Insurer Healthfirst’s Hyphen Platform Highlights Care Gaps in EHR

In a recent Healthcare Innovation interview, GT Sweeney, CIO of New York-based insurer Healthfirst, and Sami Boshut, CIO of health system MediSys, described how they are using a new technology platform called Hyphen to connect longitudinal data from claims, quality measures and EHRs to identify gaps in care and share that information with clinicians.

Hyphen is a cloud-based platform that uses Fast Healthcare Interoperability Resource (FHIR) standards to share member data directly into provider or hospital EHR systems, along with patient- and population-level analytics and predictive modeling tools. Hyphen is a wholly owned subsidiary of HF Management Services LLC, a management services company, and is an affiliate of Healthfirst, the largest nonprofit health insurer in New York State, with 1.8 million members.

“We've had gaps in care for 25 years, and yet most of the times patients go to their provider, the provider doesn't see their gaps in care. Insurance companies have it, we put it on spreadsheets, we send it out to everybody, but these providers are really busy so they're not going to open up some portal and look for gaps in care,” Sweeney said. “We recognize that if we're going to make healthcare easier for consumers, we have got to make it easier for providers. We can't keep throwing all these different tools at them. We have to give them solutions that fit into their tools and workflows, and serve the freshest information into the delivery system.”

Hyphen builds on Healthfirst’s business model, which has always fostered collaboration, Sweeney added. “If you believe that the healthcare ecosystem is going to be disrupted by digital ways of collaborating in the future, we want to be at the forefront of that. Everybody's got their own starting point, their own set of investments. The one thing that we know from talking to providers is that nobody wants to redefine the way they collaborate with an insurance company or anybody else in a way that only works with that insurance company. We have to have a payer-agnostic strategy and vision.”

Using Hyphen eliminates the need for spreadsheets and delivers actionable data directly into the workflows of EHRs and other systems used by healthcare providers and care managers, Healthfirst said. Hyphen is available to MediSys within their Epic EHR system, so all MediSys providers can participate.

The MediSys Health Network is the not-for-profit parent organization of two Queens-based hospitals, Jamaica Hospital Medical Center, and Flushing Hospital Medical Center, as well as the Jamaica Hospital Nursing Home, the Advanced Center for Psychotherapy, and a network of eight community-based family healthcare centers. “Before this tool became available, we were using strictly Excel sheets to get the data. Through the collaboration with Healthfirst, we were able to bring that single tool inside our Epic EHR system,” Boshut said. “It pulls the patient data from either claims or other healthcare organizations inside our EHR system, and then the physician can take advantage of this tool to see what happened with the patient outside of our MediSys network.”

After only a few months on Hyphen, Boshut said, it is clear that MediSys clinicians already know a lot more than they used to know about patients, and it should soon be reflected in measures of care gap closures.

Sweeney explained that the technology behind Hyphen came from the acquisition of a company that also has an extension to community service organizations. It allows a risk-taking provider to collaborate with social service agencies. “A typical example would be an ACO that is taking risk on a high-risk maternity population,” Sweeney explained. “They would, develop a network of social service agencies that would deliver the housing support, food support, nutrition, childcare support, legal support. From within this tool they could facilitate referrals to this curated network. They could do the referral and enforce the downstream programmatic structure to allow the community-based organization to get paid. We now have over a million members served on that platform,” he said.

I asked Sweeney if Healthfirst would be seeking to get other payers to adopt Hyphen with their health system partners.

“Absolutely,” he replied. “The idea is that if we can help our providers collaborate more effectively in value-based business models — and we're embracing industry standards, everything's based on FHIR— then other payers can publish their insights into this platform as well and can participate in the platform more broadly as we build and assemble more capabilities into the platform.”