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ACO participation may force hospitals to play nice in HIE sandbox

BOSTON – An interesting side effect of accountable care organization (ACO) participation could be that it forces currently competitive hospitals to cooperate with health information exchange (HIE) to get paid, said Larry Yuhasz, Director for Strategy and Business Development, Truven Health Analytics (formerly Thomson Reuters Healthcare) at the Medicaid Enterprise Systems Conference.

Hospitals who now don’t cooperate with each other- often for competitive reasons that sometimes run contrary to their patients’ best interests – will be forced to work together. Otherwise they won’t be able to aggregate data on quality measures, report it to payers, and collect ACO revenue. Period. Health information exchange (HIE) will have to happen whether the hospitals want it or not.

“It’s true, many hospitals and integrated delivery networks, they don’t want to let go of their data, they want to keep their data close to the vest,” Yuhasz said. “Sharing data…is kind of a concern for them until, of course, they are a part of an [ACO] – where they are accountable for knowing what happened to their patients when they leave their four walls. Since they don’t have to deal with that yet, they’re [still] holding that data close to the vest. But eventually, that may be liberated.”

Like a growing chorus of health care thought leaders, Yuhasz sees the economics of the present health care system – combined with a large population of baby boomers getting older and sicker in the coming years — as spelling doom for the present fee-for-service model. It’s so doomed that ACOs or some payment model will have to replace it, he feels.

That’s good news for HIEs, too, he points out. Right now, as grant funding runs out for state HIEs and other exchanges, they’re looking for new revenue streams in order to just survive – let alone add infrastructure as more docs come online with EHRs and must pipe their patient data into the HIEs to reap federal incentives. Providing payers and providers with needed data exchange in order to pay and get paid in the ACO universe, Yuhasz thinks, could provide desperately needed income for those HIEs.

And the side effect of all that, if his crystal ball proves correct? Patients will benefit from the free flow of their data between providers whether or not they happen to be competing hospitals.

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#ACO participation may force hospitals to play nice in #HIE sandbox #MESC2012 http://t.co/4BSMeejF
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#ACO participation may force hospitals to play nice in #HIE sandbox #MESC2012 http://t.co/4BSMeejF
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What do you think? #ACO participation may force hospitals to play nice in #HIE. http://t.co/rRyfqMSq
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Don't think hospitals are the problem here... #ACO participation may force hospitals to play nice in #HIE. http://t.co/1fzMhVBi
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Don't think hospitals are the problem here... #ACO participation may force hospitals to play nice in #HIE. http://t.co/1fzMhVBi
Cancel
What do you think? #ACO participation may force hospitals to play nice in #HIE. http://t.co/rRyfqMSq
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Don't think hospitals are the problem here... #ACO participation may force hospitals to play nice in #HIE. http://t.co/1fzMhVBi
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