The need for this kind of service has been evident for some time, as ambulatory care physicians are often unaware that their patients have either been admitted or discharged until they show up in their offices. For hospitals, the issue has become more important since Medicare began imposing payment penalties on hospitals that have excessive readmissions.
"Readmission is high on the agenda of hospitals because it's high on the agenda of payers, starting with Medicare," Jon Zimmerman, general manager for clinical solutions at Availity, told InformationWeek Healthcare.
That's one reason why Availity has teamed up with MEDecision, he said. Another is that MEDecision is owned by Health Care Service Corp. (HCSC), a holding company for four Midwestern Blues plans that also owns part of Availity.
Besides the HCSC insurance firms, which operate in Illinois, New Mexico, Oklahoma, and Texas, the two companies will also offer their transition-of-care platform to United Healthcare, Humana, Blue Cross Blue Shield of Florida, and other health plans, Zimmerman said.
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Early next year, hospitals can start using their admission-discharge-transfer (ADT) systems to send admission and discharge notices to these payers via Availity and MEDecision. Encased in HL7 messages, these transactions will flow through the Availity clearinghouse to MEDecision's care management system.
"We can create a request for the transaction and a task for the care manager, who can initiate a transition of care plan while the patient is still in the hospital," noted Nancy Bucceri, director of solutions marketing for MEDecision, in an interview.
The health plan or accountable care organization (ACO) care manager will then contact the hospital to find out more about the patient's care plan and discharge instructions, and where the patient is going. She or he will also alert the patient's personal physician about the discharge, said Bucceri.
In the future, she added, MEDecision will also send alerts to its iExchange physician portal, which is part of a multi-payer clearinghouse to which MEDecision has access via an agreement with NaviNet. The 75,000 physicians who have access to that portal can check it for updates to the claims-based "clinical summaries" that MEDecision prepares. Among those updates will be the information about admissions and discharges.
During the first half of 2013, Zimmerman said, Availity will begin to send MEDecision clinical data extracted from discharge instructions and discharge summaries. This data will populate the same continuity of care documents (CCDs) that have been approved to send discharge and referral information under the Meaningful Use stage 2 rules, he noted.
Zimmerman admitted that many hospitals still don't have electronic health records (EHRs), and that hospital information system vendors are just starting to include CCD capabilities in their EHRs. But he noted that Availity has begun enabling providers to send electronic attachments to payers. Those same document attachments, he said, could be discharge instructions or summaries.
MEDecision will provide care managers with this real-time data so they can have more informed conversations with patients and clinicians in the hospital, Bucceri pointed out. They will also consult MEDecision's clinical summaries, which go back more than two years and contain information about a patient's medical history, including their chronic conditions and medications.
"If a patient were being managed for a chronic condition, the care manager could look at both the acute plan of care as a result of the admission and make sure that everything is in sync. She could make sure that the barriers to getting follow-up visits [with physicians] are removed. It's really just a helpful tool to make sure that the patients get the follow-up they need."
MEDecision is also starting to work with ACOs so their care managers can have the same information from Availity, she added.
Availity has recently branched out from administrative to clinical data exchange. Besides the document attachment capability, Availity enables providers to integrate the clinical data in their EHRs with claims data from health plans and to extract data from EHRs for quality reporting, eliminating the need for manual chart reviews. Availity can also send admission, discharge, lab, and concurrent review data to health plan care managers. What MEDecision adds is the ability to apply analytics and add other useful data to the mix.