Wednesday, January 26, 2011

#Health3 How #HIE drives down ER use and drives up Medical Home use

Live blogging from the 

Health 3.0: The Next Online Generation Conference in Orlando Florida.
Here is the outline for this session from the published Agenda. 

Learn How a Health Information Exchange (HIE) works to
Drive ER Use Down and Medical Home Use Up for Improved
Healthcare Outcomes
This session presents a case study of the Wisconsin Health Information Exchange (WHIE). From this study, learn strategies that can be implemented by health plans for effective utilization management through a Health Information Exchange. This will prove how an information support network can add value to the health plan as well as the provider community. As a result, populations will experience improved health outcomes through appropriate use coordination. In this session you will learn how to:

  • Manage appropriate ER use
  • Promote Medical Home PCP involvement
  • Generate improved health outcomes
  • Reduce costs to insurers
  • Achieve accountable care objectives

Tom Lutzow
Chief Executive Officer

Kim Pemble
Chief Executive Officer

The average medicare patient in one year sees 2 PCPs, 4 Specialists across 4 hospital systems.

Meaningful use in simple terms means information follows the patient. [Ed: Shouldn't that be with the patient]

Health Information Exchange is not a technology issue - it is a cultural information exchange challenge.

Wisconsin HIE is using Admission Records to create patient relationship maps.
At this stage WHIE knows what you have been admitted for, what Medicaid prescriptions have been paid for. The next step is to capture outcomes of procedures.

ICHP is a managed care plan established in the early 1990's. The average SSI member has 6 co-morbidities. The members covered by ICHP in their iCare plan use the Emergency Room (ER) as their Medical Home. The WHIE is invaluable for ICHP.

WHIE is used to target better care for the 1,623 iCare members that visit the ER more than 3 times in a year. This group can be given better care by recognizing where they have previously been cared for and what procedures and tests they have already had.

iCare CORE members (Medicaid only - typically homeless people) have a Medicaid requirement to record basic Health Assessment information in order to maintain Medicaid eligibility. iCare ensures this need is brought to the attention of the Physicians in the ER when a member checks in at an ER.

70,000 people on waiting list for iCare CORE. Costs $60 to join plan. Losing eligibility is a big deal. 

iCare SSI members targets members using the ER more than 4 times per year. The notice via the WHIE alerts the ER that the patient needs to be diverted to their PCP or other local clinic. iCare coordinates this providing transportation.

iCare expects to save $2M by increasing spending in Medical Homes and reducing ER costs.

PPACA (Affordable Care Act) has a provision to put in place mechanisms to reduce patient readmissions. 

Discharge plans: Hospitals don't present to iCare. 35% of members don't get a discharge plan. Of those 67% get presented to iCare by the member. Of those 63% are complete. Of those 88% are legible. 

When the Care Coordinator intervenes (home visits etc) the plan's experience is that Costs Per Member Per Month (PMPM) can be reduced by ~22%.

Self reporting doesn't work [Ed: We know this because relying on patient memory is a poor plan]

WHIE impact: in 44% of cases information from the WHIE changed the treatment plan for patients. From Efficiency perspective 40% reduction in time to find information. 44% reduction in time to treatment disposition.

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