HIEs take on data aggregator role for CPC+ program

Health information exchanges in select markets across the country are providing data aggregation and reporting services to help transform and improve primary care in the United States.

Western New York is one of the regional markets selected to participate in Comprehensive Primary Care Plus (CPC+), an initiative established by the Centers for Medicare and Medicaid Services, which is aimed at providing better healthcare outcomes and paying doctors for achieving those results through regionally based multi-payer payment reform and care delivery transformation.

As part of the program, BlueCross BlueShield of Western New York recently announced a partnership with HEALTHeLINK—the local HIE connecting hospitals, physicians, and payers in the greater Buffalo, N.Y. area—to support providers and improve health outcomes for the payer’s members.

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“The claims are coming in in support of some population health analytics and measures,” says Dan Porreca, executive director of HEALTHeLINK. “It stems from Western New York being designated as one of the CPC+ communities.”

According to CMS, there are currently nearly 3,000 primary care practices participating in CPC+ in 18 regions throughout the country. The agency has partnered with commercial and state health insurers to support practices in delivering this advanced primary care under the program.

“The payers associated with the initiative defined the need for a data aggregator, and that’s the role HEALTHeLINK will play,” Porreca adds. “In our role as the data aggregator, CMS will also make their fee-for-service Medicare claims available to us with the intent of having a consistent set of measures evaluated in a uniform way. We are working towards that (with prime contractor Deloitte Consulting). We have to go through a process and we’re in the midst of that.”

By providing this kind of claims data aggregation for participating health plans, as well as utilization, cost and quality measures, HIEs in the data aggregator role are meant to ensure that the performance of participating primary care practices are being accurately reported to determine incentive payments.

“We have the technology in place, an analytics tool which we brought on in the last six months, to help us do the measures calculations,” Porreca says.

In particular, HEALTHeLINK will be using the NextGen Population Health and Analytics Solutions (formerly EagleDream Health), which leverages clinical, financial, claims and patient-derived data, aggregating it into a unified view of the entire patient population as well as statuses and trends of individual patients.

This aggregated data enables clinicians to get an overall snapshot of their patient population to identify care gaps and target areas for improvement.

“We’re big believers that HIEs, given the nature of what we do and the depth and breadth of data that we have, are in a unique position to support population health and quality measures for their communities,” adds Porreca, who is also chairman of the board of the Strategic Health Information Exchange Collaborative, a national HIE trade association.

According to Porreca, the increasing role of HIEs to provide these kinds of “value-add” services are part of an emerging trend that will continue to grow across the country.

“We’re not replacing services—all of this is additive, it just takes different skills,” he concludes. “While this is still in the beginning stages, you’d be hard pressed to have any other type of organization better situated. We’re very fortunate here in Western New York to have some forward-thinking stakeholders.”