Accountable Care Organizations

HealthShare Exchange (HSX) works with several accountable care organizations (ACO) and other risk-bearing entities that care for specific populations across the Philadelphia region. Through participation with HSX, ACOs have access to more timely notifications about patient activity in HSX-member hospitals and can more effectively coordinate care in collaboration with patients and their treating providers.

Service Descriptions 
  1. Encounter Notification Service (ENS)
    • ACOs subscribe to panels of current patients and receive timely notifications when they are hospitalized or present to an emergency department and then are subsequently discharged.
    • ENS notifications are provided by admission, discharge, transfer (ADT) feeds from more than 40 member facilities in the Philadelphia region.
    • Encounter Notification Service (ENS) Overview
  2. Clinical Data Repository (CDR)
    • Collects and retains medical-records data about patients, permitting a patient’s provider and/or care-team members to query for clinical information.
    • ACO representatives usually access the CDR using the HSX query portal.
    • Clinical Data Repository (CDR) Overview
  3. Quality Reporting
    • Leveraging the CDR, current medical information can be accessed by authorized users to support quality reporting initiatives.
  4. Clinical Activity History (CAH)
    • Collects recent clinical history about a patient from the patient’s healthcare insurer, based on the patient’s member identification within the health plan and translates this claims/utilization data to a clinical care document — returning this information to the requesting provider or emergency department.
    • Admission, discharge, transfer (ADT) feeds from the provider organization trigger the clinical activity history process.
    • Download our Clinical Activity History Overview
  5. Automated Care Team Finder (ACTF)
    • Leveraging the Provider Directory, ACTF routes continuity of care (C-CDA) documents, containing discharge information, using the patient’s member identification with his or her healthcare insurer to identify the patient’s primary care provider.
    • Through the ACTF, health plans receive the C-CDA documents from participating hospitals for members meeting eligibility.

HSX information has changed our world as a care management organization. Incorporating their notifications feed in what we do daily has been a defining moment for us. For the first time, we can see where our patients are in near real time.

Ann M. Marks, RN, MBA, CCM
Director, Care Coordination
Delaware Valley ACO

Benefits 

By participating with HSX, ACOs can:

  • Receive timely information about patient encounters with the healthcare system to improve care management and decrease potential for hospital readmissions and unnecessary Emergency Department utilization
  • Obtain clinical information about current members from a variety of data sources to support care coordination
  • Obtain necessary clinical information from the data repository to streamline quality reporting efforts

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