Better Care at Reduced Costs? A Real-Life Example!

The results of a recent peer-reviewed study conducted by Humana Inc. and Wisconsin Health Information Exchange (WHIE), a long-time Amalga customer, are both exciting and important.

They’re exciting because the results begin to prove what many people involved with health information exchanges have long theorized –  that providing a more complete view of a patient’s medical history at the point of care helps doctors make more informed decisions that can improve the quality of care while reducing waste. Humana and WHIE achieved an average cost savings of $29 per emergency department (ED) visit when doctors queried the WHIE for information about the patient’s medical history upon registration. Redundant testing represents a huge strain on the healthcare system, and as the study demonstrates, can be reduced when ED clinicians have the right information at their fingertips. This degree of savings, if extrapolated across all of the emergency encounters in the country (120 million per year), could potentially yield $3.5 billion in savings annually. You can learn more about how these savings were achieved by reading a blog from Ed Barthell, MD, director, Microsoft Health Solutions Group.

The study results are important because they demonstrate the power of the public and private sector working together to drive greater efficiency and value in the healthcare system – by enabling an open, secure exchange of data. From the beginning, WHIE leaders recognized that the exchange needed to focus on the ends – rather than the means – of health information exchange: improved care of individual patients and data to support initiatives to provide better care across populations.  WHIE implemented Amalga to support a regional data aggregation strategy as a core component of the solution – in contrast to many other HIEs that concentrate only on point-to-point messaging.

In addition, aligning innovation across health IT and business, WHIE and Humana were able to establish a symbiotic relationship that can serve as a model for state and community HIEs across the country – a model that benefits the payer, the provider, the patient, and the public. Specifically, WHIE and Humana have shown:

• Health plans can reduce their costs by partnering with emergency departments to use health information exchange to access patient information at the point of care.  
• Providers can reduce the cost of caring for uninsured patients – and might also share some of the savings. In addition, providers can benefit from unlocking data, aggregating it, sharing it and learning from it – to provide care based on more complete information.
• Patients and their families can gain peace of mind knowing caregivers are coordinating care and making informed decisions – and not worry about piecing together their medical history in an emergency situation.

And, although it wasn’t covered in this study, the WHIE also demonstrates how a community-based HIE can help protect populations by allowing the near real-time analysis of cohorts and the ability to identify trends and epidemics as they emerge.

Perhaps most important, the Humana and WHIE study presents a model of sustainability for HIEs. If payers can realize a greater than 2:1 return incenting hospitals to use health information exchange, as Humana has, there’s reason to believe similar payer-provider partnerships can create sustainable HIEs across the country.  And, imagine how much progress we could make on ‘bending the cost curve’ if we liberated the data across the entire system?