Could a payer-led HIE do the trick?

By Anthony Brino
12:17 PM

While the debate about sustainable health information exchanges tends to pit public entities against private ones in a survival of the fittest scenario, two competitive large insurers are taking a new tack by creating a "public utility" data sharing service. 

Blue Shield of California and WellPoint, the parent of Anthem Blue Cross, are investing a combined $80 million to start the California Integrated Data Exchange, as a “next generation” health information exchange service for providers, payers and patients.

Dubbed Cal INDEX, the service will offer California physicians, nurses and hospitals “a unified statewide source of integrated patient information.” It will be one of the largest exchanges in the country, starting off with the health records of a quarter of the state population, the companies say.

Modeled after a public utility, Cal INDEX’s technology platform is set to operational by year’s end and will be open to any health data contributor, meaning insurers beyond Blue Shield and Anthem and providers beyond their networks. The companies say they are also going to de-identify the data and use it for public health research.

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Anthem, Blue Shield and other major players in California are hailing the development as much-needed and aptly timed to address what has been a shortcoming of the national switch to electronic health records — the ability to share digital patient records in usable formats at the point of care.

“We believe that providers and plans must collaborate to ensure that Californians receive quality healthcare at a sustainably affordable price,” said Mark Morgan, president Anthem Blue Cross, in a media release. “A fundamental component is sharing comprehensive patient information broadly and efficiently,” Morgan added.

“Although Blue Shield and Anthem Blue Cross are fierce market competitors, in order to create the scale Cal INDEX needs, we knew we needed to work together,” said Blue Shield CEO Paul Markovich.

Priya Mathur, board VP of the California Public Employees Retirement System — 40 percent of whose members are covered by Anthem and Blue Shield — lauded the new information exchange as an indication of healthcare organizations collaborating and investing for shared quality improvements.

“What really makes this initiative exciting is that two competitors have agreed to carve this innovation out of a competitive landscape and cooperate to improve the integration of healthcare,” Mathur said.

Lloyd Dean, the president and CEO of Dignity Health, California’s largest hospital network, called Cal INDEX “a much-needed innovation whose time has come.”

Cal INDEX will be an independent, not-for-profit organization; the $80 million seed funding will be enough to cover costs for three years and onboard about 30 large provider organizations.

“After three years, participating providers and insurers will provide revenue to Cal INDEX through subscription fees,” the companies said.

[See also: How using mHealth helps reach Medicaid populations.]

The technical work of linking providers and plans across the state could be a large and challenging undertaking — with many hospitals and physicians struggling themselves to connect digital health record software sometimes within the same health system and various regional health information exchange initiatives still looking for a sustainable way to operate. But its rewards would be fairly significant in terms of reducing duplication, improving the patient experience and simplifying clinician’s workflows. 

This payer-led HIE could also create a new impetus for other payers across the country to invest in health information exchange models, at a time when HIE, as service and organization, is facing a sort of crossroads.

The service will connect claims and EHR data to create comprehensive, longitudinal patient records that participating providers can access through a portal that “works with most major electronic medical record) systems” and displays data, alerts and analytics, along with basic care management tools.

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