HIE Sustainability

Overview

While the potential returns for Health Information Exchanges are great, they face considerable sustainability issues. Recent problems with large grant funded exchanges show that grants, while great for startup funding, are not sufficient for the long term.

Long Term Sustainability

We believe the answer lies in becoming a community hub for administrative and third-party services in addition to the transfer of clinical information. The idea is to become the local hub for healthcare information, in all forms, to get patients, providers, and payers using the HIE. By reducing administrative costs and providing value added services, the hub can now be used as a revenue stream for the HIE. The hub can provide previously unavailable services and, by taking advantage of community wide pricing, existing services at a lower cost.

 

Some services the HIE can provide:

  • Payer eligibility
  • Payer claim submission
  • Payer claim inquiry
  • Payer referral processing
  • Transcription services
  • Coding services
  • Provider/payer report distribution
  • Community wide credentialing
  • Community wide provider portal services
  • Community wide authentication and authorization
  • Enrollment services and screening
  • Provider EMR support and help desk

A small margin on these services can result in considerable amounts of funding for the HIE, while still providing savings to members over current costs. As each HIE and region is unique, the menu service offerings depend which services deliver the most “bang for the buck” for your members.

RHIOnet transaction revenue projections

This chart shows the projected revenues for just a few of the possible services that can be delivered through RHIOnet. The chart is based on a 1MM population service area and a 50% adoption rate after 18 months. Revenues are monthly.

RHIOnet

RHIOnet provides a standards compliant infrastructure for building value added services for your HIE. All the services above are available “out of the box” or through interfaces to allow you to use existing services or negotiate with vendors to obtain the best deal for your HIE.