For the past year, CICOA Aging & In-Home Solutions has worked with a Medicaid payer to reduce readmissions to the hospital for certain high risk CICOA clients. CICOA provides services and support to the elderly and people with disabilities in Indiana. It’s important that CICOA, whose clients often have unique and multiple challenges, help manage these patients so that they service their contract appropriately, help their patients utilize healthcare resources appropriately, and most importantly, service their clients to the highest level possible.
Because CICOA covers customers throughout Indiana, they need to know all the locations where their patients receive health care. When one of CICOA’s clients present to an emergency room, CICOA receives an ADT (admission, discharge, transfer) report. IHIE sends these reports automatically into their EMR, where an auto box pops up to alert CICOA that one of these clients has visited an emergency department.
Two staff people monitor this activity and contact the patient directly to see what happened, if they need additional assistance, and to help them understand their follow-up care instructions.