The next chapter of affiliate strategy

Health systems need turnkey interoperability with their ambulatory ecosystem

For more than a decade, I’ve partnered with health system leaders trying to solve the same foundational problem: how to deliver integrated care to patients across a network of specialists and facilities. Whether it is in pursuit of clinical quality, patient experience, value-based contracts, or optimized patient flow – these leaders turn to their IT partners for seamless interoperability and standardized, scaled connectivity to meet these needs. Unfortunately, they are often left underwhelmed by the available options. At last year’s CHIME Fall Forum, that challenge came into sharp focus.

I hosted a focus group with IT leaders from some of the most forward-thinking health systems in the country, exploring how they define and govern their connectivity with affiliate and independent ambulatory providers. We explored strategies they’ve deployed to cobble together interoperability, what drives these efforts in terms of ROI, and how they leverage technology and other means to succeed in value-based care. What emerged was a picture of an industry in dire need of better options – and we urgently need to talk about it.

Integration is still too hard and too resource-intensive

Every leader in the room agreed that interoperability with affiliated and independent practices remains one of the most difficult and at the same time most essential challenges for health systems.

Affiliates sit on a wide variety of disparate electronic health record (EHR) systems. Many large health systems run integration programs staffed with talented teams, and while aligned with their affiliates, full integration often fails to materialize. Not because the goal is not important, but because the operational realities are stacked against them. Integrations require significant technical resources that are already stretched thin, and the practices with which health systems are trying to integrate lack technical staff and internal expertise to deliver their end of the project. One-off interfaces demand ongoing maintenance, and health systems are understandably hesitant to add yet another EHR to an already complex stack.

The problem is not just technical. Ambulatory practices also differ significantly based on specialty, services, and organizational governance and affiliations. Scaling cross-organizational workflows across potentially dozens of independent practices can be a herculean endeavor. This leads many large health systems to extend or host their own EHR from the large hospitals out to their ambulatory providers as a solution to interoperability. While this may work for tightly aligned affiliates, many practices prefer autonomy and independence and have invested in optimizing EHR workflows specifically designed for the ambulatory environment. In the end, many health systems end up with partially deployed strategies: they emphasize technical integration with their largest and most aligned affiliates, but deprioritize smaller practices because they don’t want to wade through the complexity of hundreds of integrations.

Our industry has made a lot of progress to create data sharing at scale, with initiatives including the CommonWell Health Alliance, TEFCA, and the CMS Interoperability Pledge. Unfortunately, despite these advances, there is a reality many in the industry quietly acknowledge: even when integration between health systems and ambulatory providers would improve patient care, the operational lift is often too heavy to prioritize, and interoperability continues to be an unmet need.

Why integration with affiliates is a key priority for health system leaders

Despite the challenges, the case for integrating affiliate ambulatory providers continues to strengthen. The leaders I spoke to at CHIME consistently cited three ways better integration can help health systems:

1. Integrated care delivery: Fragmentation across ambulatory and acute settings is one of the biggest threats to care quality. Health systems can’t coordinate if they can’t collaborate and see patient records across the continuum of care.
2. Value-based care success: VBC requires discrete, reliable data flowing in both directions, especially for risk adjustment, care gaps, and network engagement. It also needs the right data presented to the right user at the right time within the workflow; otherwise, the data  may not prove as useful.
3. Patient volume and experience: Ease of referrals, speed of follow-up, and seamless patient navigation increasingly determine where, and with whom, patients choose to seek care.

A call to rethink our interoperability model

One of the clearest themes shared by the focus group was that the current approach of building one-to-one interfaces and point-to-point mapping between health systems and independent care sites is unsustainable. In today’s care delivery environment, it simply doesn’t scale. Data lives in so many places. Patients move everywhere. And affiliates will continue choosing the technology that fits their clinical and operational needs regardless of subsidies and EHR-extension strategies invoked by large health systems. Our job isn’t to change that reality — it’s to design connectivity that works within it.

As health system leaders said repeatedly, clinicians need direct, usable data at the point of care, without the cognitive overhead of hunting for it. And for that to happen, interoperability has to evolve. Leaders described a need for approaches that are easier to deploy, lighter to maintain, and capable of moving beyond basic exchange to something more curated, contextual, and longitudinal.

In other words, the next chapter of interoperability can’t just connect systems — it has to connect the ecosystem. That’s the shift many of us in the industry have been working toward, and it’s encouraging to see how strongly health system leaders are calling for it.

Health systems are looking for partners, not just platforms

The insights from CHIME reaffirmed that our industry has the right vision, but we need more scalable tools to execute on it. At athenahealth, we’re providing health systems with an approach that eliminates the need for one-to-one interfaces, easing the burden on health systems as well as their affiliates. Through our cloud-based, single-instance platform, we can create one connection for any health system that connects them to all athenaOne® customers, large and small. Instead of one-to-one, it’s one-and-done.

If your organization is rethinking how to connect affiliates, streamline integration, or build a data strategy that supports value-based care, I encourage you to read a deeper dive on how athenahealth is approaching this challenge: Scaled connectivity through Platform Services.

I’m grateful to the leaders who participated in this conversation and shaped our understanding of the real-world pressures they face. And as always, I welcome continued conversation. The more we learn from each other, the stronger our healthcare ecosystem becomes.