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Health Information Exchange System

LaToya Thomas Nova Southeastern University. Health Information Exchange System. Overview:. Current tends in healthcare Rising costs Chronic illness Health care reform Medicaid expansion.

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Health Information Exchange System

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  1. LaToya Thomas Nova Southeastern University Health Information Exchange System

  2. Overview: • Current tends in healthcare • Rising costs • Chronic illness • Health care reform • Medicaid expansion

  3. “1/2 of the 32 million Americans expected to gain insurance by 2019 will be covered under state administered Medicaid programs” (Summers & Epstein,2011)

  4. Impact of Medicaid Expansion • Larger Medicaid population • Low income • Disabled • Chronically ill (COPD, CHF, ESRD, HIV) • Barriers • Limited Access to healthcare • no PCP follow-up • Poor utilization of community resources

  5. How does this affect Humana? • Increased readmission rates • Increased use of the ER • Higher cost

  6. Strategies for Improvement • Establishing a Health Information Exchange (HIEs)between the hospital and the insurer • Benefits: • Improves patient care • Reduces costs by fostering collaboration • Reduces administrative burdens

  7. “To make expansion of health insurance coverage truly meaningful, all individuals must have access to care that is timely, convenient and available in the community” (ANA, 2011)

  8. Strategies for Improvement The transportation brokerage service will: • Work in conjunction with the Accountable Care Organizations (ACOs)that have high concentrations of Medicaid members • Negotiate payment rates with various transportation providers in addition to NEMT • Verify eligibility • Arrange timely reservations • Monitoring of the quality of service rendered

  9. Budget Proposal • Product: Humana will partner with a statewide transportation brokerage service • Time Frame: This will be implemented over a two year span with mid year budget adjustments. • Benefits: • Grows financial funding • More transportation services • Avoids service duplication • Improves service delivery efficiency • Creates comprehensive systems

  10. Budget Proposal Costs Alternatives Creating company- managed transportation (Purchasing a fleet of handicapped accessible vehicles, hiring new employees $15,000 x 250 vehicles= $375,000) Costly and potentially ineffective. • 1% of the trips provided by Humana would help a member avoid a hospital stay (on average $7,900 per stay) Humana’s ROI would be 1108% or $11.08 for each dollar invested Fares for the different services range from $1.00 per day on • the fixed route service to $6.00 for the longest demand response trips. • Utilization of brokerage consultants cost approx. $100,000 annually

  11. Decision Making Strategy: John Katter's Eight Step Change Model • Phase 1: Creating a climate of change • Phase 2: Operationalizing the entire organization • Phase 3: Implementing and sustaining the change

  12. Transportation Coordination..…. • Maximizes limited resources • Promotes increased mobility and Improved lives • Ensures accountability for millions of tax dollars • Provides a Return on the Investment • Improves readmission rates • Decreases readmission rates • Improves the quality life for the ultimate stakeholders, Medicaid beneficiaries

  13. Conclusion • Personal mobility is a crucial need for all individuals, but especially for the transportation disadvantaged • Managed care companies will have to utilize innovative strategies to prevent disruptions in access to care • Interventions will entail ongoing monitoring and oversight to ensure protection of stakeholders • Resources must be invested wisely to accommodate the needs of Humana’s Medicaid members and improve the quality of care and outcomes of this vulnerable population.

  14. References Farber, N. & Rall, J. (2010). Human service transportation coordination state profile: Florida. Federal Transit Administration and the U.S. Department of Labor. Retrieved: http://www.ncsl.org/documents/transportation/FL-HSTCprofile.pdf Kim, J., Norton, E., & Stearns, S. (2009). Transportation brokerage services and medical beneficiaries’ access to care. Health Services Research, 44(1), 145-161. Roby, D., Kominski, G., & Pourat, N. (2008). Assessing the barriers to engaging challenging populations in disease management programs: the Medicaid experience. Disease Management & Health Outcomes, 16(6), 421-428. Summers, B., & Epstein, A. (2010). Medicaid expansion - the soft underbelly of health care reform?. New England Journal Of Medicine, 363(22), 2085-2087.

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