Financial Sustainability

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591

141

Summary: HSX is primarily supported by membership/subscription fees.  It also continues to benefit from federal and state grants.

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592

Discussion: A variety of revenue streams can lead to financial sustainability for a health information exchange (HIE), so long as the HIE chooses a model that suits its specific environment.  Common revenue streams include: subscription/usage fees, transaction fees, grants, and value-add service fees.  HealthShare Exchange has established a revenue approach, described below, for its expanding list of services.  To receive data, participating members must also contribute data.  

In its current financial-sustainability update, HSX has projected:

  • expenditures required to manage its business growth from 2016-2018;
  • revenues from founding members and current participants;
  • and new membership and income streams.

593

Current revenue structure:

726

Hospitals

Hospital/health system fees are based on a system’s annual percentage of acute care admissions in the region.  During its 2014-2015 member-reaffirmation process, HealthShare Exchange offered other possible measures to the hospital community members as alternatives.  The members chose to continue to use admissions as the metric for fees and include an initial one-time administrative cost for new members.  Charge basis is also essentially the same for non-acute care facilities.

Health Plans

Annual subscription fees for healthcare insurance plans are based on the industry standard metric of comparative annual member enrollments in the market, with a one-time administrative fee for new plans.

Ambulatory Providers

HealthShare Exchange provides services using the Direct standards to owned, affiliated, and independent ambulatory practices at no charge.

HSX developed this principle in alignment with its mission to support the triple aim: improving the patient experience of care, including quality and satisfaction; improving the health of populations; and reducing the per capita cost of healthcare.  HSX places special emphasis on participation of primary care providers at all points of care, including in private and governmentally supported practices.  Among steps aimed at removing obstacles to this participation, HSX likewise does not charge City of Philadelphia health clinics and federally qualified health centers (FQHCs) for services.  For certain services, such as ENS and CDR, affiliated and independent practices will have a one-time administrative fee and an annual subscription fee. 

Additional principles

• HealthShare Exchange also establishes revenue schedules for additional new types of members, including accountable care organizations, skilled nursing facilities, and urgent care centers.

• HealthShare Exchange does not rely on grant funding.  Nor does it include grant funding in the revenue projections.  (However, HSX tracks and pursues grant opportunities actively, to develop new opportunities and help to offset member fees.) 

• HealthShare Exchange maintains a reserve of funds to continue operations in case of emergency and for technology investment needed to support new services or capabilities that HSX members request.