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Molly Joel Coye, MD
Founder and CEO
Health Technology Center
Board Chair
California Regional Health Information Organization
San Francisco

In May, the California Regional Health Information Organization became the first RHIO to sign a deal with a major insurer that will pay for a statewide electronic information exchange initiative.

As part of the deal, CalRHIO will deliver secure patient information—including medication history, lab results, and clinical data from claims—to hospital emergency departments for United Healthcare/PacifiCare of California commercial HMO health plan customers.

That information should reduce unnecessary duplication of tests and help emergency clinical teams deliver more appropriate care more quickly.

Coye: It's the first time a national plan has paid for statewide HIE. In a handful of cases, a plan has offered to pay for it in a local demonstration area, but certainly not for an entire state. This deal builds a sustainable business model that is needed to offer services across the country on a permanent basis.

Because California was so big, there was no way we could mount HIE without sustainable financing. The nitty-gritty is who's going to pay for it. All of the previous efforts have been funded by foundations, which are generous but are not sustainable.

If we connect ERs, the major beneficiaries are those who pay for care.

All of the plans we've worked with have agreed there would be substantial savings and those would justify an investment in HIE on the order of what we've concluded with United, but anyone who is involved in negotiations knows there is still a big climb from demonstrating a credible business case to getting health plans to sign on with financial support.

Philip Betbeze

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