IHIE_cs1
Problem
As the responsible party for their patients’ health, the Franciscan Alliance ACO needed a solution to help them track what care their patients received, no matter where they received it. This endeavor helps support the ACO’s overarching goal of providing coordinated, comprehensive care across hospitals, physician practices and other healthcare providers, with an aim to bring down the overall costs of medical care.
Solution
IHIE implemented their ADT alerts service that informs Ms. Nolan about when their ACO-related patients have received acute care anywhere in Indiana, in near-real time. Franciscan can then conduct audits based on the alerts, and follow-up with those patients in a timely manner to find out more information about the visit and provide interventions and hopefully avoid a subsequent ER visit.

Ms. Nolan explains that while the service helps them know where their patients have received care in the community, it also opens up the dialogue as to why they went there so they can address the particular needs of that patient. Combined with their access to CareWeb, the ADT alerts system provides the Franciscan Alliance ACO insight into their patients that is unique in the country.
Keywords
CareWeb, interoperability, quality data mining, inpatient interoperability, accountable care organizations, ACO, doctor/patient relationship, Shared Savings, Medicaid, ER visits, ED visits, admissions, discharge and transfer alerts, ADT alerts, care coordination
Identifier
Nancy B. Nolan, RN-BC
Clinical Care Coordinator III
Franciscan ACO-Central Indiana Region
Clinical setting: Outpatient / Accountable Care Organization
Benefits
  • Opportunities for timely follow-up with patients after hospital discharge.
  • Serves as example of impactful way to manage healthcare expenses
  • Provides insight in to utilization of healthcare resources to help the ACO better track and manage patients.
Quotes

The ADT alerts can help us determine if our patients are ER hoppers or if they need care from a specialist, which helps us expedite interventions.

IHIE’s services give me a more rounded picture of my patients, as opposed to just partial pieces.

We have a better understanding of why and where our patients are going to seek care.

Case Study

Situation:
A national Medicare analysis found 50% of patients who were re-hospitalized within 30 days had no intervening physician visit between discharge and re-hospitalization.

Benefits:
Providing timely ADT alerts supports better care for patients and is a critical component to the success of any accountable care organization.

What it Means:
Better utilization of healthcare resources, provides opportunities for timely interventions, and supports overarching goal of ACOs, combined with EMRs and health information exchange will reduce costs, and assist in providing quality care at the time when it is needed.