Transcript Event Notification Service (PowerPoint)

Event Notification Service
A Service of the Florida Health Information Exchange
Presented by Milly Hardin
May 20, 2014
Hospital Trends
• There were 8,479,256 emergency department
(ED) visits in Florida in 2011
– 28% Medicaid
– 23% Medicare
– 22% Commercial
– 19% Self-pay
– 8% Other
2
Hospital Admissions
• Almost 19% of all ED visits resulted in
hospital admission
– 1,599,511 total hospital admissions
– 250,138 admits (15.6%) were Medicaid patients
• 200,399 adults (80%)
• 49,739 children (20%)
3
Non-Urgent ED Use
• Over 50% of ED visits in FL in 2011 were
potentially avoidable through treatment in a
primary care setting
– 4.2M ED visits could have been avoided
– $10.6B in services could have been delivered by a
primary care provider (PCP)
4
The Opportunity
• Finding a reliable way to reduce non-urgent ED use
can significantly decrease the costs of providing care
– PCP visits cost less than ED visits for non-urgent care
– PCP visits provide routine and preventative care
• Health plans could promote better utilization of health
care resources if they had timely notice of member
hospital encounters
5
An Example
• A hospital alert pilot in Indiana
provided notice of hospital
encounters to health plans
– Alerts used to identify cases of nonurgent ED use
• These members were given information
about the plan’s 24-hour nurse line
• Encouraged to contact their PCP for
questions and follow-up care
• Frequent ED users provided with more
personalized support
6
An Example
• Indiana pilot results
– Reduced non-urgent ED use by 53%
– Increased PCP office visits by 68%
– Less fragmented patient care
– Reduced the cost of providing care
by an estimated $2M - $4M over the
six month pilot
7
Event Notification Service
• ENS allows Florida health plans to receive
timely notice of member hospital encounters
– Health plans subscribe by submitting
a roster of current members
– Participating hospitals provide
patient data to match against health
plan rosters
– When a match is made, information
from the patient’s hospital visit is
sent to the health plan
8
Subscribing
• Health plans subscribe by providing a roster of
current members (a panel) to the Florida HIE
– Panel only uses information that
plans already have and use regularly
– Panels are updated frequently to
reflect changes in patient
relationships
– Panels can include both commercial
and Medicaid enrollees
– Panel can consist of all plan
members or a subset
9
Hospital Data
• Participating hospitals provide the Florida HIE
with copies of their ADT feeds
– ADT = Admit, Discharge, Transfer
– Feeds include information that
identifies the patient and the reason for
the hospital visit
– Pilot participant Broward Health
System sees over 250,000 patients/year
– Additional hospital data sources will be
joining throughout 2014
10
Receiving Alerts
• Once a match is made between the ADT feeds
provided by the hospitals and the “subscribed
to” panel provided by the health plan:
– Alerts are packaged and delivered via
• Direct Secure Messaging (DSM) or
• Secure File Transfer Protocol (SFTP)
– Alerts can be delivered as available or
batch delivered daily or weekly
11
ENS Alerts
• Content of ENS alerts
Source Facility
DOB
Event Time & Date
Source Class (ED/Inpatient)
Address
Hospital Name
Name
Home/Cell/Work Phone
Hospital MRN
Gender
Event (Admit/Discharge)
Primary Complaint
12
Sample Alert: As Available
Sample Alert: Daily Batch
14
Event Notification Service
• Delivers timely, actionable information on
members’ hospital encounters
– Facilitates better care coordination
and case management
– Can be used to proactively prevent
unnecessary hospital readmissions
• Provides up-to-date contact
information
15
Florida HIE
• Contact the Florida Health Information
Exchange
– www.florida-hie.net
– [email protected]
– 850-412-3766
16