Anthem, Blue Shield launch massive California data-sharing effort

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Cal Index Art

Anthem Blue Cross and Blue Shield of California announced the formation of the The California Integrated Data Exchange, an $80 million, three-year effort that seeks to share information of some 9 million patients among the state’s top payers and providers in an attempt to bring down healthcare costs and improve outcomes.

The two insurers, along with officials from the state, CaLPERS and Dignity Health, California’s biggest hospital system, said they are putting aside competition to create what they say is one of the largest health information exchanges in the country.

The two insurers also said they hope to add additional payers and providers, large and small, while incorporating some 15-odd HIEs that already exist in California to Cal INDEX as it builds steam.

The effort is similar to the previous formation of a successful ACO that was formed between Blue Shield, Dignity, Hill Physicians Medical Group and CaLPERS, which saved millions of dollars by cutting down on redundancies in care and sharing patient information, said Lloyd Dean, CEO of Dignity, who added the health system has a “deep interest” in Cal INDEX.

By taking the effort across the state, Cal INDEX is poised to be one of the largest health information exchanges in the country, with the goal of better connecting the vast, often disparate healthcare landscape across California.

“Currently in California, the healthcare system is fragmented and complex,” said David Feinberg, president of UCLA Health System, which is also participating in Cal Index. “Much of this is because we remain disconnected. We cannot easily share patient information. In today’s digital age, there’s simply no excuse. There’s an unmet need in California for a secure electronic health exchange.”

The funding of Cal INDEX lasts for three years. The data-sharing effort will charge a subscription fee for each provider, payer and HIE that wants to join and share its data. Specifics on the fee will vary. Cal INDEX will launch before the end of 2014, officials said.

The 9 million members of the two health plans account for about one in four Californians with private insurance, giving providers vast reaches into clinical data that includes claims information and procedures, labs and X-ray information gleaned from EHRs, officials said.

Patients will eventually be able to access their own medical record, and privacy is and will remain a top priority, officials said. Patients who wish to not share their information will be able to opt out of the exchange.

Modeled after a public utility, Cal INDEX has five main goals:
— Improve the quality of care by providing clinicians with a unified statewide source of integrated patient information
— Provide patients with a seamless transition between health plans or across various healthcare professionals and hospitals
— Improve efficiency and reduce the cost of healthcare
— Encourage healthcare technology innovation
— Improve public health by providing de-identified data for medical research.

Dean said San Francisco-based Dignity Health has seen significant progress from the ACO effort with Hill Physicians and Blue Shield, and that taking the concept state-wide will bring savings to the entire system.

“When hospitals and doctors and insurers share information, the people we serve get better care ,” he said, adding that the ACO with CALPERS saved members “tens of millions” of dollars.

“Cal INDEX takes this kind of sharing to the next level. The more we know, the better care we can deliver. We see Cal INDEX speeding up communications between patients and providers,” he said. “Instead of wasting critical time, Cal INDEX puts this information in the patient’s hands in real time. It’s going to reduce the cost of healthcare delivery.”

The database that will house patient data will be overseen by Orion Health, officials said. The information will only be used for clinical purposes. Academic research institutions may be able to use the Cal INDEX de-identified data for research to benefit the public good, such as population health initiatives.

The data may at some point become part of a national effort such as the DirectTrust Transitional Trust Bundle, of which Orion Health is already a part, said Simon Jones, vice president of health information technology for Blue Shield of California.

“We are looking into DirectTrust and some of the other standards and we do intend to participate,” Jones said.

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Dan Verel

By Dan Verel MedCity News

Dan Verel writes about how hospitals and health insurance companies are leveraging cutting-edge technologies to transform the industry -- from health IT to telemedicine to healthcare social media. Previously, he was a reporter at the North Bay Business Journal, where he covered healthcare, insurance, HR and employment, law and hospitality and tourism. His byline’s also appeared in the Oakland Tribune and the San Francisco Bay Guardian. He is based in San Francisco. Follow him on Twitter @DanVerel.
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Peggy Zuckerman
Peggy Zuckerman

Re the above, "Patients will eventually be able to access their own medical record", I must ask how it is that the patient having access to their own data is not a FOUNDATION of the sharing of the data.  Only when patients have the appropriate and immediate access to their own data, with the ability to correct the errors which are common to many such records, is the patient able to be treated safely and thoroughly.

Any patient advocate can tell endless stories of missing data, data from other patients (a male friend whose CT scans were clearly those of a woman!), incomplete family histories, errors in allergies and medications, etc.  Without a proper review and the ability to correct those errors--yet with responsible oversight--this data will not have the desired value to the patient.  

Peggy Zuckerman

Dan Verel
Dan Verel

@Peggy Zuckerman That's an interesting point, Peggy. They did say it was an eventual goal of the project, but perhaps doing that and getting the parties involved to participate is simply too much at once? I gather that's at least part of the issue. 

Peggy Zuckerman
Peggy Zuckerman

@Dan Verel @Peggy Zuckerman Not only is this interesting point, it should be an essential goal. The failure to plan for this speaks volumes of the lack of concern for the patients who must "opt out", or have their records simply open to everyone but the patients themselves. This is an example of poor design, which fails to protect the patient, and indeed with the opt out requirement, endangers the privacy of the patient.

The better approach would be to start with the patient having access to his records, and then agreeing--or not--to provide them to the providers as permitted by the patient.  If the system cannot respond to these needs, it reflects the lack of coordination within the system itself.