When HIEs are used, health plan costs go down

By Mike Miliard
10:38 AM

A new study from Humana and the Wisconsin Health Information Exchange (WHIE) shows that using health information exchanges in emergency departments results in improved provider efficiencies and health plan cost savings.

The peer-reviewed analysis, billed as the first to closely examine the benefits accrued by health plans that support health information exchanges, is published in the July/August issue of American Health & Drug Benefits.

[See also: HIEs offer ‘astronomical benefits’.]

The study, which ran from December 2008 through March 2010, evaluated the effectiveness of community-based HIEs – the secure transfer of healthcare-related data among facilities, health information organizations and government agencies, for patients seeking care in emergency departments.

The analysis examined 1,482 fully-insured Humana members in Southeast Wisconsin who sought care at emergency departments at 10 Milwaukee hospitals. Clinicians in the emergency department could query the HIE to view patients’ historical medical encounter information to help them make diagnosis and treatment decisions.

“Emergency department utilization continues to increase across the country, with inefficiencies such as duplicative testing and lack of medical history contributing to increased costs and creating a burden on the entire healthcare system,” said Albert Tzeel, MD, national medical director of HumanaOne and the study's author. “By allowing clinicians to have access to patients’ medical history at the point of care in the emergency department, we found significant cost reductions and a decrease in redundant diagnostic testing. This proves that HIEs not only provide a value for the health plan, but also improve care coordination and help control costs for patients.”

[See also: HIEs poised for growth, change.]

The research found definitive decreases in four of the top five emergency department-based procedures, including CT scans, EKGs, laboratory testing and diagnostic radiology, when the patient database was queried by clinicians. These decreases resulted in an average savings of $29 per emergency department visit due in large part to the reduction of test redundancy, which helped mitigate waste and control costs.  Prior research has shown that even cost reductions of $10 per emergency department visit could yield substantial savings for health plans.

“While historically it has been difficult to measure the economic value of health information exchange, this research further demonstrates that HIEs provide substantial value for health plans, in addition to value realized by providers and patients,” said Kim Pemble, executive director of the Wisconsin Health Information Exchange. “Hopefully, HIE initiatives will see a rise in the adoption and support of this technology by health plans as a result of the increasing validation of  its numerous benefits, including cost savings, patient safety and improved care coordination.”

[See also: HIE lessons of two states.]

The study, titled “The Business Case for Payer Support of a Community-Based Health Information Exchange: A Humana Pilot Evaluating Its  Effectiveness in Cost Control for Plan Members Seeking Emergency Department Care,” was an observational and retrospective analysis of Commercial Humana members who had a minimum of 12 months of continuous plan coverage.

Patients were classified into two groups: the test group, which had the WHIE database queried during at least two emergency department visits, and a control group, which did not have a HIE utilized during either of at least two emergency department visits. Members who were self-funded, not fully insured or received coverage from government programs, such as Medicare, were not eligible to participate.

For the purposes of the pilot, Humana provided incentives to the WHIE to promote clinician queries for eligible Humana members. Researchers then analyzed claims for cost and utilization in the emergency department to assess the savings per visit.

WHIE launched the Emergency Department Linking Project in 2007, with clinical use beginning in March 2008.  There are now 13 emergency departments and one Federally Qualified Health Center using WHIE across three counties in Southeast Wisconisn.  In 2011 WHIE plans to expand the number of ED and ambulatory participants that are using the system and the number of health systems participating in syndromic surveillance through WHIE.

The WHIE Emergency Department Linking project is being pursued in collaboration with the Milwaukee Health Care Partnership, Wisconsin Department of Health Services, and participating healthcare providers across Southeast Wisconsin.