The HIE Phenomena – is it time to say “enough”?

On August 5, 2014 Anthem Blue Cross and Blue Shield of California announced they would jointly invest $80 million in creating a state health information exchange for California – Cal Index. An article in the San Francisco Business Times stated: “other efforts to create such a statewide exchange, including the now-defunct CalRHIO and Cal eConnect, among others, have floundered over the last 20 years, but the companies say they’ve done significant due diligence and learned from earlier mistakes.”

There have been many attempts to organize the movement of health data to provide better care, outcomes, efficiency and innovation on a local or state-wide basis. The efforts are not limited to California. However, virtually all have failed.

As another $80mm is thrown into this blackhole, is it time to step back and consider the future of healthcare vs the history of healthcare.

The history of healthcare is a local industry with the majority of care delivered locally. Therefore, the theory goes build a community based infrastructure to support the delivery of care within a community. While the world may have gone global, it is argued that “healthcare is different”. Few could debate that point of view. Where the U.S. generally leads the industrialized world in efficiency, in healthcare we spend exponentially more per capita than any other country in the world. However, a 2014 Commonwealth Fund study reported that for the fifth year in a row, the U.S. ranked dead last among the top 11 industrialized nations for health industry efficiency, equity and outcomes. Yes, healthcare is different.

The one absolute that we know is that the history of healthcare is not sustainable. Continuing on our current path will bankrupt our country.

The future of healthcare will be far different then its past. One of the greatest influencers of the industry going forward is the concept of consumer centric care. If we consider the behaviors of consumers across all industries a certainty that has emerged is they gravitate toward “experiences”. Isolated, unique experiences that vary from county to county, state to state do not survive. The concept of “local” is the one constant that is truly “history”. We are a global society. The corner grocery store, local hardware store had their day, had their advantages but there is no turning back. The internet, big box brands – defined consumer experiences and a global economy have changed everything – and no – healthcare is no different. A tsunami of change is brewing.


• Lowes is offering employees nationwide incentives in the form of reduced out-of-pocket costs to go to the Cleveland Clinic for heart procedures. Lowe’s Companies Inc. decided to shop nationally for the best deal in heart surgery for its employees, and it landed at the Cleveland Clinic.

• Tele-medicine offers the potential to address long-standing challenges in healthcare, including limited accessibility, cost inflation, and uneven quality. Do consumers want the “best” at the best cost, or do they want whatever is local, even if that may mean waiting for an appointment or battling traffic and searching for parking?

• Medical tourism is still in the earliest stages, but is growing at a rate of 15 – 25% per year. Patients Beyond Borders estimates that 1.2 million U.S. citizens will travel outside the country for medical care in 2014.

• Accenture projects that by 2015 there will be almost 2900 retail clinics with capacity to handle 11 million patient visits. The consumer experience at a Minute Clinic is consistent whether the clinic is in San Diego or Biloxi. (Consumers crave consistency and convenience.)

• Non-traditional entities are increasingly focusing on health industry opportunities. Apple, Samsung, Google, and many others will continue to bring innovative products, services, devices and applications to the consumer health market that will engage people in managing their health. Consumers will demand a seamless experience to release their health information at their direction and not have to consider are they part of Cal Index, one of the other 30 California-based health information exchanges or a member of Kaiser and not sure where they fit. With consumers if you have to ask them to think, you’ve already lost them; they simply “expect”.

Against this backdrop another $80 million is being invested in an effort to keep healthcare local. This point of view is not meant to single out Anthem Blue Cross or Blue Shield of California, but to focus on the larger challenge facing U.S. healthcare. That is, we must begin looking at the industry through the lens of the future, not the past. Data portability doesn’t mean efficiently moving data between Anthem Blue Cross and Blue Shield of California or any of the hoped for 30 California providers being courted to join over the next three years. Data portability means moving data from L.A. to Rochester, MN., Cleveland, OH or Singapore, Thailand or Costa Rica – wherever, whenever and however a consumer may choose to engage in their healthcare.

New thinking, fresh ideas are necessary. Approaches that embrace the realities of today and enable the world of tomorrow are required if our Nation is to afford the healthcare bill that falls to us and future generations.

Healthcare can become efficient, more accessible and cost effective, provide better outcomes, and accelerate research that will revolutionize health – only if we look to the future, not the past.

Brian J. Baum
Founder/CEO vitaTrackr, Inc.

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