reducing costs. Most of the improvement derives from the effective sharing of patient data, enabling clinicians to have access to far more comprehensive information about a patient’s clinically relevant information, particularly when they’ve had care across organizational boundaries.

The full results of the study will be published in the next six months and will explore exactly how HIEs can reduce Medicare spending. The study focuses on areas like reducing duplicate and unnecessary medical tests, the short and long term economic and population health benefits, as well as implementation and development of modern HIE models.

These benefits should extend to non-recipients of Medicare as well. Patients of any age can appreciate fewer needle pricks and less exposure to radiation from CTs and X-rays. More comprehensive information means better treatment choices can be made. We all have some stake in the success of projects like health information exchanges.

Another reason to carefully watch development of HIEs and similar initiatives is the explosion of available health data from implementing EMRs in the US under HITECH. As noted by John Halamka, M.D, in his New England Journal of Medicine article, The HITECH Era in Retrospect the vast majority of U.S. hospitals and physicians now regularly use EHR systems. He notes, “…data sharing is a business imperative. The needs of care management are now creating genuine demand for interoperability services, such as “pushing” data to support referrals and transitions and “pulling” data for unscheduled visits such as emergency care.” This means HIEs are poised to provide more value than ever.

Read John’s New England Journal of Medicine article, The HITECH Era in Retrospect, by following the link below.

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