The Utah Health Information Network

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The Utah Health Information Network
South Dakota Health Information Technology
Summit August 23, 2007
Jan Root, Ph.D. Assistant Executive
Director [phone] x202 jroot_at_uhin.com
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UHIN What is it?
A Secure Electronic Post-Office
UHIN
UHIN reads the address and delivers the envelope
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UHIN a Secure Electronic Postal Service for the
Health Care Community
UHIN links many community members
UHIN community creates Data Transaction Standards
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Mission

• The mission of the Utah Health Information
  Network is to provide the consumer of health care
  services with
• reduced costs
• improved health care quality and access
• to facilitate research

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Achieve Mission By

• Network Creating and managing an electronic
  value-added network to link the health care
  community participants in the State of Utah for
  the purpose of interchanging important financial
  and clinical information
• Standards Standardizing health care transactions
  and health care reporting, electronic interface
  development and communications services, (done
  in compliance with national data standards)
• Data Gathering and providing data to a statewide
  data repository, (stored at UDOH, not UHIN)
• Education Conducting educational programs
  consistent with the purposes for which the
  Corporation was organized, and
• Reduce Burden Providing charitable services
  which lessen the burden of government by
  providing data to help state agencies fulfill
  their responsibilities as legislatively mandated.
• Goal increased efficiencies and reduction of
  administrative costs so the entire Utah health
  care community, including the consumers, may
  benefit.

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UHIN

• Non-profit
• Self-sustaining through member fees
• Handles about 50 million standard transactions
  per year
• HIPAA Standards
• State Standards
• UHIN Community Standards

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Successful Community Effort

• UHIN serves the entire Utah health care community
• 100 of hospitals
• 90 of physicians
• 450 payers
• 60 million transactions
• Self-sustaining for 13 years through member fees

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Governance

• UHIN Board of Directors
• Represents the health care community
• Equally divided between payers and providers
• Charge Take off Corporate hat and determine what
  is best for the community
• Reduce costs
• Improve quality of care
• Do not compete on information exchange

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Standards

• UHIN is a VAN, not a clearinghouse
• UHIN doesnt open envelope or store data
• Therefore community must use Standards
• Community created standards through consensus
  process in Standards Committee
• Thousands of volunteer hours from payer and
  provider staff who know the details
• Created a UHIN community of payers and providers

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UHIN Business Philosophy

• Bring value to the entire health care community
• Large and small entities
• Make it so anyone who wants to can exchange
  health information - UHINt
• Reduce administrative expenses for members

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UHIN Services

• Core Administrative exchanges
• Credentialing information exchange
• Provider accounts reconciliation tool
• Moving to new exchanges
• Provider hospital
• Claim and Prior Auth attachments

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UHIN Prices

• All prices are public Attachment A
• No sweetheart deals
• UHIN posts its prices on UHINs home page
  www.uhin.com

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Attachment A - Pricing

• Them who benefits pays
• Price according to the benefit received by the
  entities exchanging the information
• Prices are determined by the Pricing Committee
• The Pricing Committee is composed of
  representatives of the Board
• Payers
• Providers
• Government

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Value ExampleAdministrative Health Data

• Efficiency of Claims Processing by 1 adjudicator
• Paper 100-150/ day
• Scanned 300/ day
• EDI 700-800/ day
• Autoprocessing 60 of claims require no
  human involvement
• Payer value- just for intake of claim
• Paper 6-10/ claim
• EDI lt 1/ claim
• Provider value
• Paper 4-8/claim
• EDI lt1/ claim
• Faster payments and fewer rejected claims

EDI Electronic Data Interchange
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Value UHIN Core Services

• Goal Cover Operating Expenses for Service
  Equitably
• Payers and Providers got together and decided
• Payers receive
• 70 of the value
• Providers receive
• 30 of the value

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ValueUHIN Core Services

• Payers decided they wanted to charge themselves a
  per claim click charge
• Claims 17 ea
• Remittance Advice 0.025 ea
• All other transactions are no charge
• Capped at 450,000 annually
• Providers decided they wanted to charge
  themselves an annual membership fee
• Scaled to size of provider
• 1 Physician 120/year
• gt100 Physicians 9,000/year

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ValueElectronic Commerce Agreement

• Created by the Community
• Everyone signs the same agreement
• Covers all the HIPAA BAA issues
• Simplifies BAA management (you only need to sign
  UHINs ECA to cover all your UHIN trading
  partners)
• Available on UHINs web site (www.uhin.com)
• Allows all members to exchange with other members
  without additional BAAs for data exchange

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ValueUHIN Standards

• UHIN handles transactions based on STANDARDS
• Community creates the Standards (not UHIN staff)
• Inclusive
• Consensus process
• Utah Insurance Commissioner adopts some Standards
  as State Rule
• Rule R590-164. Uniform Health Billing Rule
• Community gets to create its own rules to follow
  (and modify them as needed)

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New Value Clinical Messaging

• Problem Peoples health Information is
  fragmented across many health care information
  silos.
• Change jobs/insurance
• Change residence
• Change health status
• Difficult to know all the pertinent health
  information about a person needed to provide
  effective treatment
• Causes decrease in quality of care and increase
  in costs

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Proposed Clinical Messaging System

• Create a secure system to exchange basic health
  information (with patient permission) across all
  information silos using standardized messages
• Enable providers to see a complete patient record
• Fulfill the mission of the Utah Health
  Information Network to provide the consumer of
  health care services with
• reduced costs
• improved health care quality and access
• to facilitate research

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Connecting the Community