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Business Intelligence: The First Product for RHIOs

Regional Health Information Organization (RHIO) membership could be one of the most important developments in your organizational strategy, and getting ahead of the analytical curve is one of your best strategic moves.

This article originally appeared on the BeyeNETWORK

Regional Health Information Organizations (RHIOs) are forming at a remarkably rapid rate across the country. Two years ago, there were fewer than a dozen of these organizations in the formative stages. A year ago, there were approximately 110 RHIOs. At last count, there were just over 200.

What is a RHIO?
As the name implies, a RHIO is a group of healthcare organizations banding together in a region such as a state, a group of counties, a geographic area or one or more municipalities. There is no single model for a RHIO. Typically, they are a combination of hospitals, physician organizations, clinic groups, health plans, research organizations, labs and major employers in the area. Like families, RHIOs come in all shapes and sizes, and are made up of different types of members based on the needs of the particular area.

The reason for forming such organizations is implied by their name – to share and make better use of their combined healthcare information. This combined information is used to improve the quality of healthcare, measure provider performance (clinical and financial) and provide public reporting to help purchasers, payers, patients and consumers make informed healthcare choices.

The RHIO movement grew out of the Community Health Information Network (CHIN) movement of the early 1990s, and is being driven by the intense pressure being applied to all participants in the healthcare industry. These healthcare industry participants are all trying to provide the highest quality healthcare for their various constituencies, while still making business sense in terms of cost-effective care. In many respects, the CHIN movement might have simply been ahead of its time. Plus, the focus of the CHIN was directed toward achieving public-oriented community health goals, whereas the RHIO is more oriented to achieving clinical and financial goals. For this reason, the time is perfect for RHIOs in the United States.

The First Step Toward a National Healthcare Information Network
But the RHIO itself is not the top of the pyramid. Individual RHIOs are viewed as the basis for a National Healthcare Information Network (NHIN) envisioned by the federal government as well as major healthcare and non-healthcare business leaders. The impetus for a NHIN is the lack of consistency in patient care, safety, cost, effectiveness and quality across the United States.

A single, national organization and information repository is simply too big to be successfully formed and run. The development of RHIOs at state and local levels is seen as the first step toward the development of the NHIN. In essence, the NHIN will be a federation of federations. Given the volume of transactions and information flowing through even the smallest of RHIO members, the eventual magnitude of the NHIN will be enormous.

Key Issues in RHIO Formation
Forming a RHIO is itself no small task. Several studies and evaluations of the relatively brief history of RHIO formation indicate that there are four key issues in their development:

  • A viable business model. The major issue here is determining how to fund the organization. There is a very real imbalance in who will benefit most from the RHIO (purchasers and payers will benefit the most as well as the fastest) and who will have the largest relative investment (providers will have the greatest upfront investment in terms of data input as well as technology investment). Patients are seen as the key beneficiary in this movement, so it would make sense that they should help pay for it. But, patients find it difficult to see the value of paying for something they assume should be in place already (i.e., that healthcare organizations work together and share information that is important to their health needs).

  • A viable governance model. Determining how the RHIO will be organized and how priorities will be set is another key issue. It is difficult enough to govern an individual healthcare organization where most of the people have the same basic mission and goals. For instance, a provider organization provides care and makes decisions based on this mission. Payers pay claims, and so forth. RHIOs, by contrast, are made up of a group of diverse businesses, most of whom have different missions, goals and agendas. In addition, many are direct competitors, which further complicates matters. On the other hand, healthcare organizations of all types have been forming various sorts of business combinations and alliances for decades, so models do exist to help solve this issue.

  • Sustainable value proposition. The key form of value that RHIOs provide is the sharing (primarily by members, but also by the public) of patient-level data for operational and analytical purposes. Currently, eighty percent of the work of RHIOs is standardizing the data requirements and improving the efficiency and consistency in sharing this data. The other twenty percent of the work of RHIOs is currently in the form of using the aggregated data for analytical purposes, such as quality reporting, performance and pricing comparisons, and safety and satisfaction trends. This ratio will flip in the future as the information flows become more efficient and the analytical needs grow in importance. The leaders in RHIO formation see this coming and are already thinking about how to maintain a high level of value throughout the life of the organization. This is one area where business intelligence can provide significant value to RHIOs.

