How this health system reduced readmission rates to meet CMS requirements

While the various waves of vaccine priority may be largely defined, the ability for many providers to segment their patient populations based on those designations isn\'t always simple. Without accurate data, there’s a risk that some vulnerable patients will be missed out. We interviewed Mindy Pankoke, senior product manager at Experian Health, about the challenges in segmenting patient populations for the COVID vaccine and how providers can best overcome those challenges. How does addressing patients’ barriers to care increase vaccination rates? The early versions of this vaccination have two doses which comes with its own set of challenges. Getting a vaccination is one thing but getting people to follow up for a second dose in a certain time frame is another. It’s the non-clinical factors that will prevent patients from getting the vaccine. So, things like inflexible work schedules, lack of transportation or even the access or comfort levels with technology required to schedule an appointment online can prevent patients from receiving or prioritizing the first and/or second dose. It can be an uneven playing field with those patients that do not have more flexible schedules, a vehicle or even access to the proper technology to schedule and register for both doses. It’s much easier for patients to prioritize getting the vaccine when those non-clinical factors are a non-issue. What challenges may providers face when trying to segment patient populations for vaccine administration? There are a lot of gaps in patient demographics which can make it difficult for providers to accurately identify and segment patients. Think information like date of birth or occupation. If providers want to segment by age, which many will likely do for the first wave of vaccinations, that would require a complete record of every patient with an accurate birth date. Providers may also want to segment by occupation, knowing essential workers are also eligible for the vaccine. But how can you understand who is an essential worker? Especially when that definition may vary by state or local government? Including non-clinical insights and enhancing demographic data as part of the patient record can help providers fill in the gaps and better segment patient populations for vaccine administration. By combining the power of Experian’s consumer demographic information with more than 40 years of experience compiling consumer data from self-reported and state license boards, Experian Health is able to drill down into occupation data to view different types of employment (construction, utility, etc.) for you to use to outreach, verify and streamline the scheduling (and automated scheduling) or the COVID vaccination. What are some best practices to move from identifying at risk or priority populations and operationalizing that information into actually administering the vaccine to those groups? This is really where it all comes together, and really where providers need to act fast. Once a group is identified, providers can automate the process as much as possible. First, it is imperative that providers clean up their data. Recent processing of Experian’s Universal Identity Manager solution has identified 1,800 duplicate records in COVID vaccination registrations, for individual facilities. Providers can remove the duplicates, enhance the demographics where they may be out of date or missing, and put in place a proactive system to call out and prevent duplicates moving forward. And the vaccine has a shelf life, correct? So even after segmenting the right patients, how can providers act fast to ensure it is administered? So another best practice is to automate the scheduling for as many vaccination appointments possible. With a tool like Patient Schedule, providers can leverage the demographic data to programmatically push out a notification to a patient’s cell phone via IVR or text message, have them verify their eligibility based on the age or occupation data from Experian, and then allow the patient to book their appointment on the spot for a time that works best with their schedule. On the back end, the Patient Schedule solution syncs with the clinic or mobile vaccination site’s calendar to confirm the appointment, allowing staff the opportunity to tackle other pieces of the COVID vaccination strategy. Anything else you\'d like to add? Providers will also want to risk stratify using social determinants of health insight on the individual level. Patients in every wave of vaccine priority present an opportunity for better patient engagement (68% of the US is impacted by at least one social determinant of health hindering them from accessing or prioritizing their care). Many patients will need help adhering to that second dose and knowing that information and those circumstances on the individual level can help providers engage in the best way possible to ensure the vaccine is administered correctly. Interested in learning more about how Experian Health can help supercharge the COVID-19 vaccine management process?

Published: March 3, 2021 by Experian Health

The revised medical necessity form will be mandatory starting January 1, 2021. Here's what’s changed and what providers can do to prepare.

Published: November 5, 2020 by Experian Health

Visits to emergency departments (ED) dropped by 42% in the early months of COVID-19, according to the CDC. In pre-pandemic times, this might have been a positive sign. Two-thirds of ED visits are thought to be avoidable, with emergency care used as a safety net in the absence of access to more appropriate services. Excessive emergency care also comes with a high price, often resulting in a poor patient experience. UnitedHealth Group estimates that the 18 million preventable visits per year cost the health system up to $32 billion annually. Unfortunately, the rapid decrease in ED use during the pandemic isn’t a signal that care management and access challenges have been resolved. Social distancing, stay-at-home orders and fear of being exposed to COVID-19 have prompted patients to avoid seeking care in person altogether. Inevitably, as more individuals either postpone or forego the care they need, ED use will start to creep back up again. For health plans, the worry is a sudden influx of their members returning to emergency departments with more complex care needs arising from delayed treatment. Medical costs could sky-rocket, while gaps in care could reach critical levels as health plans and providers struggle to keep track of ED admissions and readmissions. As health plans look to curb ED utilization in the aftermath of COVID-19, digital tools can provide a valuable lifeline. 4 ways health plans can use digital tools to reduce unnecessary ED visits 1. Take action to engage members before acute episodes occur Proactively involving members in their own care management can help head off unnecessary ED visits before they’re even a possibility. Understanding how the social determinants of health affect a member and how they access care can help health plans tailor their engagement strategies and close gaps in care. Experian Health’s Member Engagement Solutions draw together all the insights needed to connect the dots between emergency visits, social and economic risk factors, and digital care coordination, so health plans can communicate with members in the most effective way. 2. Make it easier for members to access care when they need it Part of the ED visit volume is based on members’ frustration of not being able to access care when they want or need it. Health plans can prevent unnecessary ED visits by sending automated outreach prompts to encourage members to schedule appointments, via interactive voice response or text. A digital scheduling platform can give the member an easy way to book their appointment, without needing to call during office hours. With digital scheduling, health plan member engagement teams and call centers can facilitate member appointment scheduling with the right providers without the cumbersome three-way call. 3. Implement a real-time tracking strategy for ED admissions One of the biggest challenges for health plans is not knowing when members are admitted to the emergency department. A tool such as MemberMatch® can alert health plans of their members’ real-time ED encounters, so they can rally around active episodes of care – potentially avoiding unnecessary, out-of-network admissions and readmissions – and optimize the cost and quality of encounters across the continuum of care post-discharge. Using Experian Health’s leading referential matching system, a member’s care team can be notified via text, portal or email for quick insights that enable better care coordination. 4. Ensure better management of post-discharge follow-up care Every health plan’s checklist for reducing readmissions should include a follow-up strategy when patients have visited the ED. Given that post-ED follow-up for members with chronic conditions is likely to be a STAR measure in the future, plans should prepare their proactive intervention strategy now. USMD WellMed Health System used Experian Health’s Member Utilization Management Solutions for better care coordination for patients within 30 or 90 days of leaving hospital, significantly reducing their readmissions rate. Within just four months, the ROI trends gave them confidence to roll out Care Coordination Manager from USMD clinics to WellMed clinics too. Reducing admissions and readmissions is not about making access to the ED more difficult, but making access to other services, care options, and care management solutions easier. With the right digital solutions, health plans can take action to make this unprecedented transition of care from the ED to other, more cost-effective arenas the ‘new normal’ and put the old model of ED over-utilization in the past. Contact us to learn more about how Experian Health can help health plan reduce unnecessary ED visits.

Published: October 29, 2020 by Experian Health