FEATURE · INTEROPERABILITY & HIE
HealthShare Exchange’s Marty Lupinetti on HIE’s Role in Philadelphia Health Ecosystem
By Mark Hagland A
lot of exciting things are happening these days at HSX—HealthShare Exchange—the Philadelphia-based
health information exchange (HIE) orga- nization. The region-wide HIE notes on its website that “HealthShare Exchange envi- sions a trusted community of healthcare stakeholders collaborating to deliver bet- ter care to consumers in the Philadelphia tri-state region (Pennsylvania, Delaware, New Jersey) region and beyond.” Among the most successful regional HIEs in the nation, HSX continues to innovate forward to provide a broader range of services and create broader and deeper connections with stakeholder groups of all kinds—health plans, hospitals, medi- cal groups, health systems, public health, community-based social service agencies, and local, county and state governments. Under the leadership of CEO Martin
“Marty” Lupinetti, HSX continues to expand outward, even as it continues to ensure that the proper governance and financial foundations continue to move it forward. Among other recently developed collaborations have been grow- ing partnerships with non-traditional healthcare stakeholders like MANNA, the Metropolitan Area Neighborhood Nutrition Alliance, which focuses on “us[ing] nutrition to improve health for people with serious illnesses who need nourishment to heal. Indeed, Lupinetti this spring joined the board of directors of MANNA, as HSX’s collaboration with MANNA has continued to broaden and deepen over time. Lupinetti’s vision for HSX is continued
expansion of activity to provide value for all its stakeholder partners and improve the quality of healthcare delivery through the appropriate exchange of data and information. He spoke recently with Healthcare Innovation Editor-in-Chief Mark Hagland about where HSX is right now in its ongoing journey, as well as the future of HIEs nationwide and of the nationwide push for healthcare interoperability. Below are excerpts from that interview.
To begin, can you give me a sense of this current moment in HSX’s ongoing journey forward? Where
are you right now in terms of the constellation of your partnerships with various stakeholder groups? It’s important to remember that we really started out with not only large health system participation but also with strong health plan participation; we had several health plans around our table, day one. We’re now up to 14 health plans that are active HSX members, receiving a variety of value and are contributing financially to sustaining us including Medicaid, Medicare and commercial plans. As an HIE, HSX is in the middle of this
health ecosystem, and we’re not created or funded by a single health system or health plan; we’re completely independent and neutral. And that’s forced HSX to become independent and very entrepreneurial, and constantly looking at new ways to extend the services and value we can offer. Some HIEs that have been health system backed or received early-on state-funding, haven’t had to build a strong and broad base of members and services, from which to grow.
Yes, the era when there was a lot of public funding evaporated now a while ago. That’s right. Several years ago, there was still a lot of grant money. That’s disap- peared as of 2021 (i.e., HITECH funds), and HIE leaders have to figure out new innovative ways to survive and thrive without heavy grant-based support.
Let’s talk about the broad chal- lenge of interoperability for the healthcare system. There are still some really big gaps, healthcare system-wide, across the U.S. healthcare system. Yes, there are still big gaps but rapidly getting better. And TEFCA [the Trusted Exchange Framework and Common Agreement] and the designation of the QHINs [qualified health information net- works, as designed by the Office of the National Coordinator for Health IT] will influence how that plays out. And in our market, we have a concentration of Epic- to-Epic connectivity and CareEverywhere, that influences that as well. So as an HIE you need to think differently and look
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at the edges of healthcare, look to fill in the blind spots of where people seek care. We’re at the point now as we have the “last two feet” of connectivity to these providers, to these care teams. And the encounter notification service that many HIEs offer—we have over 7 million people being tracked by that service—that is a 24/7 service; and when that goes down, you hear about it. And you hear most from the people trying to care for underserved, low-income, Medicaid patients, and from ACOs [accountable care organizations] and FQHCs [federally qualified health centers]; they’re using and depend on that service every single day, managing through chronic conditions, and high-risk patients, 24/7. So the HIE lives in the tra- ditional sense; but that’s not enough to sustain us. So what we’ve done is to extend the use of that data value, that connectivity value, into other ways, extending further into the community.
So, what have you and your col- leagues been up to lately? We developed a strategic plan in 2021,and implemented it in 2022. We still do tra- ditional HIE—query, ENS [encounter notification service]; but we’re using the data and connectivity to promote value- based services, and HEDIS and our recent NCQA certification services; to promote services that our members and users need. And we’re also moving heavily into health equity and quality improve- ment programs, focused on diabetes, on hypertension. We are even meeting with the Greater Philadelphia Coalition on Gun Violence to determine if HSX data could support predicting of individuals who might be involved in a future shooting. And naturally, resulting from our work during the pandemic, health equity and the social determinants of health—SDOH is now a major focus for HSX.
How are you getting involved in health equity and SDOH issues? In a couple of different ways. First, the Commonwealth of Pennsylvania has put the HIE in the middle of a closed-loop referral service for all social services. We’ll be the ones to understand what
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