Timely and efficient care coordination is a must for health plans and other payer organizations to truly improve their health, produce the best possible outcomes, and reduce health care costs. But care coordination isn’t easy. Incomplete, delayed, or missing health information about a member can have serious consequences, including medication errors, unnecessary or repetitive diagnostic tests, unnecessary emergency room visits, and preventable hospital admissions and readmissions. Often, you may not become aware of your members' emergency department (ED) or other hospital visits until you receive the claim resulting from the visit - which can be up to 30 days after the event. During this time, members may have had even more hospital or ED visits.
In addition to improving care coordination, timely clinical information on your members can also help reduce the administrative burdens associated with gathering data for quality reporting programs. Programs like Healthcare Effectiveness Data and Information Set and the Medicare Advantage star rating system strongly encourage patient-centric approaches for member management that require greater access and use of clinical data to reduce adverse reactions and cut down on repeated clinical procedures like laboratory tests and scans. Often, obtaining the data necessary for reporting in these programs is a manual and time-intensive process.
If you’re looking for effective and efficient care coordination and to reduce your organizations administrative burden WISHIN can help by communicating your members’ information appropriately, consistently and without delay.