Care Transition Notifications Help Payers Control Costs

For years we have known about the negative impacts to cost and quality of care relating to lack of continuity between different providers, unnecessary costs from redundant tests and treatments, and substantial differences in care practices that yield significant variation across the healthcare system. New care coordination strategies are needed that facilitate and improve collaborative care and help payers with proactive care planning, enhanced communications and follow-up which will improve health outcomes, while reducing costs for their covered lives.

Payers need new systems to deal with the new paradigms in healthcare delivery and payment models. A large percentage of today’s insured patients have chronic diseases – diabetes, COPD, CHF, obesity, and cancers. These patients have multiple co-morbid conditions and require care from a wide variety of providers in multiple settings.

Payers need the ability to make sure that all participants in the care delivery continuum are doing their parts – patients and providers alike. Monitoring usage and compliance with shared plans of care and best practices for specific populations will lower risk of variation. This would allow payers to match the right services with the right costs across their covered populations.

This requires care coordination that deliberately organizes patient care activities and the sharing of information among all of the participants concerned with a patient’s care. A patients’ needs and preferences must be known ahead of time and communicated at the right time to the right people. This information can then be used to provide safe, appropriate and enhanced patient care.

Care Transition Notifications (CTNs) driven by Admit-Discharge-Transfer (ADT) data are an effective way of establishing care coordination during episodes of care. Patients transitioning from one provider or healthcare setting to another will not get lost in the shuffle. CTNs provide important details that give insights into an extremely complex set of care decisions that are being made by care teams, allowing a continuity of care that not only improves outcomes, but also prevents unnecessary, redundant costs for payers.

These care decisions can also benefit from involving providers in active care relationships with a patient yet not directly charged with the patient’s immediate medical needs, such as a patient’s primary care physician or specialists with knowledge of the patient’s history. CTNs can follow active care relationships across the entire healthcare spectrum and notify organizations and physicians of important events in their patient’s care. This information is essential for doctors to improve coordinated treatment and patient outcomes and, ultimately, reduce costs for payers.

Payers administering health plans that receive CTN alerts can use the information to reach out to patients to educate them on the benefits of staying within the network as well as visiting a primary care physician instead of the ED for non-emergency cases. Payer organizations that utilize case managers can use CTNs to offer more personalized care, assist in scheduling and accessing follow-up care or to aid patients with compliance in their medications and diet management.

The results to payers who use CTNs: reduced costs, improved services utilization and enhanced care quality.

Interested in learning more about CTNs? Please contact us and we’ll be in touch.