On Tuesday, March 6, Martin Lupinetti, President of HealthShare Exchange, partnered with Andrea Gelzer, MD, MS, FACP, Senior Vice President and Corporate Chief Medical Officer of AmeriHealth Caritas and HSX board chair, presented “How an HIE and Health Plan Innovated to Improve Medical Reconciliation.” The talk focused on finding patients most in need of medication intervention and explained how an insurer worked with a health information exchange (HIE) (in this case, HSX) to find patients at risk with their drug regimen. Attendees were treated to a proof of health information technology reaching down and connecting with the patients most in need of care management at moments when they are most at risk.
Marty and Dr. Gelzer presented a pioneering collaboration between a health information organization and a health insurer that has begun to identify patients who need intervention to correct potential errors, discrepancies, or lack of compliance in their prescription drug regimen. In the innovative process described in the this talk, health plan members for whom the plan has received a discharge alert and continuity of care document through HSX are selected for medication review based on population health criteria of being either high risk or pregnant. The presenters reviewed statistical results on the differences found between facility and pharmacy medication lists, as well as identifying the percentage of the sample patients with such differences that need physician or care-manager medication review. They described sample results for the portion of cases that have been found to need follow-up with the plan member because medications were not picked up or follow-up with the member’s provider because medications were missing from the continuity of care document (the CCD submitted to the health information exchange by the medical facility that had discharged the patient).
Read the abstract:
Newly evolving HIE services are creating opportunities for health plans and providers to improve transitions in care, particularly for underserved populations. A next-generation HIE offering CCDs post-discharge from hospitals in a large metropolitan area collaborated with the leading Medicaid managed care plan to improve timely medication reconciliation. Patients facing the challenges of low health literacy and social determinants are more likely to fall through the cracks for transitions in care. Using risk stratification to target the most-needy members, high-quality data delivered by the HIE, and automated matching of the CCD data with other medication sources, the plan was able to identify patients needing immediate follow-up. Insights around HIE and health plan collaboration, data consistency and quality in a multi-hospital environment, medication matching, HIE design, and plan-provider communication offer lessons learned for this and similar use cases.
HSX's Manager of Innovation, Research, & Developement, Rakesh Mathew, spoke at the HIMSS18 plugathon, discussing HSX's new development platform: HSX MarketStreet. He disucssed this new API initiative as it applies to mHealth (mobile) apps and the IOT-M (the internet-of-things in medicine) and reviewed how the platform’s recently introduced FHIR™ server can support data sharing with medical devices and other systems.
John Donnelly, HSX’s domain consultant, helped to organize the plugathon, which serves to extend the continuum of testing activities and explore the potential for new technology to improve healthcare workflows before a defined standard or profile is established, thus rapidly moving the innovations forward.
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