California insurers want to build a huge data exchange ... will providers come?

CAL/AAEM News Service calaaem.news.service1 at gmail.com
Tue Mar 15 17:36:53 PDT 2016


       

 

March 2, 2016

 

California insurers want to build a huge data exchange ... will providers
come? 

 

 

 
<http://www.modernhealthcare.com/article/20160302/NEWS/160309963?utm_source=
modernhealthcare&utm_medium=email&utm_content=20160302-NEWS-160309963&utm_ca
mpaign=financedaily> Modern Healthcare

 

 

By Beth Kutscher

 

LAS VEGAS-Two of California's largest insurers are trying to build one of
the country's most comprehensive health information exchanges, but they're
facing reluctance from providers who are hesitant to share their data.

 

Anthem Blue Cross and Blue Shield of California-the second- and
third-largest insurers in the state, respectively, after Kaiser
Permanente-teamed up in 2014 to establish Cal Index. Their goal is to create
a complete, longitudinal health record for every California resident.

 

But they still need the buy-in from health systems, which must be willing to
share their data and pay a fee to access data from others. Cal Index
currently has payer records on 9 million people, covering three years of
claims data. The data does not include prices.

 

Only one health system-San Francisco-based Dignity Health-has so far agreed
to join the exchange and will go live at the end of this month. Cal Index is
in discussions with a handful of other systems and hopes they'll soon sign
contracts as well, said David Watson, the group's Emeryville, Calif.-based
CEO. Kaiser, the state's largest health plan, is not among that initial
group.

 

Notably, Kaiser was one of the many providers and EHR developers that
pledged earlier this week to make it easier for patients and healthcare
organizations to access and share data. It's part of an overall push by the
government to obtain the elusive interoperability of EHRs.

 

Kaiser said in a statement that it participates in all regional, state and
national HIEs that are using HHS' national standards.

 

"Cal Index could join the nationwide eHealth Exchange, sign the federal data
use and reciprocal support agreement like Kaiser Permanente and other state
exchanges have done," the Oakland, Calif.-based system said. "By doing so
they would commit to strong security and privacy provisions and the use of
national standards which would enable them to exchange data with KP and many
more providers than they have so far sold their service."

 

"We've been doing outreach to payers and providers since midyear last year,"
Watson said. "But our challenge is that we're not closing on providers as
quickly as we wanted to."

 

Cal Index is trying to simplify its pricing structure to a single fee-based
model, rather than a per member, per year fee. But Watson acknowledged that,
in trying to simplify the cost, some small or rural hospitals might find
that pricing structure cost-prohibitive. "The bigger hospital-based health
systems have a more straightforward value proposition," he said.

 

Cal Index also is amending the terms of its contract to prevent data from
being used for contracting or promotional purposes. Getting providers to
trust that payers will use their data appropriately has been one of the
biggest concerns Cal Index has faced, Watson said.

 

The business case for payers is fairly straightforward: They hope to reduce
medical expenses by 2% to 3%. That savings could come, for example, by
reducing duplicate laboratory and imaging tests when a patient transfers
care to another hospital.

 

Yet any provider taking on risk for a population of patients would have the
ability to use the data to calculate more exact risk scores; they'll have a
patient's entire medical history in front of them-even if that patient has
previously been treated elsewhere.

 

"It helps them with the reimbursement and being more appropriate with the
reimbursement," Watson said.

 

California's privately funded, multi-payer exchange is unique compared to
other state efforts. New York comes closest with its publicly funded health
information exchange. North Carolina may also soon pass legislation that
will mandate an information repository for its Medicaid population.

 

The exchange will include sophisticated analytical tools, including Apache
Cassandra, a data management system that stores cloud-based data and can
handle real-time datasets. Cal Index is also using tools such as Spark and
Elastic so that data analysis can be performed at "Google-like speeds," as
soon as new data is entered, said David Bennett, executive vice president of
product and strategy at Orion Health.

 

Orion Health is working with Cal Index on the technology component of the
platform.

 

"It's supporting what you can do today as well as what you can do tomorrow,"
Bennett said.

 

Orion and Cal Index gave a presentation about the project at the Healthcare
Information and Management Systems Society convention in Las Vegas Tuesday.

 

Health systems and insurers are currently limited to their own data when
they want perform analyses.

 

"That's not a way to rapidly scale and change the healthcare delivery
system," said Blue Shield CEO Paul Markovich. "If you can create this
integrated data exchange on an open source platform, the platform becomes a
bit like the iPhone is for apps. Now you have the potential for innovations
coming from Silicon Valley and other places."

 

 

 

Jeff Wells
Deputy Editor, CAL/AAEM News Service

 

Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service



Contact us at:  <mailto:calaaem.news.service1 at gmail.com>
calaaem.news.service1 at gmail.com

For more articles, visit our  <http://www.calaaem.org/news_archives.php>
archives. 

 <mailto:somcaaem at uci.edu> To
<https://maillists.uci.edu/mailman/listinfo/calaaem>  unsubscribe from this
list, visit our mail server.

Copyright (C) 2015. The California Chapter of the American Academy of
Emergency Medicine (CAL/AAEM).  <http://www.calaaem.org>
http://www.calaaem.org. All rights reserved.

CAL/AAEM, a nonprofit professional organization for emergency physicians,
operates the CAL/AAEM News Service solely as an educational resource for
physicians. Dissemination of an article by CAL/AAEM News Service does not
imply endorsement, agreement, or recommendation by CAL/AAEM News Service,
CAL/AAEM, or AAEM.



Follow CAL/AAEM on Facebook and Twitter:

 

 <http://www.facebook.com/pages/CalAAEM/172577489479442?sk=wall&filter=12>
<https://twitter.com/#!/CALAAEM>
<http://escholarship.org/uc/uciem_westjem> 

 



---
This email has been checked for viruses by Avast antivirus software.
https://www.avast.com/antivirus
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://maillists.uci.edu/pipermail/calaaem/attachments/20160315/6dd50713/attachment-0001.html>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image009.jpg
Type: image/jpeg
Size: 24675 bytes
Desc: not available
URL: <http://maillists.uci.edu/pipermail/calaaem/attachments/20160315/6dd50713/attachment-0004.jpg>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image010.jpg
Type: image/jpeg
Size: 877 bytes
Desc: not available
URL: <http://maillists.uci.edu/pipermail/calaaem/attachments/20160315/6dd50713/attachment-0005.jpg>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image011.jpg
Type: image/jpeg
Size: 819 bytes
Desc: not available
URL: <http://maillists.uci.edu/pipermail/calaaem/attachments/20160315/6dd50713/attachment-0006.jpg>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image012.jpg
Type: image/jpeg
Size: 1823 bytes
Desc: not available
URL: <http://maillists.uci.edu/pipermail/calaaem/attachments/20160315/6dd50713/attachment-0007.jpg>


More information about the CALAAEM mailing list