HealthShare, payers, and managed care organizations
With U.S. healthcare spending expected to grow at an average rate of 5.8% per year between now and 2025, everyone paying the bills is looking for ways to get more from that spend. We all want better outcomes, for more people, at lower cost. But those goals will be difficult to meet if you’re still making business and care decisions based only on aging claims data.
InterSystems HealthShare software enables you to aggregate and share near real-time clinical data to augment coordinated care management, enhance and automate business processes, and reduce your costs.
Dynamic Information Sharing Makes a Difference
Enabling the best care for your members requires timely access to information that will make a difference in their outcomes. This is the essence of proactive risk management and care collaboration.
Risk is constantly changing because member profiles are dynamic. Emergency room visits, admissions, diagnoses, readmissions, and care plan or medication compliance can all affect risk and influence outcomes. The only way to stay ahead of risk is for health plans and providers to exchange timely, complete, and credible information at the point of care.
HealthShare lets you integrate and share this information across health plan systems, provider systems, and care delivery workflows. Information such as pharmacy claims, ADTs, test results, and clinical notes help complete the picture of a member’s profile and care requirements.
With comprehensive member-centric information available in real-time, care managers can be notified of events that matter to the health of your members. They can collaborate effectively with you, with your members, and with each other.
For example, Healthfirst, a regional, not-for-profit health plan in the New York City area owned by a consortium of healthcare providers, is enhancing collaboration across its entire care network. Healthfirst began by targeting medication management and gaps in care with a secure information exchange and clinical portal. This includes information about its members’ general practice, acute, community, mental health, and social care.
Success for your provider network means success for your members
The shift to value based care requires providers to deliver better care at the same or lower cost. Reimbursement will be based on care being delivered within a fixed dollar amount while demonstrating improvement on key quality measures. According to a recent study1, providers find they are not meeting their stated performance targets 60 to 70% of the time. Gaps include data, resources, and ability to coordinate care. As partners in this value-based model, payers can help their provider network by aligning care coordination activities, combining claims with clinical data to support quality measurement, and sharing analytics capabilities. Ultimately this will benefit members with better care and outcomes.
HealthShare enables you to deliver the real-time and actionable health information your provider network and members need. As a result, you’ll be able to:
- Engage with your members when they can benefit from assistance navigating the healthcare system
- Ensure that care decisions are based on complete information
- Support care transitions with timely information for the entire care team
1 -“The State of Value-based Reimbursement 2016” conducted by ORC International and commissioned by McKesson.