Enterprise Software

Health information exchanges and health insurance exchanges make for complexity and excitement

First there was the buzz last year about the funding of health information exchanges state-by-state, and in recent weeks we have heard about even more funding for health insurance exchanges. Both require tremendous IT efforts in interoperability, meaningful use distinctions and execution, data analysis, privacy, and security. Both will then be integrated. It is repeated as gospel by our federal government and anticipated by all now, with some naysayers, of course.

From revenue cycle management to the electronic medical record to these exchanges is more than a little leap of faith and millions of dollars. At the low end of the mega-spending spectrum, we have hospital physician groups moving forward. Take University of Louisville Physicians, Inc., part of U of L Healthcare, which just spent $12 million alone to lay the technical infrastructure for its electronic medical records. And, by doing so, it takes the title of being "first" in the region to have its system fully operational. Eighty-one percent of hospitals and 41 percent of office-based physicians plan to achieve meaningful use requirements and take advantage of federal incentive payments (Source: ONC). These IT challenges fade in comparison to what is next.

Moving along stateside to the health information exchanges and now the health insurance exchanges, we see the sheer volume of capital just beginning. The anticipated expense announced last week just for the early adopters of health insurance exchanges was $241 million by the U.S. Health and Human Services, for Kansas, Maryland, New York, Oklahoma, Oregon, Wisconsin, and a consortium of New England states. Under the federal reform law, states are required to have health insurance exchanges operational by 2014 or the HHS will create them. Alaska has decided to go it alone, presumably with its own trustworthy programmers, but will they be left out in the cold? By law, states can even have two insurance exchanges — one for small group markets and one for individual markets.

Indiana has determined that it should engage Deloitte Touche to do a gap analysis first, according to Logan Patrick Harrison, Director of Health Insurance Reform & PIO in Indiana. He recently spoke on a panel discussion for One Southern Indiana, a local chamber, saying that "the amount of technology that has to support employers, and the insurance side alone will be mind-boggling." His example was for the immigrant: integration from immigration services via IRS to the Department of Work Force Development to Family and Social Services, then to find out if they qualify for Medicaid. "If anyone in IT can figure out how to do that, you will make a lot of money," he said.

Companies like Louisville-based Healthland, a market leader for electronic medical records at rural hospitals, agree enough to jump in and participate in the new Health Information Trust Alliance (HITRUST) mobile device working group formed this month. HITRUST continues to gain attention because it offers collaboration industry-wide regarding the Common Security Framework (CSF), a certifiable framework to exchange or store personal health and financial information. CSF is currently the most widely adopted security control framework on the U.S. block.

Ladies and gentlemen start your engines. We know it is going to be many laps and predictions from four years to a decade before true IT solutions come together for an interoperable health system, according to a recent HealthLeaders' annual industry survey, but, oh, the journey. The same survey indicated that 28% of healthcare technology leaders are already sharing data with one or more competitors and another 61% said they intend to do so.

Let's hear it for job security. According to Paul Keckley, Executive Director, Deloitte Center for Health Solutions, "Health care is central to both: while the overall economy slipped 1.1 percent last year, the health care industry grew four percent. And during the downturn, while 8.4 million jobs were lost, health care employment grew 800,000."

Proposed rules on healthcare insurance exchanges are anticipated from HHS/OCIIO (Office of Consumer Information and Insurance Oversight) in March of this year. While the general public often exhibits fear, healthcare IT professionals thrive on chances to innovate, as is evidenced at HIMSS 2011 with the top attendance of 30,000 plus since 2008.

Dr. Farzad Mostashari, deputy national coordinator for programs and policy at the Office of the National Coordinator for Health Information Technology at HHS, pointed out in his opening remarks at HIMSS that "threat is not a political threat. The real threat is that we don't show value." He spoke to what people will say about the financial spend of the American people.

There's only one way to go from here, and that's up the scale of abstraction into a living, breathing healthcare system of the future. You will be a part of it — one way or another.

About

Dawn Yankeelov, president of Aspectx, is a strategic planning consultant in the areas of marketing, PR, and competitive analysis for the healthcare and IT fields.

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