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Navigating Complexity, Building Trust

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Angie Bass, President and CEO

By Sandy Cyr

Cutting-edge technology and the nonprofit sector are not concepts that people often combine. But for Missouri Health Connection, navigating the complexities of health record information and earning the public trust as a nonprofit organization go hand in hand.

Missouri Health Connection (MHC) was formed in 2011, using one-time Federal funding from the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. The idea of Health Information Exchanges (HIE) began in the 1990s with large health systems seeing the need to connect particular communities. With the HITECH Act, states now had Federal funding to ‘promote the adoption and meaningful use of health information technology.’ That funding gave birth to most of the HIEs that are in existence today across the country.

Some states set up their HIEs through their health agencies as an extension of state government, some formed it around a health insurance carrier or large health system. Others, like MHC, chose a nonprofit model. MHC engaged members from the onset, building equity and inclusion into their business model. This helped foster trust within the community, which has been key to MHC’s success. After putting their governance together and standing up their infrastructure, MHC began onboarding new participants in February of 2013.

Serving the entire state of Missouri, as well as providers throughout the Midwest, MHC has quickly become one of the largest HIEs in the country. Their job is to be the broker between providers and patients wherever health information resides on different and disparate platforms, and to make that data exchangeable so that it can be used for better health outcomes and better clinical decision making. With almost 17 million patients registered in their patient index, and more than 70 participating hospitals, and hundreds of clinics, it is no small task.

MHC’s platform allows participating members to query each participant that MHC has a connection with. Their technology connects directly into participants’ Electronic Medical Record systems so that data can be pulled when another member in the system needs it. And with that data transaction, there are additional complexities such as data normalization, data validation to ensure the information being sent is for the patient that it is being requested for, and ensuring MHC has the proper privacy and security policies and operations and methodologies in place to do such transactions. “That’s why the complexities of what we do are so vast,” says Angie Bass, MHC’S President and CEO. “It is not only technical, but it is a lot of policy implications around patient privacy and HIPAA and so forth.”

Working with a commodity such as health information data requires a lot of trust on the part of the membership. HIEs believe a patient should have access to their health information no matter where they go. Their healthcare providers and the participating members that are paying for their health information should also have access to the health data at any given point. Most healthcare providers are nonprofit organizations, and since these providers are MHC’s predominant customer, adopting a nonprofit model for their own organization was a natural fit.

Because of HIPAA and patient expectations around healthcare data, restrictions and regulations that dictate the nonprofit sector offer a comfort that helps build the rapport of Health Information Exchanges. Almost half of the HIEs that were started under the HITECH Act have been absorbed into others, closed or restarted in another form. According to Bass, “I think the reason that we remain and have had success as a nonprofit is because a provider, a hospital, a clinic wouldn’t hand over their data to someone that they didn’t have trust in to do what we do. Being a nonprofit, being a business that holds the community good at the forefront gives us an ability to stand up in front of a patient, in front of a provider, in front of a community and say, ‘this is why we have this model – we are here to do a public good and a public service. We exist  to do right by your health information.’”

In the healthcare space, there is a lot of competition – competition for patients; competition for the best care; competition for affordable care. But within MHC’s membership there is cooperation, collaboration and trust. No one gets treated differently. Every single one of MHC’s participants signs the exact same contract, everyone plays by the exact same rules. This was a deliberate choice made at the very beginning of the organization. Member organizations wanted equity, and that has been key and critical to MHC’s success.

It took a long time for MHC to build that foundation of trust, but without it, they wouldn’t be where they are today. Participant members were at the table from the beginning and helped put together not only the organizational structure, but the completed governance that now currently rule the organization. “Having everyone at the table, everyone having an opportunity to have input, by way just affords that environment of inclusion where everyone’s data is equal. We always say everyone is equitable. It doesn’t matter whether you are a large health system or a small one doctor practice, everyone’s data is equal in value and we want everyone to be a data contributor as well as a data consumer,” says Bass.

Nonprofits are uniquely positioned to build trust within the community. With information as sensitive as medical records, MHC as a nonprofit is able to broker the exchange of information between patient and health organizations with a moral trust that a for-profit model may not be perceived as having. By engaging participant members from the onset and successfully navigating the complexities of health record information, Missouri Health Connection has become a national leader in the Health Information Exchange space.


Angie Bass is the President and CEO in for Missouri Health Connection. She is responsible for management and strategic direction for Missouri’s statewide health information exchange and maintaining the internal and external operations of one of the largest health information exchanges in the country. Angie’s tenure at MHC includes Chief Operating Officer and Director of Business Development and Customer Services. Prior to joining MHC, Angie worked as a Legislative Research Analyst in the Missouri House of Representatives and was responsible for health care policy analysis and development and legislation.

Sandy Cyr is the Managing Editor for the Philanthropy Journal, and a fan of all things related to the nonprofit sector.

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