Albert Tzeel1, Victor Lawnicki2, Kim R Pemble3. 1. National Medical Director, HumanaOne, and Clinical Leadership & Policy Development, Humana, Milwaukee, WI. 2. Econometrician, Business Intelligence & Informatics Competency Center, Humana, Louisville, KY. 3. Executive Director/CEO, Wisconsin Health Information Exchange, Mequon, WI.
Abstract
BACKGROUND: As emergency department utilization continues to increase, health plans must limit their cost exposure, which may be driven by duplicate testing and a lack of medical history at the point of care. Based on previous studies, health information exchanges (HIEs) can potentially provide health plans with the ability to address this need. OBJECTIVE: To assess the effectiveness of a community-based HIE in controlling plan costs arising from emergency department care for a health plan's members. Albert Tzeel. METHODS: The study design was observational, with an eligible population (N = 1482) of fully insured plan members who sought emergency department care on at least 2 occasions during the study period, from December 2008 through March 2010. Cost and utilization data, obtained from member claims, were matched to a list of persons utilizing the emergency department where HIE querying could have occurred. Eligible members underwent propensity score matching to create a test group (N = 326) in which the HIE database was queried in all emergency department visits, and a control group (N = 325) in which the HIE database was not queried in any emergency department visit. RESULTS: Post-propensity matching analysis showed that the test group achieved an average savings of $29 per emergency department visit compared with the control group. Decreased utilization of imaging procedures and diagnostic tests drove this cost-savings. CONCLUSIONS: When clinicians utilize HIE in the care of patients who present to the emergency department, the costs borne by a health plan providing coverage for these patients decrease. Although many factors can play a role in this finding, it is likely that HIEs obviate unnecessary service utilization through provision of historical medical information regarding specific patients at the point of care.
BACKGROUND: As emergency department utilization continues to increase, health plans must limit their cost exposure, which may be driven by duplicate testing and a lack of medical history at the point of care. Based on previous studies, health information exchanges (HIEs) can potentially provide health plans with the ability to address this need. OBJECTIVE: To assess the effectiveness of a community-based HIE in controlling plan costs arising from emergency department care for a health plan's members. Albert Tzeel. METHODS: The study design was observational, with an eligible population (N = 1482) of fully insured plan members who sought emergency department care on at least 2 occasions during the study period, from December 2008 through March 2010. Cost and utilization data, obtained from member claims, were matched to a list of persons utilizing the emergency department where HIE querying could have occurred. Eligible members underwent propensity score matching to create a test group (N = 326) in which the HIE database was queried in all emergency department visits, and a control group (N = 325) in which the HIE database was not queried in any emergency department visit. RESULTS: Post-propensity matching analysis showed that the test group achieved an average savings of $29 per emergency department visit compared with the control group. Decreased utilization of imaging procedures and diagnostic tests drove this cost-savings. CONCLUSIONS: When clinicians utilize HIE in the care of patients who present to the emergency department, the costs borne by a health plan providing coverage for these patients decrease. Although many factors can play a role in this finding, it is likely that HIEs obviate unnecessary service utilization through provision of historical medical information regarding specific patients at the point of care.
Authors: George Hripcsak; Rainu Kaushal; Kevin B Johnson; Joan S Ash; David W Bates; Rachel Block; Mark E Frisse; Lisa M Kern; Janet Marchibroda; J Marc Overhage; Adam B Wilcox Journal: J Biomed Inform Date: 2007-08-30 Impact factor: 6.317
Authors: J Marc Overhage; Paul R Dexter; Susan M Perkins; William H Cordell; John McGoff; Roland McGrath; Clement J McDonald Journal: Ann Emerg Med Date: 2002-01 Impact factor: 5.721
Authors: Zachary M Grinspan; Erika L Abramson; Samprit Banerjee; Lisa M Kern; Rainu Kaushal; Jason S Shapiro Journal: AMIA Annu Symp Proc Date: 2013-11-16