Electronic Health Reporter

The healthcare system is in the midst of a dramatic revolution, driven by requirements in the Affordable Care Act, and made possible by recent innovations in information technology. Leveraging cutting-edge technology solutions to create healthcare sharing and care-connected communities is key to enhancing patient experiences, improving clinical outcomes, and reducing healthcare-related costs.

Dr. R. Corey Waller of Spectrum Health Center for Integrative Medicine (Grand Rapids, Michigan) and Douglas Dietzman, Executive Director of Great Lakes Health Connect (GLHC), co-facilitated a discussion this past week at the 2016 Healthcare Information and Management Systems Society (HIMSS) conference demonstrating how Spectrum is harnessing health information exchange (HIE) technology to coordinate care for vulnerable complex patients within its emergency departments and other population groups.

Vulnerable complex patients are individuals who seek treatment in the emergency department setting ten or more times annually These individuals often do not have a primary care physician, and may have undiagnosed psychological or substance abuse disorders, or lack stable housing, or dependable transportation. These individuals may also be seeking care at multiple healthcare provider locations.

“Care coordination can significantly enhance an individual’s health outcomes while at the same time resulting in fewer medical tests,” says R. Corey Waller, MD, MS. “By leveraging information that is readily available in the GLHC patient registries and through solutions such as the Virtual Integrated Patient Record (VIPR), Spectrum providers are able to access data from other health entities, in addition to our own electronic health record database.”

According to a recent Agency for Healthcare Research and Quality (AHRQ) report, more than half of all healthcare costs in the United States can be attributed to just five percent of the patients who seek care annually. As an emergency physician, Dr. Waller has experienced this phenomenon first-hand. In 2008, he identified a group of patients who frequently visited the ER for non-emergent treatment or management of chronic health conditions such as Diabetes, hypertension, or asthma.

Medicare and Medicaid participants represent the majority of complex patients in Grand Rapids and across the nation. With the expansion of insurance coverage under the Patient Protection and Affordable Care Act, the need to demonstrate effective care modeling is more critical than ever.

One of the greatest barriers was developing a new care model in the midst of a fee-for-service system of payment. There are three major health systems in West Michigan and four hospitals offering emergency services. In 2009, Spectrum Health, Trinity Health and Metro Health came to an agreement to cooperatively participate in clinical data exchange, laying aside their competitive interests to improve the overall health of the communities they serve. There was no prior precedent for an agreement of this kind.

The inception of HIE capabilities and the area hospitals’ collaborations with GLHC offered the solutions needed to develop a care-connected healthcare delivery model that allowed for data sharing between the competing hospitals. This new model is also supported through strategic relationships with community-based social service organizations.

The Center for Integrative Medicine has been treating nearly 900 patients each year. Among this population, 84 percent have had a substance abuse disorder; 90 percent were diagnosed with a psychiatric illness; and more than 95 percent reported some form of early life trauma. In just its first year of existence, Spectrum Health saw a 65 percent reduction in ER admissions. Working collaboratively with the various stakeholders and GLHC, the Center has identified approximately 2,200 additional patients who could benefit from care coordination and enhanced care planning.

The value of HIE is realized when it contributes to the care provider’s ability to facilitate communication and enhance overall care coordination. “At the Center for Integrative Medicine, we use HIE to gain a wider perspective about our patients and work towards identifying how we, as a system, can assist in getting that person into a preventative and/or management role related to their health versus the crisis management stage related to symptoms and illness,” says Dr. Waller. “Our registration department also works with doctorless or uninsured individuals to help them establish a patient-physician relationship where they receive routine screenings, ongoing assessment and disease management referrals and with obtaining insurance coverage to assist with medical expenses.” Engaging patients through the Center for Integrative Medicine resulted in a 72 percent reduction in ER visits over a two-year period, equating to a cost reduction of $28 to $36 million dollars.

“Recent and planned innovations in HIE to promote data sharing are changing the way healthcare providers deliver care,” says Dietzman. “Collaboration across disciplines and organizations, facilitated by access to seamless and secure electronic patient data is demonstrating that the Triple Aim goals of enhanced patient experience, improved outcomes, and reduced healthcare costs are achievable.”

About Great Lakes Health Connect:

Great Lakes Health Connect (GLHC) is among the leading providers of health information exchange services in the nation. Based in Grand Rapids, Michigan, GLHC is the largest provider of health information exchange in Michigan connecting 128 hospitals and more than 4,000 primary, specialty and allied care practices statewide. Great Lakes Health Connect securely and seamlessly facilitates the transmission of more than 1 billion message transmissions each year for more than two-thirds of Michigan’s residents. The community-based nonprofit is dedicated to improving the quality and accessibility of healthcare information for more than 6.5 million patients. For more information, visit GLHC online at www.gl-hc.org.