DHIN Launches Acute Care Alert System For Two Medicaid Managed Care Organizations
New System Sends Alerts For Hospital Encounters
Dover, DE, September 30, 2013 –The Delaware Health Information Network (DHIN), is now delivering daily hospital encounter notifications to a Medicaid managed care organization (MCO) to support its care coordination efforts in Delaware. DHIN, in partnership with Audacious Inquiry (Ai), an innovative management and technology consulting firm, successfully launched its Encounter Notification Service (ENS) on Friday, September 20. DHIN, founded in 1997, is one of the nation’s oldest and most successful statewide health information exchanges.
“DHIN is thrilled to meet our strategic goal of providing encounter notifications to our customers in Delaware,” said Mark Jacobs, CIO at DHIN. “This go-live marks the beginning of a longer term strategy to provide hospital encounter notifications to all payers and providers in Delaware.”
ENS, powered by Ai, delivers real-time, encrypted notifications to interested parties such as primary care practices, patient-centered medical homes, hospital readmission programs, and managed care organizations when patients under their care experience a hospital-based encounter. Today, providers and others with care coordination responsibility may not know when one of their patients is admitted to a hospital, or they may find out well after the hospital event. ENS supports hospital communication with primary care providers and care managers to promote care coordination, reduce readmissions, and prepare for new payment models.
ENS utilizes core infrastructure which many health information exchanges and hospital systems already operate—such as demographic feeds and master patient indexes—to support care coordination, reduce hospital readmissions, and drive revenue. In Maryland, ENS delivers notifications to more than 30 organizations, providing caregivers with actionable information on hundreds of patient encounters per day across 47 hospitals.
Ai developed ENS in response to demand from its statewide health information exchange customers, as a way of capitalizing on existing infrastructure to drive business value for HIE participants and help ensure HIE sustainability.
“ENS is the product of two basic insights we have gained in the last five years of work with HIEs,” said Scott Afzal, principal of Ai. “First is that the basic demographic feeds which many HIEs have established with facilities throughout their service area are undervalued and include lots of impactful information. Second is that patient matching—master data management—is one of the most important things an HIE does, if one does it well. The solution capitalizes on these insights to put actionable information in the hands of the right caregiver at exactly the right time.”
The cloud-based ENS solution allows for rapid deployment and time to value for both HIEs and their participants. It holds a clear value proposition for the following groups:
- Hospitals – ENS helps hospitals regulatory compliance, such as CMS A-0133 which states, “The patient has the right to have a family member or representative of his or her choice and his or her own physician notified promptly of his or her admission to the hospital.”
- Ambulatory providers – CMS recently approved two new transitional care management (TCM) CPT codes to reflect non face-to-face care management work involved in primary care. Reimbursements began on Jan 1st, 2013. According to AAFP, payments are estimated to total $600 million in 2013. Incentive payments under the new TCM codes range from $135-$231 per patient.
- Insurance plans, managed care organizations and ACOs – ENS supports responsive case management, delivers up-to-date member contact information, and supports a range of quality initiatives.
About the DHIN
The Delaware Health Information Network was created by the Delaware General Assembly in 1997 as a public-private partnership for the benefit of all citizens of Delaware to establish a statewide health information network and to address Delaware’s needs for timely, reliable and relevant healthcare information. With all Delaware acute care hospitals and approaching 100% of providers now participating, DHIN is sharing real-time clinical information to improve patient outcomes, eliminate the duplication of service and reduce the cost of healthcare.
Audacious Inquiry works as a strategic partner to government agencies, businesses, professional associations, and non-profits to maximize the positive outcomes and minimize the risks of initiatives at the intersection of healthcare, technology, and government. Our customer base includes state agencies and state-designated entities for health information exchange (HIE), federal agencies including the Departments of Health & Human Services, Interior and Agriculture, hospitals and large integrated delivery networks (IDNs), national payers, as well as private-sector clients in the financial services, healthcare, education, and non-profit sectors. Ai has been certified as a “B corporation” in the state of Maryland, only the fifth company in the state to do so; as a “B corporation”, the company meets comprehensive and transparent social and environmental performance standards, agrees to meet higher legal accountability standards than ordinary companies, and is building a business constituency for good business.