Health Plans

HealthShare Exchange (HSX) is unique as an organization by having three health plans as Founding Members.   The collaboration between payer and providers HSX encourages across its services benefits all parties that strive to provide and manage patient care in the most effective and efficient way possible.  By being able to easily access members’ data, HSX member health plans are able to more effectively coordinate care with patients and their treating providers.

Service Descriptions 
  1. Encounter Notification Service (ENS)
    • Health Plans subscribe to panels of current members 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 information about members in a centralized database that can be accessed by authorized users for permitted purposes, including care coordination.
    • Health plans 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.

Health Plans add value for other HSX-provider members through these services…

  1. 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.
    • Clinical Activity History Overview
  2. 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.

In a healthcare market as significant as the greater Delaware Valley region, doctors, hospitals, insurers, and others must work together to improve healthcare quality, lower costs, and improve satisfaction. One way that will happen is through innovation and by creating a superior health information exchange, such as HealthShare Exchange

Richard L. Snyder, MD (Chair), Senior Vice President / Chief Medical Officer, Independence Blue Cross

Benefits 

By participating with HSX, health plans can:

  • Receive timely information about patient encounters with the healthcare system to improve care management and decrease potential for hospital readmissions
  • 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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