  • Achievable technical architecture. As stated earlier, the number of transactions expected to flow through a RHIO is estimated to be enormous, as is the complexity of the data records. Several models for the data architecture have been proposed, from a distributed model (go get data when called for) to a centralized model (keep all of the data in a single repository). The first architecture is similar to the way law enforcement agencies collaborate, by sharing information with each other as needed. The latter architecture is similar to the way the federal government clears financial transactions through large clearinghouse repositories. Both extremes have significant limitations, so hybrid models have been increasing in popularity.

Business intelligence can help most with one of these four key issues, namely providing sustainable business value to the RHIO’s members.

Business Intelligence is a RHIO’s First Product
A sustainable value proposition for any organization relies on offering a product that has immediate impact, but also grows as customer needs change. One of the key issues in RHIO formation is creating a model for sustainable business value. As stated earlier, the focus right now is improving the efficiency of getting operational data in the right place at the right time. In other words, the goal is to get patient data across the organizational borders. As improvements are made in the networks for sharing data, this focus will shift to the analytical uses of this data.

Business intelligence in the form of aggregated data for a variety of clinical, financial, administrative and research purposes is the first product of a RHIO, and the most viable means by which a RHIO can provide long-term value for providers, payers, purchasers and universities as well as patients and consumers themselves.

The customers for this product (aggregated data) include:

  • Purchasers. To understand patterns and trends in the quality and cost of the healthcare they are buying. This information can be normative or it can pertain to an individual organization. Both would be valuable.

  • Payers. To understand the same patterns and trends so they can provide the greatest value to their clients in terms of efficiency, protection and cost-effectiveness.

  • Providers. To understand the patterns and trends in the care they are providing and how their care measures compare to their peers and to industry averages. They can also see how their patient populations are doing in terms of wellness and preventative measures across employers and demographic dimensions. In addition, a new concept is emerging – the development of payer and even purchaser scorecards. During the past few years, providers have been hounded to provide measures of their performance (treatments, outcomes, costs, etc.). Now, these providers are turning the tables to evaluate payers in terms of speed of paying claims, efficiency in adjudicating those claims, timeliness of settling disputes and so on. This type of evaluation is likely to extend all the way back to the purchasers themselves in measures such as workplace safety, wellness programs, etc.

  • Researchers. Studies based on real-world clinical data present another valuable product of RHIOs, especially as these organizations get larger and more diverse. This value compounds if two or more RHIOs band together by providing a larger sample population on which to test hypotheses.

While the value today is in communicating operational data among members, the focus tomorrow will be on aggregating, reporting and manipulating that data for member use, as well as for public reporting purposes.

The key subject areas for analysis include:

  • Treatment and outcome effectiveness for the individual member and comparison to group averages.

  • Cost and efficiency performance (individual and group).

  • Service and access effectiveness (individual and group).

  • Standard quality measures for various types of provider organizations (hospitals, physician groups, specialty clinics, etc.).

  • Claims payment and claims processing efficiency.

  • Wellness, prevention and chronic condition management measures and their effect on reducing reactive forms of healthcare such as hospitalization, emergency room visits, etc.

  • Demographic trends and patterns.

There are literally dozens of measures and analytical uses for the aggregated data being provided by RHIOs. Which measures are developed and/or chosen depends on the healthcare issues and the makeup of the specific RHIO.

Next Steps
The RHIO movement is growing at a tremendous rate in response to the intense pressure on all participants in the healthcare industry for a good return on health dollars spent. If your organization is not already involved in a RHIO formation, it will be. It is usually better to be in the driver’s seat when it comes to a trend as strong as this one. And, a powerful way to lead a trend is with a powerful product.

The first product of RHIOs is aggregated data for analysis of trends and patterns at the individual member level and normative measures across the entire group. This is business intelligence, and this is the place to begin. Begin with your own analysis of what is effective and what is not. Begin with the analytical expectations of your patients, payers, purchasers, providers, consumers and government and public authorities. Develop your product, standard measures and aggregated data from those expectations.

RHIO membership could be one of the most important developments in your organizational strategy, and getting ahead of the analytical curve is one of your best strategic moves.

Thanks for reading!

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