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The A v aility ® Health Information N etwork: Capabilities and Connectivity Supporting the Next Generation Revenue Cycle. Good for Health Plans, good for D elivery Systems, and good for Patients. Tomorrow’s Information Needs. T oday ’s Information Exchange. largely consists of:
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The Availity® Health Information Network:Capabilities and Connectivity Supporting the Next Generation Revenue Cycle Good for Health Plans, good for Delivery Systems, and good for Patients
Tomorrow’s Information Needs Today’sInformation Exchange • largely consists of: • EDI/HIPAA Transactions • Claims • Eligibility & Benefits • Claim Status • Remits • Physician Self Service • Web portals • Real-time information • Care management tools • Revenue Cycle Management • Advanced claims management for physicians and health plans • Migration to value-based programs and payment models demands: • Inpatient Information • Admissions • Concurrent Review • Lab Results • Discharge Information • Medical Attachments • Clinical Summaries • As well as expanded integration • and connectivity with: • HIEs • Hospital/physician systems • Health plans
Focus on Impact Impact Requires Provider Adoption Provider Adoption Requires Demonstrable Value and Simplicity Simplicity is Achieved via Workflow Integration Workflow Integration is Accelerated by Use of Standards Adherence to Standards Can Drive Impact
Health Plan Overview Hospitals The Availity Network Providers Clinical Data Medical Attachments Clinical Summaries EMR Integration with Availity®CareProfile® Clinical Data Clinical Data Clinical Data Admission Concurrent Review Lab Results Discharge Information Medical Attachments Clinical Data
Integrated Clinical Documentation Value Propositions Cost / Quality / Compliance Care Coordination Revenue Cycle Care Management PCMH / ACO Risk Management HEDIS / Stars Administrative Savings
Integrated Authorizations Exports to .csv file Displays Patient Acct #, Patient Name, Medical Record # Allows user to set filters by facility, date, auth status or health plan Refresh screen Displays facility name, health plan info Displays status of authorization Quick search Displays auth responses, ADT message data, user comments by patient Displays Patient Class, admit date, discharge date, diagnosis
Clinical Summaries for Care Managers EMRs Allscripts Athenahealth eClinicalworks Epic GE Healthcare Greenway MedPlus NextGen Vitera Structured data CCDc32 • Provider NPI, Name, Group Name • Patient Name, DOB, Member ID • Allergies • Date of Service • Chief Complaint • Problem List • HPI • Review of Systems • Assessment and Plan • Medications • Progress Note • Diagnoses • Consult • Procedure Codes (CPT, HCPCS)
Integrated Clinical Documentation Value Propositions Cost / Quality / Compliance Care Coordination Revenue Cycle Care Management PCMH / ACO Risk Management HEDIS / Stars Administrative Savings
Good for Health Plans, good for Delivery Systems, and good for Patients
The Availity® Health Information Network:Capabilities and Connectivity Supporting the Next Generation Revenue Cycle
Thank you jzimmerman@availity.com