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How community-based HIEs are supporting value-based care

Interoperability is an important level for value-based care. Not only does it lead to higher reimbursement under MIPS, but examples from leading HIE entities show how interop enables care coordination as well as cost reduction.
By admin
Apr 25, 2022, 2:15 PM

Through the Merit-based Incentive Payment System (MIPS), the Office of the National Coordinator for Health IT has prioritized the role of interoperability in value-based care. Promoting interoperability through health information exchange (HIE) accounts for 25% of a provider’s final MIPS score.

Along with increasing incentive payments, participation in HIE has been directly linked to positive value-based care outcomes. A recent literature review identified a range of benefits to information exchange, including reduced hospital admissions and readmissions, reduced care costs, improved medication reconciliation, reduced care disparities, and improved monitoring of patients with a history of high emergency department utilization.

Community-based HIEs, which operate at a state or regional level, are particularly well-positioned to help healthcare organizations realize these benefits. As the literature review noted, these entities “attempt to facilitate information exchange among the widest set of available providers within an area” – which is something to consider when looking at enterprise or vendor-hosted HIEs. 

Related story: Interoperability will play a key role in renewed HHS strategic plan

Here are five examples of efforts led by community-based HIEs to promote value-based care.

CORHIO, the Colorado Regional Health Information Organization, encourages the use of Z codes, which are a class of ICD-10 codes that document non-medical factors that impact health status, from living circumstances to loss of a close family member to problems in a personal relationship. The presence of Z codes within an individual patient’s longitudinal record can help providers address health disparities, improve care coordination, and support quality improvement.

CyncHealth, which serves the state of Nebraska, integrates clinical and claims data and enables participating providers to use analytics and risk stratification to identify high-risk patients. This helps providers connect patients to primary care, behavioral health, and other services they may need but not otherwise seek on their own.

Health Current, Arizona’s HIE, has implemented a closed-loop referral system for social services through a partnership with the state’s Medicaid agency and crisis response network as well as a third-party vendor. The initiative helps screen patients for social risk factors and refer them to community-based organizations best positioned to meet their needs.

KHIN, the Kansas Health Information Network, promotes clinical data sharing as a way to improve quality measurement. The organization has found that providers who incorporate longitudinal HIE data in their quality calculations see changes in 15% of all calculations, including 24% of diagnosis calculations, compared to providers who use data from a single EHR. This is important, the HIE said, as it leads to more informed application of care guidelines and clinician outreach as part of treatment.

SHIN-NY, the Statewide Health Information Network for New York, has achieved significant success in cutting costs for unnecessary care. For example, giving providers access to integrated clinical and claims data sets reduces the likelihood of a repeated order for an existing medical image by roughly 25%. In addition, access to clinical data for public health staff has been linked to faster identification and treatment of sexually transmitted infections


Brian Eastwood is a Boston-based writer with more than 10 years of experience covering healthcare IT and healthcare delivery. He also writes about enterprise IT, consumer technology, and corporate leadership.

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