Looking Forward Into the Future with HSX's Marty Lupinetti
A lot of exciting things are happening these days at HSX—HealthShare Exchange—the Philadelphia-based health information exchange (HIE) organization. The region-wide HIE notes on its website that “HealthShare Exchange envisions a trusted community of healthcare stakeholders collaborating to deliver better 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, medical 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 a growing partnership 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 fourteen 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 disappeared 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 challenge 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 networks, 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 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 traditional 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 colleagues been up to lately?
We developed a strategic plan in 2021,and implemented it in 2022. We still do traditional 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 improvement 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 the provider is requesting, confirming that the patient received that service, and “closing the loop” by providing that information back to the provider and care team. So we’re taking the lead role in now implementing this new service. As a result, it is going to push HSX very quickly into ingesting SDOH health needs assessments, taking that data in and sharing that as needed to better inform patient care needs. So HSX will now combine SDOH and physical-health data to improve overall care for a patient. And many new and valuable things can be done with that combination of data sets.
That piece should be launched by the end of the year. Today, providers are not able to close the loop on community service referrals; they don’t know that the patient went, or what happened. We’re going to know that and introduce new information for better follow-up care.
About when do you expect to go live, then?
Another great example of extending the value, Pennsylvania Dept of Aging offers the PACE benefit to seniors, a prescription assistance program. And patients leaving the hospital who fit criteria based on their health data, HSX will forward their information to Benefits Data Trust(BDT) a company specializing in outreach, educating on program value and assist patients in the application process. The result has significantly increased applications and approvals for receiving the PACE benefit. Lack of prescription/medication adherence is a major issue for readmissions and ED visits. So having more physical and SDOH data, you could apply this same model to increase access to other benefit programs (i.e., SNAP or LIHEAP). And that’s where we believe we’ll provide the next level of value: not only to close the loop on community services, but to also help people gain access to benefit programs.
So you’re no longer just about providers and plans, right? You’re becoming more enmeshed with community services and state and local governments, correct?
Yes. HSX is becoming a health equity platform; we’re moving into the intersection of physical health data, SDOH data, services, and programs, that offer financial benefit for these vulnerable populations. And one of our members is MANNA; they deliver food and counseling, but mainly food services—meals—to vulnerable, chronically ill populations, for example, HIV/AIDS populations. They became a member, because they needed to better understand more of a patient’s needs, in terms of nutrition, etc. So if we’re enabling more SDOH data access, there’s a whole new level of engagement and value directly impacting overall patient care that we can offer MANNA and other community services.
Where do you see HSX five years from now?
It can be difficult to look five years into the future in the health IT and data sharing field; but I see HSX really working with several key strategic partners; not only with state and local governments, but organizations like American Diabetes Association, and the American Heart Association, which are developing new ways to better manage chronic conditions . Also, working more closely with organizations like the United Way, a great community partner and convener looking to expand opportunity for all. HSX can assist community partners as a data platform to help baseline an improvement program and track its success, and see whether they’re making things better. We will have that data set to support these kinds of partners. So I see strategic partnerships as a key component to our future, as these data sets become more mature and people are better able to leverage them.
How will the forward evolution of TEFCA and the QHIN architecture affect your work?
To me, the QHIN becomes a new set of pipes to connect across a larger regional area, tri-state area—Pennsylvania, Delaware, New Jersey and beyond. With all the movement and change going on; I just think that the QHIN will enable us to think more in terms of larger regionwide solutions, and delivering value across a larger community. This referral service mentioned earlier could easily be scaled beyond Pennsylvania, but across the entire region and many of our partners and members are interested in larger geographical coverage and services. Partners like the American Heart Association wants to broaden its impact. MANNA wants to deliver services more broadly; so we believe HSX can be the data platform and sharing hub to enable this to happen.
Are some HIE leaders feeling threatened by the development of larger EMRs and QHINs?
Absolutely. Many are in the traditional HIE swim lane. They’re still offering value, but that value is becoming marginalized in different ways. And combine that with the HITECH grants ending. So they’re keeping the traditional services running, yet they’re seeing all these changes, financial pressure and marginalization happening, so yes, I would imaging many HIEs are threatened.
In that sense, it’s important for HIEs to move forward beyond their original core mission and vision, correct?
Yes. Coming out of the pandemic, health equity became a glaringly important priority. And HIEs are in a strong position to be extremely helpful in that space. In my view, this needs to be a priority initiative going forward for the HIE.
What have been the biggest lessons learned for your organization in the last few years?
The more diverse the membership, as well as expanding strategic partnerships, the better the HIE is positioned for future success. We had health plans and providers from the start; but, now quickly moving into the non-traditional healthcare space—MANNA’s a great example of that. And organizations that want to improve quality across chronic conditions like diabetes or hypertension. Developing diverse relationships and creating new partnerships. And HSX has always been a convener, bringing together a constellation of members and partners; to enable higher levels of service and value.
What should HIT leaders be thinking about right now, in relation to everything we’ve discussed here?
Before they invest, buy or build something new, take a look around their health ecosystem to see what’s happening. You may be surprised of what some HIEs are already doing and the innovative things they can offer; so assess, find out what’s going on. And if an entity is already doing certain things, partnering with them may be the better option.
Is there anything you’d like to add?
One event we have started to contemplate is FIFA World Cup, coming to the U.S. in June of 2026; Philadelphia, New Jersey and New York, the mid-Atlantic region, areas selected as FIFA host cities. So we’re looking at services to support the influx of people to the region. We believe a family reunification service and coordinated regional data-sharing, could be very helpful to better support the event and patient care in the region. Following an incident resulting in patients being triaged to a variety of places for their care, HSX/HIEs will know about it. You may recall, we did some test data-sharing with Italy in advance of the Pope visit to the U.S. and Philadelphia in 2015 and stood up a patient reunification service for Philadelphia.
[ML1]Might be duplicative to above para so I removed some but your call.
