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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.