Finding revenue for sustainability

Finding revenue streams for sustainability is in its early stages. However, Pennsylvania's Chronic Care Initiative has a tie-in with HIE efforts and offers a potential model, Magistro said. Sixteen payers committed to $30 million of supplemental payments to providers over a three-year period to fund the initiative. Although the office didn't have ROI to show, the PCMH concept is viewed favorably, he said.

Learning collaboratives are operating in seven regions, with four funded by payers. Begun in May 2008, the learning collaboratives are the largest PCMH pilot in the country, with 800 primary care physicians and 1.1 million patients participating, Magistro said.

Getting the information electronically from hospitals or doctors to other providers offers some level of benefits, but making that information actionable offers exponentially more value, he said.

Last year, the reporting body Pennsylvania Health Care Cost Containment Council estimated that $2.5 billion of hospital charges for readmissions were attributable to 20 reportable conditions.

Four chronic diseases accounted for $4 billion of potentially avoidable hospital charges.

"There is a lot of money sitting out there in the chronically ill and readmission sides," Magistro said. "We know from the work done at Geisinger Health System and the University of Pennsylvania that if a PCP gets a care manager in front of a patient within 48 hours of discharge, you can have a significant reduction in readmission rates, maybe 40 percent or more."

The transformation of how care is delivered can positively impact those numbers and costs, he said. The savings could potentially be split three ways: Fund health IT activities; provide incentives to hospitals and other providers to continue working with health IT; and give money back to the payers, which ultimately would come back to the patients, he said. Bottom line: "The savings could be phenomenal," Magistro said. And HIE could be the mechanism to achieve the transformation.