IBM's health exchange pilot generates extra $2M for users, study says

MedVirginia’s health information exchange pilot program with the Social Security Administration has generated an additional $2 million in revenues for the providers involved during its first six months, according to a new study commissioned by the SSA.

The SSA and MedVirginia, a health information exchange organization, went live with the collaboration in February 2009 by using the Nationwide Health Information Network (NHIN) to perform the exchanges. MedVirginia gets its data from various health plans and hospitals in the state. IBM Corp. is the contractor assisting with the project.

The goal was for MedVirginia to electronically share patient medical data with the SSA to help the agency make disability support determinations. The exchange has reduced by almost half the processing time for such rulings, from 84 days to 46 days, a news release said.

The increased speed for making determinations resulted, in many cases, in more disability income that provided additional revenue to health plans, hospitals and other care providers using the health exchange, wrote the authors of the SSA study, which was released on Jan. 26.

“This is revenue that the facility would not necessarily collect otherwise. These data are suggestive of one area of potential provider value in using the NHIN for the exchange of medical information with SSA for disability determination,” wrote Sue Feldman and Thomas Horan of the Kay Center for e-Health Research, Claremont Graduate University.

Some of the revenue generated is considered a recovery for care that otherwise would have been uncompensated, the report said.

“The practical side of uncompensated care cost recovery was described by an interviewee from MedVirginia as a patient who ordinarily would not have generated any revenue, but because of a benefit determination that resulted in health benefits (Medicare or Medicaid), did generate revenue,” the report said.

The SSA-MedVirginia collaboration faced two major technical challenges, the authors said. The first was achieving interoperability between MedVirginia’s clinical repository system and its gateway to the NHIN. Initially, MedVirginia used a proprietary gateway, but it reconfigured the system to conform to the Federal Health Architecture’s open source Connect gateway several months into production. The decision to change was made because Connect was viewed as a more sustainable model, the authors wrote.

The second technical challenge was identifying a technical standard that would accommodate an image of an authorization form.