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.
WISHIN’s Patient Activity Report for Payers
WISHIN’s Patient Activity Report for Payers (or PAR-P) provides you with a daily notification when your member has had an ED or other hospital visit. The report provides basic patient demographic information (name, address, gender, etc.), encounter metadata (admit date/time, registration date/time, etc.), and high-level clinical data (chief complaint and diagnosis) – enough information for you to follow-up with providers and patients, organize your member’s care activities, and help ensure safer and more effective care.
WISHIN’s PAR-P can help you provide targeted care coordination - improving outcomes for everyone: members, providers, and payers.
Learn more about PAR-P.
WISHIN Express provides real-time clinical data about your members that can significantly minimize – or even eliminate – the need for manual, time-intensive data collection efforts. WISHIN matches your member list against real-time encounters received from providers that are enabled for the service. If one of your members has an encounter with the enabled provider, the clinical information about that encounter can be directed to you real-time. WISHIN can send you ADT information (i.e., information on the member admissions, discharges, and transfers), laboratory test results, pathology test results, radiology reports, EKGs, and transcribed reports.