The goal of achieving a financially sustainable HIE infrastructure within a state does not end with implementation. State-level HIEs must address the ongoing challenges of sustaining the infrastructure for interoperability. A recent report articulates some strategies for HIE sustainability.
State officials will need to focus on incentives for exchanging data from EHRs to achieve cost and efficiency benefits when moving to an electronic health care environment. State leaders will also need to establish dedicated revenue sources for long-term HIE operations minimally within state programs and may need to assist with broader statewide functionality.
The most critical challenges to achieving a financially sustainable HIE are the lack of financial incentives and the question of which entities benefit from the HIE and which bear the costs. Implementation of EHRs and HIE will have value, but the majority of the benefits will come through improvements in care and better health outcomes and cost efficiency.
State-level HIEs must deliver value to their customers by reducing costs or creating revenue generation opportunities. It is important for state-level officials to work with the health care industry to develop a sustainable business model. Developing an inclusive structure with stakeholder participation will result in a sense of ownership and inclusion and financing mechanisms that ensure the financial sustainability of HIE.
There are several potential methods to finance HIE including:
|Transaction Fee||Data providers or data users pay pre-negotiated fees to the HIE based on transactional volume. A nominal one-time start-up fee may be charged.|
|Subscription Fee||Data providers or users may pay fees to the HIE on a subscription basis in the form of annual membership, monthly subscription or specific set of fees for services consumed.|
|Transaction or Subscription Fee with Value-Added Service Fee or Gain Sharing||Data providers or data users pay a Transaction Fee based on volume or a Subscription Fee, and there are additional fees for Value-Added Services, such as report cards, dashboard analytics. This option may be more complex to administer, and may be perceived by providers as a disincentive for adoption depending of level of fee and value of additional services.|
|Insurance / Medical Claim Assessment Fee1||Some states have legislative authority to collect a fee that is used to fund grants for HIT/HIE initiatives. Such a fund can be used for direct grants or to match federal funds available through both ONC and CMS to provide for statewide development of the HIE infrastructure. This option requires legislative authorization.|
1 Pursuant to 32 V.S.A. chapter 241 § 10301, Vermont collects a fee (2.10ths of 1 percent) on insurance claims, which generates annual revenues for the state HIT Fund, which provides grants to support HIT/HIE. The Fund is scheduled to sunset in 2015. 32.