Michigan Blues Joins Statewide Health Information Exchange

State's dominant insurer seeks clinical and administrative data for care management and reporting to state health insurance exchange.
6 HIE Vendors: How They Measure Up
6 HIE Vendors: How They Measure Up
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Blue Cross Blue Shield of Michigan (BCBSM), the largest private health insurer in Michigan, has joined the statewide health information exchange (HIE), known as Michigan Health Information Network Shared Services (MiHIN). It is the first insurer in the state to do so, and one of only a few health plans across the nation to achieve this level of involvement with a health information exchange.

MiHIN binds together the state's Department of Community Health, the South East Michigan Beacon Community, and six "substate" HIEs. Those include Great Lakes Information Exchange, based in East Lansing; Ingenium, based in Jackson; Jackson Community Medical Records (JCMR), based in Jackson; Michigan Health Connect, based in Grand Rapids; Southeast Michigan Health Information Exchange, based in Ann Arbor; and Upper Peninsula Health Information Exchange, based in Marquette.

MiHIN executive director Tim Pletcher said in a news release, "BCBSM is helping pioneer the next phase of health information exchange in Michigan. With the inclusion of health plans in Michigan's statewide network, the opportunities for better care coordination rapidly accelerate."

BCBSM has participated in MiHIN for four years and has had a representative on the statewide HIE's board, noted Richard Boehm, a director in BCBSM's IT organization, in an interview with InformationWeek Healthcare. "What's new is that we contractually signed up to be a qualified data sharing organization, which means we now have a pipe between us and MiHIN."

[ How can the healthcare industry encourage interoperability? Read National Health Information Exchange: Why The Delay? ]

Initially, the insurance company plans to use this access to data flowing up from the substate HIEs through MiHIN to improve utilization and care management. For example, BCBSM has begun receiving admission, discharge and transfer (ADT) information from Michigan hospitals. The health plan will use this data to analyze how its resources are being used. It also intends to alert primary care doctors when one of their patients is discharged from the hospital so they can follow up.

One large substate HIE, Michigan Health Connect, is already doing this, Boehm pointed out. "If a PCP is on the discharge record, they route it to them and it ends up in that physician's mail box. Some of that routing is already occurring. We're trying to get it to happen on a much broader scale."

BCBSM would also like to gain access through MiHIN to clinical data from hospitals and physician practices, he noted. For example, the health plan can already obtain lab results from reference labs, but it would like to get data from hospital labs.

Outside of care management, BCBSM, like other health insurers, faces new reporting requirements to participate in the state health insurance exchanges that are scheduled to start up next year. In Michigan, Boehm noted, the pool of money available to pay insurers from the exchanges will be distributed partly on the basis of how sick each health plan's members are. So BCBSM must provide information on the health of its members. Some of that is available in claims data, but clinical data can provide a much more accurate picture.

BCBSM provides some claims data to physician groups and accountable care organizations (ACOs) in Michigan, Boehm said. But it has no current plan to make such data available through MiHIN.

The company did not want to make separate contractual arrangements for clinical data with the substate HIEs, but it believed that connecting with the statewide HIE would deliver the benefits it sought. "We believe that MiHIN has matured to the point where it makes sense to deal with just one organization and have them be the connection point to the substates, who connect to the caregivers," said Boehm.

Other insurers in Michigan will probably reach the same conclusion, he said, adding that he believes some of them are in discussions with MiHIN.

Nationwide, other insurers have also been involved in forming HIEs, and some are viewing the information in them, according to the 2012 HIE report of the eHealth Initiative. Nearly half of the 107 HIE initiatives that responded to the eHI survey said that private payers were involved in their governance. But payers provided data to or received data from fewer than 10% of these HIEs.

Boehm believes that will change as insurers become more proactive about care management and as they start working more closely with provider groups. In addition, he observed, they all face the same reporting requirements in the state health insurance exchanges, and HIEs can help them meet those.

Regulatory requirements dominate, our research shows. The challenge is to innovate with technology, not just dot the i's and cross the t's. Also in the new, all-digital The Right Health IT Priorities? issue of InformationWeek Healthcare: Real change takes much more than technology. (Free registration required.)