Two California insurers announced Tuesday that they are partnering for an ambitious project to establish one of the nation's largest health-information exchanges, an effort they hope will reduce duplication and improve patient outcomes.
The not-for-profit Blue Shield of California and Anthem Blue Cross, a subsidiary of private insurance giant WellPoint, announced that they are starting the California Integrated Data Exchange, medical-sharing portal with information about 9 million plan members.
The health plans will provide $80 million in seed money for the first three years of the information exchange, known as Cal INDEX. It will launch at the end of the year and adhere to state and federal privacy laws.
The announcement was welcomed by California state officials and advocates for health technology after a federally funded effort to modernize health information known as Cal eConnect fell apart.
But a consumer advocate questioned the governance and oversight of a privately funded effort. "We'd really like to see robust consumer participation," said Betsy Imholz of Consumers Union, which is based in San Francisco.
Cal INDEX is designed to share patient records electronically among providers, including doctors and hospitals, in real time. The hope is for emergency room doctors to be able to pull up a patient's medical records to review existing conditions and medications.
Using the information exchange, someone who moves or changes health plans won't have to worry about rounding up their medical records when they see a new doctor. That could save time and money on duplicate tests and treatments.
The exchange will operate as a nonprofit with a five-member board, which will have a hospital, doctor, health plan, public sector and consumer representative.
Anthem and Blue Shield executives said they hope to build on past lessons and said their exchange offers unrivaled scale, financial sustainability and value. Patients will eventually be able to see their own records.
"Why is everybody on Facebook for their social networking? Because everyone else is on Facebook," said Paul Markovich, president of Blue Shield, in a call with reporters Tuesday. "Why would a provider want to sign up for Cal INDEX? Because that's where the data is."
In 2009, the federal government allocated $548 million in stimulus funding to encourage the development of health information exchanges for sharing patient data. There are now about 300 public and private exchanges nationwide.
Markovich and Mark Morgan, president of Anthem, said they will use the industry's leading providers and learn from successful models such as the New York e-Health Collaborative and Indiana Health Information Exchange.
"This is going to be closely watched by everybody in health care," said Jennifer Covich Bordenick, chief executive officer of eHealth Initiative, a national nonprofit coalition to improve health care through information technology. "It's a really ambitious initiative."
Bordenick said the success of Cal INDEX will depend on providers' willingness to share clinical information, such as a patient's blood pressure or cholesterol, to complement claims data provided by Anthem and Blue Shield.
"That's the information that can really help a patient real time, not so much a doctor being able to review all the claims to the insurance company," she said.
California has about 30 health information exchanges and many have already expressed interest in Cal INDEX, said Rim Cothren, executive director of the California Association of Health Information Exchanges. The exchange will need to be supported by subscription fees from providers and insurers once the seed money runs out.
"We're thrilled that they're bringing their claims data to the table. None of our other HIEs that I'm aware of have claims data. They focus exclusively on treatment data," said Pamela Lane, a deputy secretary at the California Health and Human Services Agency. "And I think that has tremendous potential and presents tremendous challenges."