Geisinger Health Plan sees benefits from HIE participation

Geisinger Health System and its health plan, Geisinger Health Plan, are working together to advance healthcare through the use of the organization’s Keystone Health Information Exchange.

Before now, health plans have not thought extensively about the use of HIEs, but that’s changing, say executives at Geisinger.

With value-based care growing, the environment is ripe for change, as healthcare providers and organizations across the continuum strive to find ways to improve care while holding costs down. As evidence of this trend, Pennsylvania has indicated it wants to close care gaps for chronic conditions and is encouraging healthcare organizations, including health plans, to participate in HIEs.

Geisinger Health System founded Keystone Health Information Exchange (KeyHIE) in April 2005, creating it through a memorandum of understanding between eight hospitals throughout central Pennsylvania. Today, KeyHIE offers a wide range of services to 179 unique member organizations across the area, including 29 hospitals, 369 physician practices, 36 home health locations, 82 long‐term care facilities, four pharmacies, four payers, four emergency medical services and 19 urgent care units. Showing the volume of the exchange, this March, KeyHIE reported 273,000 documents were accessed by 5,087 users.

Geisinger Health Plan (GHP) became a member of KeyHIE in 2011, and uses the HIE’s services to close care gaps; access real-time patient data; receive real-time notifications of admissions and discharges from emergency departments and acute settings; and to access real-time test results, according to Kim Chaundy, senior director of operations for Geisinger.

“KeyHIE believes that health plans are just as important to delivering quality healthcare as physicians, hospitals and other providers,” she says. The proactive delivery of information like lab results for patients that have chronic conditions is one key area that can really pay off. “Health plans are starting to understand HIEs can be the conduit for efficiency and how we can parse the data,” she says. “They see the value of it.”

Having a health system, health plan and an HIE all tied together “can really make a strong push for interoperability,” Chaundy says. “Being able to have access to the health system and data needed to identify for health plans’ potential high-risk patients allows them to have all the necessary components to be well-versed about what’s going on with patients.”

When HIEs began rolling out more than a decade ago, there were many concerns about their sustainability—but that hasn’t been a problem for KeyHIE. During the past eight years, the HIE has been funded by $27 million in local, state and federal grants. Grant funding has played a key part in participation in the HIE, because implementation fees were covered, Chaundy says.

With fees covered and an aggressive marketing strategy, the HIE has seen tremendous growth as well as sustainability in recent years. In roughly 2016, KeyHIE went from 40 member organizations to 142. From 2016 to present, the HIE experienced a 61 percent growth in active patients.

KeyHIE sustainability and growth has also been maintained by targeting “white space” and saturating that population to show community value, says Joe Fisne, associate chief information officer at Geisinger. Saturation of a community gives a 360-degree view and increases access to data from providers in rural areas.

Fisne says the HIE enables the process of allowing the information to flow—when and where it’s needed. Health plans are becoming increasingly interested in preventative care and reducing care gaps. All of these things together make involvement with an HIE important. “We serve our patients and members of our community that much better with the use of IT,” he says.

KeyHIE’s growth coincided with the HIE’s migration from the Caradigm’s platform to Orion Health’s platform in 2016. Some of the attractive qualities of Orion Health include the robust, powerful platform with the added benefit of access to an embedded team model, Fisne says. “Orion is the central repository for all KeyHIE data. Other benefits include increased access for support and troubleshooting purposes, as well as expanded reporting and analytics.”

Health plans should consider joining an HIE to improve customer satisfaction and claim a stronger voice in care management, Fisne advises. Plans that want to become involved in an HIE should look for one that offers a robust, proven platform, in addition to stability, sustainability and a large participant base.

“We’re involved in the HIE business; we want to make sure we are connecting information when and where it’s needed,” Fisne says. “Our goal is to be a community resource.” KeyHIE is a member of the Strategic Health Information Exchange Collaborative (SHIEC) and also participates in several other national organizations.

Several members of the HIE are working to include social determinants of health in the data exchange, Fisne says. It’s a collaboration with Orion, and the HIE is working through innovations and iterations to make that happen. “It’s a nice balance of entities working together,” something, he says, happens often at KeyHIE.