PATH 1 Improved One-to-One Interactions
Reduced Unnecessary Costs
With access to the patient’s complete health history through
a community HIE, providers are positioned to avoid ordering
duplicative tests or services or prescribing medications that
may not interact well with medications the patient already is
taking. This reduces costs of care, improves efficiency, and
results in an improved patient experience.
There’s also the benefit of reduced redundancy in workflow.
When physicians and other care team members have access
to the patient’s full health narrative, they can see actions
that have been taken in other settings—such as a screening
for depression or discussion around medication safety—and
avoid duplicating those actions. They can also review notes
from other physicians and ask timely follow-up questions
based on available information.
A recent study found that if all U.S. physicians were part of
an HIE, Medicare could save $63 million annually on procedures performed in physician offices. 3 Physicians also would
reduce patients’ risk of exposure to unnecessary treatment.
Another example demonstrates the potential of a community HIE to reduce costs in the ED. 4 When ED physicians had
access to a community HIE, laboratory tests decreased 25%,
and radiology orders dropped by 26%–47%.
Our community HIE automatically pushes notifications to
physicians regarding patients’ recent care interactions—and
it’s a game changer for our performance under value contracts.
Patients often neglect to share important information that could
determine next steps in care, such as a visit to the emergency
department (ED) with complaints of chest pain. With automatic
alerts prompted by the community HIE, physicians can access
data from a patient’s recent trip to urgent care or visit to a
specialist in just a few clicks. The clinical data received, and the
one-on-one conversations that occur afterward, may lead to
adjustments in the patient’s chronic care plan.
Automatic alerts also prompt conversations around why
patients are relying on the ED for care or haven’t filled recent
prescriptions. The answers inform interventions that can
make a difference in the patient’s health, such as access to
transportation for physician visits or financial assistance
needed to afford prescribed medications. Such conversations
also reveal opportunities to connect patients to community
resources—such as Meals on Wheels and home health services—that help reduce the risk of negative outcomes.
An EHR combined with a rich community HIE
helps providers to easily identify patients at high
risk of developing chronic conditions or showing signs of complex health issues not being
properly managed. With this information in hand,
providers can fast-track patients into chronic
care management programs designed to prevent
ED visits and costly admissions.
We know that the earlier a disease is diagnosed, the greater the opportunity to improve
health outcomes and reduce costs. One example
is heart disease, which is projected to affect
45% of the U.S. population by 2035—at a cost of
$1 trillion. 2 It is currently the costliest disease in
our nation, at $555 billion in care costs annually
and 60 hours in lost productivity per employee
However, what if a patient’s primary physician
were better attuned to the patient’s risk factors for
heart disease as soon as they develop? What if a
physician had access to data such as a rise in LDL
levels recorded on a recent wellness test, a visit
to an ED for chest pain, complaints of shortness
of breath during a visit to an orthopedic specialist
after a foot injury, or swelling of the ankles noted
by a podiatrist? A community HIE allows providers
to see trends in critical data across the continuum
of care and positions providers to act quickly—
before a life-altering event occurs.
At HMG, automatic prompts built into our
practice management system alert front-desk
staff to patients who are covered by value contracts, ensuring these patients are seen right
away. This improves population health management as well as value performance.
Enhanced Patient Management
HIE Successes at HMG
X Increased pay-for-value payments by 44%, with more than
$13 million in value-based revenue annually
X Reduced the employee-to-provider ratio by 0.7 full-time
employees (F TEs)
X Increased fee-for-service payments by 7%
X Reduced ED visits, with a utilization rate 25% better than
that of other providers in the market—as well as significantly