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Insurers to pick up 60% of the bill for Pennsylvania’s newest HIE

9:25 am by | 4 Comments

Reduce Cost With Medical Billing

PHILADEPHIA, Pa. - When patients insured by Independence Blue Cross are discharged from the hospital, discharge reports are added to medical records at their primary doctors' offices less than 50 percent of the time.

It's a common example of the gaps in information-sharing among hospitals, doctors, and others in the health-care system.

In a bid to close such gaps, insurers IBC, AmeriHealth Mercy, and Health Partners and 37 of the 45 general acute-care hospitals in Southeastern Pennsylvania have teamed up to form a health-information exchange, which is expected to start this summer with a first wave.

Initially, HealthShare of Southeast Pennsylvania, which is chaired by Richard Snyder, chief medical officer at Independence Blue Cross, will allow insurers and health-care providers to send patients' discharge histories and medication information securely to the primary-care physicians and specialists responsible for picking up their care.


Longer term, the plan is that HealthShare will allow, for example, a hospital to pull patient information from a massive database to see whether someone in its emergency room with a heart problem was in another ER recently with the same issue.

That could speed care and help save money on duplicate tests at the 36 hospitals, which account for 90 percent of patient visits in this region. Information will be shared unless a patient opts out.

HealthShare's annual operating costs are expected to be about $2 million to start. The insurers will pay two-thirds, hospitals one-third, officials said. IBC has agreed to pay up to $650,000 annually for three years.

The organization's 11-member board will meet for the second time Feb. 27, when it will hear from two finalists for the contract to operate the system.

One is a partnership between NaviNet Inc. and Orion Health Inc. IBC is part-owner of NaviNet, and IBC executive Steven Udvarhelyi is NaviNet's chairman.

Snyder said he could not identify the other finalist.

Aetna, the second-biggest insurer in Southeastern Pennsylvania behind IBC, is not participating.

"Aetna is a national insurer, and we're looking at a wide range of health-information exchange options around the country," company spokesman Walter Cherniak Jr. said. Even so, information on Aetna customers will be in the system.

HealthShare is one of at least 11 health-information exchanges in Pennsylvania. The exchanges, and electronic medical records generally, were pushed by the American Recovery and Reinvestment Act of 2009, which allocated $19 billion nationally to help hospitals and doctors purchase electronic systems for medical records, as opposed to computer systems used for billing.

Though HealthShare is off to a later start than most of the other health-information exchanges -- not to be confused with health-insurance exchanges -- in Pennsylvania, it has a key advantage, some industry observers said.

"This is a rare model, to have both the plans and the providers at the table. It's unique, and unique in a good way," said Martin Lupinetti, a consultant in the Princeton office of Northhighland Co., which was hired to help start HealthShare.

"The payers are adding some intelligence" to the information system, said Lupinetti, referring to the insurance companies. They know which doctors have seen which patients, he said, and which medications the patients are taking (or are supposed to be taking), and which tests they've had.

"This is absolutely the new paradigm in health information, payers and providers working together," said Andrew Cohen, a vice president at consulting firm Kaufman, Hall & Associates Inc. "Is it unique? Probably today."

In a highly fragmented health-care market such as Philadelphia's, Cohen said, it's difficult for providers to get together and share information, but they must to survive the demands that government and private insurers will put on them to control costs.

"It's time for this region to get on board with it," said Curt Schroder, regional executive for the Delaware Valley Healthcare Council, which played a key role in shepherding normally competitive health systems through the collaboration process.

Asked whether the NaviNet-Orion partnership has an inside track on the contract, Karen Thomas, Main Line Health's chief information officer and vice chairwoman of HealthShare, said: "I don't think so."

The choice will come down to capability, track record and costs, she said.

Main Line Health has spent more than $50 million during the last five or six years building its own system for sharing electronic medical records with its doctors, Thomas said, adding that she is excited about HealthShare.

"We have been working very hard to automate the electronic medical records within the different providers," she said. "Now, this is an opportunity to let this information flow with the patient."


Contact Harold Brubaker at 215-854-4651 or [email protected] ___

Copyright 2014 MedCity News. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

By Brubaker, Harold

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It will be nice when all carriers get on board. We'll need all of the help we can get when the rates spike from The Affordable Care Act (unless you qualify for a subsidy).  EH



 @Mmedical Unfortunately the ACA is still run by private, for profit, insurance companies, Our president wanted to have a single payer system but that did not fly with congress, then he tried to have a voluntary Public Option, that people could buy into, but that was, also, negated by congress. The ACA, using the for profit insurance industry was the only option left open to President Obama. When profit making insurance companies are making medical or surgical decisions instead of physicians and surgeons there is a problem. A Medicare for All type of plan would be ideal, but since the health insurance lobby is as powerful as it is, this will not happen.


 @Chessie  @Mmedical Indeed it is a strong lobby, but keep in mind that this same lobby did not have the clout to substantially increase the tax imposed on uninsured consumers (which they heavily lobbied for). 


The answer? I have been in the healthcare field for 32 years and it's not clear what the best option is. Medicare is fraught with waste and corruption so perhaps it's not the best option...yet anyhow.


However, perhaps a more prudent way to proceed was the expansion of state high risk pools and increased utilization of HSAs through additional tax credits.


Instead, we now have a system that even the CBO says will cost consumers $20,000 per year for their health insurance in 2016.


But I'm eternally optimistic so we'll see where this goes.




 @Mmedical Medicare is still far cheaper to operate, due to lower cost of administration, no profit, and no shareholders such as is found with private insurers. Medicare fraud can be policed and stopped. There is fraud found with those using private insurers, too. 

Health Savings Accounts may be great if one has a high enough income. Someone barely subsisting on a minimum wage cannot afford to deposit money into such an account, when they depend on SNAP, (food stamps) and food banks that are run by various churches. 

Private health insurance has a strong enough lobby to force congress to want no part of even a voluntary Public Option, and will continue to buck any move toward a single payer system, which now, even physicians say that we need. Physicians see many of their patients with their chronic conditions becoming worse. Doctors report that many of the patients can not take their medications as ordered because they cannot afford to take the required numbers of pills. Often they only take their medications two days a week rather than everyday as ordered.

Our health care system is in shambles, and we are 17th in longevity when compared to other wealthy nations. In this nation, that is a disgrace.

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