Even as officials try to fix Vermont’s troubled health information exchange, they’ve come up with a plan for what to do if those efforts don’t work out.
A new report presents six options that state officials or Vermont Information Technology Leaders, which operates the patient-record database, could pursue if they are unable to meet reform mandates from the Legislature.
Most of the options represent major changes from the status quo: Scenarios include merging VITL with some other entity; replacing VITL as the exchange operator; having the state Agency of Digital Services take over the database; or shutting down both VITL and the information exchange and leaving the matter for the private sector to figure out.
While the report’s authors don’t make recommendations, it’s clear that they see value in keeping the health exchange going in spite of its problems.
“The (exchange) is of essential importance to the state, its residents and healthcare providers,” the report says. “Thus, on a qualitative value basis, the (exchange) is a valuable asset to the state and its constituents, and its services should be continued.”
The health information exchange – not to be confused with Vermont Health Connect, the state’s health insurance exchange – is a secure database of patient data such as lab results, discharge records and medication histories. It’s supposed to allow providers to access patients’ records no matter where they’re being treated, improving the safety and efficiency of health care.
But Burlington-based VITL has struggled to fulfill that mission due to administrative and financial issues. The problems were summed up last year in a consultant’s report that said many users had lost confidence in the exchange, in part because there were relatively few patient records in the system.
VITL has been working with the Department of Vermont Health Access to undertake a turnaround. That is spurred in part by the Legislature’s passage this year of Act 187, which mandated a “work plan” and a series of reports to state lawmakers and regulators on efforts to reform the information exchange.
There have been some positive results. For example, the department is developing a new state Health Information Technology Plan, which is due by Nov. 1.
Also, VITL has been streamlining its operations and increasing usage of the exchange. The organization’s fiscal 2019 budget reduces reliance on state funding by $500,000, and the number of Vermonters consenting to have their health records included on the exchange has risen from 19 percent last year to more than 35 percent currently.
At a meeting last month with the Green Mountain Care Board, Mike Smith – who took over earlier this year as VITL’s interim president and chief executive officer – said the organization is making strides.
“For the last six months, our goal was achieving some stability. And I think we’ve done that,” Smith said. “Our goal now is to move to the next step … now it’s time to look at re-establishing credibility over the next six months.”
But there’s no guarantee that either the health access department or VITL will succeed in righting the ship. That’s why Act 187 also ordered development of a contingency plan, which was completed by Washington, D.C.-based Capitol Health Associates by a Sept. 1 deadline.
The report lists six contingency proposals with transition costs ranging from $150,000 to $1.38 million, schedules ranging from three months to two years, and varying degrees of risk.
The report doesn’t prioritize those options, and state officials aren’t picking favorites yet, either. In an interview Friday, Department of Vermont Health Access Deputy Commissioner Michael Costa said officials are “still reviewing the report, and we’re not ready to make any judgments.”
Nevertheless, Costa said the document “gives state policymakers a real choice about how this program should work in the future” if it becomes necessary to abandon the current model.
Those choices include:
• Merging VITL with a private organization outside Vermont (six to 12 months to implement, at a cost of $300,000 to $600,000).
This might be an organization with experience in health information exchange operations or a health information technology company. The merger “would ideally be conducted privately between VITL and the selected company with oversight from the state,” the report says.
• Seeking a new operator for the health information exchange (18 to 24 months; $450,000 to $600,000).
In this scenario, the state would take possession of assets needed to operate the exchange and then issue a request for proposals from operators willing to take VITL’s place.
• Hiring a consulting firm to either insert new management at VITL or assist current management in a turnaround plan ($150,000 to $300,000; six to 12 months).
These options are of low to moderate complexity but questionable effectiveness, the report says.
• Merging VITL with a Vermont-based entity that would assume health information exchange operations ($200,000 to $400,000; four to eight months).
The state could play an advisory role in that merger, the report says.
• Implementing a full state takeover of the health information exchange ($200,000 to $375,000; eight to 15 months).
The report says the state Agency of Digital Services “would be willing to consider this option.” But Digital Services Secretary John Quinn on Friday said Gov. Phil Scott’s administration is still focused on “a multiyear effort” to get the current exchange back on track.
“We are still reviewing the report, and I don’t want to render judgement at this time,” Quinn said. “With that being said, I’m not ruling anything out. There would need to be a lot more analysis before I could draw an opinion on whether or not any of the alternative options would be viable.”
Costa also isn’t ruling out a state takeover, but he said the administration “has not seriously considered” that possibility. He added that “it’s not clear to me that the state should be running a technology company.”
The first five contingency options “are designed to achieve change with minimal disruption” for health care providers, consumers and the state, the report says.
But the sixth option — allowing VITL to shut down the health information exchange entirely — would bring “major disruption.” This carries the biggest potential financial fluctuations, ranging from a $267,000 net benefit to a $1.38 million cost depending on the disposition of VITL’s obligations.
In the shutdown scenario, the expectation would be that “data sharing and exchange needs will be met by stakeholder groups within Vermont such as the provider and payer community or health service area consortiums,” the report says.
But there are no guarantees anyone would pick up that thread. And state officials seem inclined to continue the exchange in one way or another.
“There’s broad agreement that health information and health information technology are needed to drive success in health care in Vermont,” Costa said.
At the same time, “there’s not a lot of agreement nationwide on how you should do that,” he added.
