Background
A health plan we collaborated with sought a comprehensive understanding of their members’ statuses regarding ER visits, hospitalizations (including admissions, discharges, and transfers), aiming to promptly address patient needs post-discharge. Additionally, they aimed to relay this information to Primary Care Physicians (PCPs) to facilitate effective medication reconciliation during follow-ups by care managers. Leveraging our experience with multiple Health Information Exchanges (HIEs), we endeavored to develop a solution within a month’s timeframe to accommodate the substantial volume of over one million plan members, which generated more than 30,000 messages daily.
Challenge
The primary challenge revolved around building an optimized solution capable of aggregating and managing the vast influx of ADT (Admission, Discharge, Transfer) messages efficiently. Specifically, the solution needed to consolidate ER visits, hospital admissions, and transfers from ERs to inpatient facilities (IPs) and between IPs and other hospitals. The objective was to present aggregated data on admissions and ER visits rather than showcasing individual ADT messages in real-time.
Solution
We devised a solution that visualizes all ADT messages within a single application, offering drill-down capabilities for detailed analysis. This consolidated view empowered the provider relations team to strategize effectively, streamline discharge processes, expedite pre-authorization requests, and promptly respond to patient needs. Moreover, this solution had implications for improving the quality measures of the health plan by enhancing care coordination and post-discharge follow-up procedures.
Implementation
The implementation involved the development of a user-friendly application that interfaces with the existing systems to ingest, process, and display ADT messages in real-time. We leveraged our expertise in data integration and visualization to ensure seamless functionality and intuitive user experience. Additionally, we conducted thorough testing to validate the accuracy and reliability of the solution before deployment.
Results:
Conclusion:
The successful implementation of the ADT message visualization solution marks a significant milestone in addressing the health plan’s challenges related to ER visits and hospitalizations. Moving forward, the plan aims to expand the solution’s capabilities by incorporating readmission predictors and Length of Stay (LOS) estimators, enabling care teams to gain a comprehensive understanding of member histories beyond individual episodes of care. This initiative underscores our commitment to leveraging technology to address complex healthcare challenges and drive meaningful improvements in patient care delivery.
