Care Continuum Alliance Annual Conference

NaviNet proudly presented at the Integrated Care Summit 10/13-10/15 in Washington DC, organized by the Care Continuum Alliance, formerly known as the Disease Management Association of America (DMAA).  The Alliance’s annual conference convenes healthcare professionals to promote and align population health improvement by sharing and integrating practice models, encouraging the widespread adoption and interoperability of health information technologies, and emphasizing the importance of both healthful behaviors and evidence-based care in preventing and managing chronic conditions.

We were gratified to join our peers, partners and customers, in showing our support for the Alliance’s mission, including its efforts to promote a proactive, patient-centric focus across the care continuum.  There were more attendees at this year’s event, and everyone seemed more engaged, a testament to the increased interest of all healthcare professionals in identifying innovative approaches, technologies and best practices to improve care delivery.

Conference themes included Transforming Care Through Technology; The Rise of Collaborative Models; Focus on Outcomes: Measuring Success, Engaging Employees, Changing Corporate Culture; and Designing for Value in Workplace Health Promotion, among many others. For full access to all tracks and presentations shared at the conference, you can visit the Care Continuum Web site.

NaviNet Vice President of Account Management Catherine Weston and AmeriHealth Mercy Family of Companies Director of e-Business Joe Miller presented on Improving Quality and Access through Administrative and Clinical Transaction Convergence. Through a case study of AmeriHealth Mercy’s success with NaviNet Clinical Messaging, they discussed the benefits of integrating administrative and clinical solutions and workflows, leveraging administrative workflows to deliver clinical data, the challenges of inserting external clinical information into the provider workflow and the differences between push versus pull methods for delivering data to providers.

AmeriHealth Mercy uses NaviNet Clinical Messaging to deliver care gap alerts into the provider office along with NaviNet eligibility and benefits inquiry results. The plan was able to demonstrate that members with alerts presented have care gaps resolved at a higher rate. There was a better than 25% improvement where gaps were viewed.  When breaking down the data and looking at specific care gaps, the two largest groups, Asthma and Preventive Health Screens, showed similar results in closed care gaps.  AmeriHealth Mercy also expected to see other benefits, such as improved HEDIS and P4P scores.

Health plans and providers both have the goal of improving the quality of care for patients, and plans can be a rich source of data to enable the practice of preventative medicine and improve population health. Health plans have a holistic view across the spectrum of a patient’s care and can provide a wealth of clinical data from outside the office setting that the office-based provider may not otherwise see. This could include inpatient stays, emergency room visits, specialist visits and prescriptions filled.  This data can be harnessed and delivered along with evidence-based guidelines to help providers deliver better and more timely care.

Catherine and Joe showed how health plans can take advantage of already-in-place administrative solutions to more effectively deliver pertinent clinical information about the right patient, to the right provider at the right time. Today, administrative transactions are the most often used electronic transactions in healthcare. Millions of transactions occur daily through a secure network of portals and system-to-system exchanges.  There is untapped opportunity to adapt these networks to transmit clinical information.

Administrative transactions herald important events where care management could be needed and beneficial. For example, an eligibility request can signal an admission to the ER or an office visit, and a referral can signal a transition in care. Administrative transactions also have a clearly defined footprint in the workflow of the provider office or facility, offering a pathway to insert contextual information into the providers’ existing process.  These transactions can be leveraged to deliver relevant clinical information at a time when it is actionable, such as when the patient is actually in the office for a visit. This can make a true difference in providing an opportunity for proactive and preventative care, as the AmeriHealth Mercy care gap alerts indicate, which in addition to improving quality can also reduce medical and administrative costs.

We left Washington energized about workflow and solution integration, patient-centric approaches to health data exchange and the potential for unified patient information management to have a quantifiable impact on improving care management and outcomes.

NaviNet is America’s largest real-time healthcare communications network.