A pair of California health information exchanges with strong links to three of the state's top 10 health insurance plans have merged. Claudia Williams from the HHS and the Obama White House will lead the yet unnamed organization.
The merger, pending approval from the California attorney general's office, will combine the newer California Integrated Data Exchange, formed in 2014 by Anthem Blue Cross and Blue Shield of California, and the Inland Empire Health Information Exchange, conceived in 2009.
Anthem Blue Cross, with 5.7 million members, is second behind Kaiser (7.4 million members) among the top Golden State health plans. Blue Shield ranks third with 3.4 million members, and Inland Empire Health Plan, ninth, with 1.2 million members, according to 2015 data from the California Healthcare Foundation. Two smaller payers, the Health Plan of San Joaquin (349,000 members) and the Partnership HealthPlan (550,000 members) are also exchange participants.
Combined, the new entity will gather data from 43 hospital organizations and 30 medical groups or independent practice associations and have access to records of more than 16 million patients.
Williams, 53, joined President Barack Obama's staff in 2012, most recently serving as senior advisor for health technology and innovation. Before that, she worked under Dr. David Blumenthal and Dr. Farzad Mostashari, heads of the Office of the National Coordinator for Health Information Technology at HHS, where she oversaw the $500 million nationwide health information exchange development program.
The industry's shift toward value-based reimbursement models requires a patient-centered, longitudinal look at information and the ability to provide data when and where it's needed — whether that's at a physician's or care coordinator's office.
“All of them require a view of healthcare beyond the walls of the hospital,” Williams said.
Williams said she'll start at her new job next month, bringing the new, not-for-profit organization together and identifying the products and services it will offer.
Despite its reputation for sunshine and fertile soil, California has had a chronic problem growing healthy HIEs.
That dates back to the Santa Barbara Regional exchange, which launched with fanfare in 1998 but folded quietly in 2006, and runs through the collapse of CalRHIO in 2010.
Dr. Bradley Gilbert, CEO of Inland Empire Health Plan, and board chairman of the Inland Empire HIE, said unlike predecessors that ran until their grant funding dried up, Inland Empire HIE knows how to operate in the black by providing customers the services they're willing to pay for. Those include alerts from hospitals to primary care physicians that one of their patients has been admitted, transferred or discharged; connections between providers and pharmacies; and links between docs and local hospital labs as well as large reference labs.
“We're still not there yet,” when it comes to total clinical data exchange, from one physician's EHR to another, Gilbert said.
Cal Index was launched in August 2014 with an $80 million commitment from its two Blues founders. Its leaders said the not-for-profit HIE, after three years, would be financially self-sustaining through subscription fees paid by its members.
With the merged exchange, a fee schedule for member services has not yet been set, but it's likely all participants would be asked to pay something, said Paul Markovich, president and CEO of Blue Shield at a press conference launching the merger.
Making healthcare data readily available “is absolutely foundational” to his company's need to help provide Californians access to quality healthcare at a reasonable price, Markovich said.