Genia Fick, Vice President of Quality for the Inland Empire Health Plan (IEHP), recently updated Connecting for Better Health about the successful multi-year rollout of the plan’s data exchange pay-for-performance program for hospitals.
IEHP is one of the 10 largest Medicaid health plans and the largest not-for-profit Medicare-Medicaid plan in the country, serving more than 1.4 million residents in the Inland Empire and nearly 90%of Medi-Cal enrollees in the region. Fick gave a year-by-year summary of the first four years of incentivizing its network hospitals to participate in its Health Information Exchange (HIE) in an effort to better coordinate care across the region. The plan currently has 96% engagement from its hospitals, and Fick said this year, IEHP is introducing its pay-for-performance system for primary care providers. IEHP partners with Manifest MedEx for health information exchange with its provider network.
Fick shared a roadmap of the plan’s journey for hospitals, from launching data sharing to improve data quality and consistency, all of which she said is helping to improve patient care.
“What was happening in parallel was, as a health plan, we were looking to see how we could leverage this information to help support business operations and ultimately to improve the quality of care that’s being provided to our members,” Fick said.
In 2018, the first year of the program, the health plan sought to build awareness and learn more about data opportunities. Hospitals were required to sign participation agreements and meet certain basic data reporting standards. IEHP also introduced new post-discharge follow-up measure for hospitals – encouraging engagement with outpatient provider networks to help support safe care transitions.
The goals in the second year (2019), included improving data completeness and expanding to capture more data elements. The plan added new requirements that focused on consistency in reporting and introduced new requirements with incentives if providers began sharing data by key milestone dates. The IEHP began using HIE hospital data to support safe care transitions.
During year two, the hospitals began providing to IEHP staff access to their electronic medical records to “just fundamentally … see and check the data as we are learning more about the information that’s flowing in,” Fick said. “We wanted to see that the hospitals were consistently reporting throughout the entire measurement period.”
The third year (2020) focused on improving data completeness and actively monitoring data.
“We needed to get better at anticipating when problems may be happening,” Fick said. This required providers to actively share all required data elements consistently throughout the measurement period. The IEHP began sharing HIE hospital data with its primary care network, prompting for timely follow-up post-discharge care.
“Because the data is coming in real-time, it’s really helpful for us to be able to share that information in a much more timely way than if we were to be relying on claim data, which would have been 30 days in the past,” Fick said.
In year four (2021), the objective was to continue to improve data quality and expand on quality checks, using the measure that providers actively share all required data elements consistently throughout the measurement period. New data quality checks and standards were put in place as well, and the IEHP began the use of the rosters as a tool for effective management and performance to further promote timely follow-up post discharge care.
This year, year five for hospitals, the objective is to continue to partner with the hospitals to improve data quality and completeness, and to introduce the pay-for-performance program for primary care providers, Fick said.
While the system is working each year to make improvements, IEHP’s pay-for-performance program offers a great example of how data sharing can be implemented and its real-world benefits for patient care. The recipe for success is clear: create a performance program with use cases that provide value to providers; garner a critical mass of your providers onto your network; and then work to improve data quality.