September 2016, WISHIN Connections

In many cases, Medicaid health plans and other payers are not aware of their members' Emergency Department (ED) or other hospital admits or discharges unless they make arrangements individually with each hospital to get notifications or until the claim resulting from the visit is received, which may take up to 30 days. 

The Patient Activity Report for Payers (PAR-P) provides daily notifications of patient hospital or ED visits to payers. The report, which includes admission, discharge and transfer (ADT) information, was created to help payers follow up proactively and timely with members who have visited a hospital or ED. The PAR-P can help to assure compliance with care plans, avoid preventable re-admissions, prevent duplicative testing and procedures and connect targeted Medicaid ED visitors with medical homes or appropriate follow-up care.

Working in Partnership for Improved Care Coordination

The PAR-P project was developed by the WISHIN team with input from payers and completed in partnership with and supported by funding from the Wisconsin Department of Health Services (DHS). The first sites, Medicaid health plans serving certain members in Milwaukee, went live in April 2015. Many of the health plans chose to include members beyond those in the pilot population.

In September 2015 a survey was distributed to the pilot sites to gather feedback on the organizations' experiences with PAR-P and what they would like to see in Phase 2.

More than 80% of respondents indicated that they found the PAR report useful and timely. When asked how the patient care coordination process changed with information from the report one respondent commented that the follow-up process has been made easier by having the most recent demographic information on a patient. The respondent continued,

"It also allows us better access to patients that have been floundering in the system without access to a [primary care physician (PCP)] due to their own lack of knowledge. The hospital inpatient notification has allowed us to share this information with their PCP and obtain referrals to our care coordination team for temporary or permanent placement into a care coordination or disease management program. These patients in the past were typically lost until they presented to an office and at that point their disease may have progressed needlessly."

Phase 2 Improvements

By the request of the pilot sites, the PAR is now delivered to an sFTP folder rather than via secure email. The sFTP folder process can simplify health plans' workflows so that their systems can automatically retrieve the file from the folder rather than taking multiple steps to open secure emails and download the files.

Additional Phase 2 improvements were made to provide more details to payers receiving the report to clearly indicate what event triggered the PAR. For example, event identifiers were added to encounters including whether the notification is being sent because of an admission, discharge or change in demographics, or change in diagnoses. Furthermore, five new data elements have been added to PAR-P: event type, discharge date & time, discharge disposition, internal visit/account numbers and the primary-care physician. With the addition of these details, case managers can quickly move through their workflow rather than spending time identifying why the report was generated or tracking down contact and other information critical to a swift follow-up.

WISHIN is pleased about the potential of the PAR-P report to connect health plans and their members to accelerate and improve care. The addition of the PAR-P to WISHIN's services builds on its mission to promote and improve the health of all communities and patients in Wisconsin. 

If you have questions about the PAR-P's capabilities and uses or would like to find out if your organization could use the report, contact WISHIN at wishin@wishin.org or (608)274-1820.