HIE Sustainability
Why So Elusive?
Doug Dietzman, Executive Director Michigan Health Connect
Discussion Topics
• What is HIE?
• Michigan Health Connect Overview
• MHC’s Sustainability Guiding Principles
• Broader Thoughts on Sustainability
• Q&A
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What is HIE?
• HIE is a personal story
for each of us
• HIE is not
fundamentally
about technology
What is HIE?
• Confusion abounds - HIE is not HIE is not HIE
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“Enterprise” HIE
“Vendor” HIE
“Government” HIE
“Community” HIE
• Each has different factors driving business model,
trust, motivations, and what sustainability means
• Sustainability in this webinar will be from
Community HIE model context
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Michigan Health Connect
To improve health outcomes for Michigan
residents by making relevant, secure data
available anytime, anywhere in support of
healthcare stakeholders state-wide.
• 87 total hospital facilities
• 2,105 office locations
• 17,000+ providers
• 24 other member orgs:
Provider organizations, FQHCs, Health
plans, Home health, Community mental
health, Local public health, Employer
Clinics, Diagnostic centers
• 4 other HIE connections
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Today’s Live Solutions
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Results Delivery
Admission & Discharge Notifications
Lab Orders
Radiology Orders
Care Transitions/Referrals (Physical & Behavioral Health)
Virtual Integrated Patient Record (VIPR)
Medication History
Community PACS Imaging
MCIR Immunization Registry Submission
MDSS Reportable Lab Registry Submission
Direct HISP (*@mhc.medicity.net)
MHC Model & Characteristics
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Privately funded & sustainable
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True community RHIO –
collaboration amongst competitors
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Focused on bottom-up incremental
value-add services and solutions
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Subscription-based “pay-as-you-grow” business model – no cost to
physician offices
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Members retain control over their data and can participate at their
own pace with the solutions that make the most sense for their
organization
MHC Guiding Principles
• There is no need, or requirement, for MHC to “do it all”
• Complement and collaborate with, don’t duplicate, existing community
services and solutions
• Connect all healthcare stakeholders across the continuum – large and
small, public and private
• Keep providers and other users in their native systems if at all possible
• ‘Can be done’ focus rather why things ‘can’t be done’
• Become “Indispensable” and “Invisible”
Sustainability Principles
• Build the business the old-fashioned way
• Core operations not dependent on grant funding
 Longevity of grant dollars
 Dictate focus for organization
 Delay focus on independent sustainability
• Ongoing cost structures, including vendor contracts, need to grow as
business grows
• Member point responsibility on local deployment priorities and
activities
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Sustainability Principles (cont.)
• The value of a network is the size of the network –
must eliminate financial barrier for community providers
• Business model must accommodate and scale
from the very large organizations to the very small
• Member organizations should only pay for the solutions and services
they need, want and use tied to specific value
• A single business model will not work for all stakeholder groups –
solutions, services, and financial model must be developed uniquely for
each group
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MHC Business Model
• Core Participation Fee
 Hospitals: Licensed beds
 Health Plans: Per member per month
 Public Health: Population in counties
 Etc.
• Solution Fees
 Results/ADT/Immunization Delivery
 Lab Ordering
 Radiology Ordering
 Virtual Integrated Patient Record (VIPR)
 Admission/Discharge Notifications
 Etc.
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Sustainability Example
• Results Distribution
– Core issue for most hospitals
– Key need for community providers with EMRs
– Value Proposition:
• “you are investing in many point to point interfaces”
• “don’t have interest, skills, technology, or vendor knowledge to build
and maintain interfaces into community provider offices”
• “instead, invest fewer dollars to build one interface to MHC and let
MHC take responsibility for connecting with provider offices”
– Once data is fluid, how else can value be created from it?
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Retailer a Retailer a Retailer?
• Consider 3 retail stores: Walmart, Brookstone, and Nordstrom
• All are “retailers” yet each have a different strategic focus
 Walmart…low cost
 Brookstone…product variety
 Nordstrom…customer service
• All must meet basic cost, product and service requirements, but each
has selected one of the three to excel in
• All have similar business functions at high level, but the way each is
carried out is totally in line with its chosen business model
• Is there really just one HIE business model we’re all chasing?
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Summary
• There is no single magic bullet to HIE sustainability
because HIEs are not the same
• Building an HIE business is like building any other
business
• Get to independent sustainability asap – don’t take grant or other 3rd
party dollars unless they are firmly in line with the business strategy
• Create a vision for your specific geography then go after it intentionally
and incrementally
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QUESTIONS
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Doug Dietzman
Executive Director, Michigan Health Connect
ddietzman@michiganhealthconnect.org
616-588-4700
www.michiganhealthconnect.org
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