Congratulations Indianapolis! (And I'm NOT referring to the Colts)

The Indianapolis Star last week had a story about the launching of a quality reporting system by the Indiana Health Information Exchange (IHIE). This is a truly exciting development, not only for Indiana but also for the many fledgling health information exchanges around the country.

The national health information exchange movement is at a fragile point at present, as the over 200 "RHIOs" across the country struggle with the question of how they'll sustain themselves once their grant money runs out. IHIE offers a shining example (arguably the shining example) of how a health information exchange can offer innovative programs that deliver value on business terms, transform health care delivery, and (hopefully) improve the quality and cost-effectiveness of health care over time. In short, they're starting to realize the vision.

The program itself is called Quality Health First of Indiana, and it builds on the community-wide results delivery service that IHIE already runs, and the Indiana Network for Patient Care created years ago by the now legendary Regenstrief Institute. The program will merge data from insurance claims with laboratory results from the IHIE system to create benchmarking reports to track physician performance. It will also generate alerts and reminders for physicians to improve tracking and follow-up of patients with chronic conditions -- this will give physicians better tools to monitor and improve themselves on the indicators that they're being measured on.

What's really unique and powerful about this program is the coalition of stakeholders that are backing it. In particular, the Employers' Forum of Indiana played a central and lead role in bringing purchasers and the health plans together with providers to agree on a set of measures that would be considered by all to be meaningful and actionable. IHIE had the platform to bring together the data, which made data collection and report delivery affordable and minimally invasive to the physicians. The health plans are funding the operations. They're paying IHIE to pull together, process, and deliver the reports. They're also paying physicians to participate at the outset ("pay to play"), and will then provide incentive payments for quality improvements over time ("pay to perform").

Another innovation is that they're bringing together claims data (from Medicare as well as local plans) and merging that with real clinical information drawn from the health exchange. That gives physicians a more complete picture of themselves than they're able to put together on their own.

In Massachusetts, we've done well on the claims and reporting side, but less well on the clinical integration side. We have the benefit of a groundbreaking program in its own right, namely, the Massachusetts Health Quality Partners. It's more far-reaching than the Indiana program in that it's statewide, the data is publicly reported, and it also brings in patient perspectives. MHQP isn't an HIE, though, so they don't have the clinical data and the resulting alerts/reminders capability that IHIE has brought to bear. The purchasers and insurers are also not nearly as engaged in the conversation in Massachusetts as they have been in Indiana.

The hardest part of achieving the health information exchange vision is lining up the economics. Insurers and purchasers (and patients) stand to benefit the most, but they have in most cases treated this as a problem that physicians need to solve themselves. IHIE and the Employers' Forum of Indiana together have cracked two nuts: they've gotten employers and insurers to invest in their supply chains by putting together a reimbursement package that allows everyone to realize value, and they've integrated claims data across payers, and clinical data across providers, and married the two in a way that no one else has yet accomplished.

So, if it's not already apparent, I'm impressed. Congratulations to Marc Overhage of IHIE and Dave Kelleher of the Employers' Forum! We're inspired by your vision, applaud your successes, and looking forward to learning more.