©2016 experian information solutions, inc. all rights ... · an encounter was received for a...

©2016 Experian Information Solutions, Inc. All rights reserved. Experian and the marks used herein are service marks or registered trademarks of Experian Information Solutions, Inc.Other product and company names mentioned herein are the trademarks of their respective owners. No part of this copyrighted work may be reproduced, modified, or distributed in any form or manner without the prior written permission of Experian. Experian Public.

2©2016 Experian Information Solutions, Inc. All rights reserved. Experian Public.

Cheryl DieterleExperian Health

Ronda GageCollaborative Health Systems

Introducing:

©2016 Experian Information Solutions, Inc. All rights reserved. Experian Public.

MemberMatch Best Practices


Quick review of MemberMatch functionality

Tips for First Notification emails

Deciphering the encounter details

Streamline workflows with queues

Client Profile: Collaborative Health Systems/A Universal American company

Options for adding other ADT feeds

Maximizing overall value from MemberMatch

Agenda


Launched in 2013, real-time notification system to alert ACOs and health plans when their members are admitted/discharged to any hospital or emergency room connected to the Passport Eligibility Clearinghouse

MemberMatch Review

Used by over 65 ACOs, ESCOs, and health plans


CARECERTAINTY

MemberMatch: How it Works

Hospitals

PassportClients

EncounterDatabase

Work Queues

Example Queues: Recent discharges New ER visits Inpatient Census

with LOS

Care Management

Member Roster

MemberDatabase

Match process

ADT Msgs

ANSI 270EligibilitySNFs

PassportEligibility

Clearinghouse


Care Mgmt System/Data Warehouse

CARECERTAINTY

MemberMatch: How it Works

Hospitals

PassportClients

EncounterDatabase

XMLInterface

Email or Text

Work Queues

Example Queues: Recent discharges New ER visits Inpatient Census

with LOS

Care Management

Member Roster

Match process

MemberDatabase

ADT Msgs

ANSI 270EligibilitySNFs

PassportEligibility

Clearinghouse


First Notification Emails

From: Experian Health [mailto:[email protected]] Sent: Tuesday, June 21, 2016 12:01 PMTo: Cheryl Dieterle

Subject:MemberMatch First Notification ‐ ER

ER Encounter NotificationAn encounter was received for a member of roster CHS - Hudson ACO on 6/21/2016 at 11:01:13 AM CDT.

Member's initials are ETH / TO.

To view notification details, follow link to view in MemberMatch portal.

Conditions: (((PatientClass = 'E' OR PatientClassMapped = 'E') OR (PatientType = 'E' OR PatientTypeMapped = 'E')) OR (AdmissionSource = 'E' OR AdmissionSourceMapped = 'E'))

You are receiving this message as part of the First Notification feature of MemberMatch. To opt out, please contact your siteadministrator.

Experian Health <[email protected]>


Utilize Smarter

► If you are receiving the emails and not logging into the portal– that’s not smart!

► Opt for notifications only when you have resources to respond in real-time

► Review list of recipients periodically

Enlist gatekeeper to monitor notifications

► Support staff can view details in portal

► Only forward when meets criteria for outreach

Get Smart about First Notifications!


MemberMatch Portal Detail

20+ Encounter fields

including:- Admission Reason

- Attending MD- Patient Type

- Discharge Disposition- PCP (from Hospital)- PCP (from Roster)and Demographic Info


Deciphering Encounter DetailsandStreamlining Workflows with Queues

Live Demo


Create queues that drive workflow

► ED encounters

► Discharges 3 days prior through today

► Inpatient census

Organize queues to support team’s assignments

► By physician

► By facility

Add risk scores to roster

Maximize Value from MemberMatch Queues


Client Profile: Collaborative Health Systems

Ronda Gage

Executive Director,

Accountable Care Coalition of Southeast Texas (Next Gen ACO)

Accountable Care Coalition of Texas (MSSP)


Management Services Organization

Early adopter of MSSP’s

Manages 22 MSSP ACO’s

More than 5,000 providers

236,000 Medicare beneficiaries

10 of the CHS ACO’s earned $40 million in shared savings in 2015

CHS ACO’s represent 6% of the Medicare ACO’s and generated 17% of the net savings to Medicare

Client Profile: Collaborative Health SystemsA Universal American Company

FloridaGeorgiaMaineMarylandMississippiNew MexicoNew YorkNorth CarolinaTexasVermontVirginiaWisconsin


Population health IT and analytics

► Broad range of data analytics

► Adaptable population health management workflow tools for provider referral intelligence

► Proprietary business intelligence tools

Clinical programs

► Locally embedded care coordinators

► Specialized care management programs for chronic populations

► Clinical best practices and tools

► Quality scoring optimization

Services Provided by Collaborative Health Systems

Provide actionable data to help coordinate care


Who we are

► 30,000 beneficiaries

► 220 providers

► Intake Coordinators

► Care Managers

► Social Workers

► Hospitalist

► Market operations

Accountable Care Coalition of Texas(MSSP) and Accountable Care Coalition of Southeast Texas (Next Generation ACO)


Intake Coordinator reviews work queues in MemberMatch portal

► Intake Coordinator calls low acuity beneficiaries

► Case Managers call high acuity beneficiaries

Interface with C-3, proprietary care management software

MemberMatch Workflow


Utilize real-time MemberMatch notifications of acute admissions and discharges to initiate care coordination

► Post-discharge call to check in

► Verify medication adherence

► Confirm follow-up visit completed

► Identify social needs and programs for applicable enrollment

► Share actionable data with provider

Identify high ER utilizers through monthly report

► Enroll in NP program/In-Home Palliative Care

► Alert PCP when beneficiaries using ER during office hours

Use Cases for MemberMatch Notifications at CHS


Always call on behalf of provider not the ACO

Relay that we are there to help and share information about various programs and support available i.e. transportation

If difficulty engaging beneficiary, will ask PCP for help

Try to engage beneficiaries while in acute settings before discharge

Tips for Engaging Beneficiaries


88% of our ACOs had an increase in primary care services utilization and visits to providers within 30-days of hospital discharge

79% of our ACOs had a reduction in hospitalizations per thousand beneficiaries, comparing results for 2015 to the year before the ACOs’ start date

Results: Improved Quality Scores in 2015


It’s All Good But We Want More ADT Feeds

Consider adding HIEs

Approach facilities about ADT feed to Passport Eligibility Clearinghouse

► No fees to facility

► Experian Health will provide a daily readmission report back to facility for a roster they provide


Be selective about First Notifications and periodically review recipient list

Utilize Experian Health team for help with encounter details and mapping

Create queues that drive workflows and support team assignments

Share actionable data with PCP’s

Take advantage of the networking opportunity here in Nashville to share MemberMatch best practices

Maximizing Overall Value from MemberMatch

©2016 experian information solutions, inc. all rights ... · an encounter was received for a...

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