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Oscar and Healthix Clinical Event Notifications Promote Well Coordinated, Patient-Centric Care for New York Health Plan Members

Oscar Insurance Corp., the innovative health insurance company, is on a mission: It aims to use groundbreaking technology to better track, monitor and assist its members with their healthcare needs. As part of this effort, Oscar has partnered with Healthix, the largest regional health information exchange in New York state. Healthix is dedicated to improving patient-centric care by seamlessly coordinating health information across Manhattan, Brooklyn, Queens, Staten Island and Long Island. The exchange connects more than 550 facilities, 10 million patients and 10,000 clinicians.
Oscar and Healthix

Oscar stays one step ahead of the competition by tapping into the Healthix network and its real-time Clinical Event Notifications alert system. Alerts allow Oscar to ensure that when members visit an emergency room or are admitted to or discharged from a hospital, they receive timely, comprehensive and cost-effective care management. When Oscar receives a notification, pursuant to member consent, the insurer’s in-house clinical staff responds by providing essential information to care providers, such as Hospital Discharge Planners, hospital medical staff and, on occasion, the private medical doctor’s office. This quick education and intervention is especially critical for patients with complex or chronic conditions.

The Healthix alerts also prompt Oscar to look into discharge activity and, if needed, help coordinate followup care and services. For example, a college student with a history of childhood kidney disease incurred a new pattern of visits to the emergency department (ED) and was even admitted to the hospital after entering college and starting to live on campus. Oscar worked with the member and physicians to ensure effective follow-up and provide regular support. The Oscar nurse practitioner (NP) suspected that the new spate of ED visits and hospital admissions were related to the patient’s assuming primary responsibility for his catheter while away at school. The Oscar NP arranged for a skilled nursing visit from a home-care worker, who taught the member how to properly care for his urinary catheter. This education helped to reduce subsequent ED visits.

Oscar also uses alerts to help members navigate the health system and manage their own costs by, for example, finding an in-network surgeon or coordinating care and services for oncology patients. Out-of-network treatments and procedures can be very expensive for patients, but a Healthix alert significantly reduced one Oscar member’s out-of-pocket costs by helping them get an immediate appointment with an in-network surgeon after the ED had referred the patient to a doctor outside their network.

Interoperability to Improve Patient Outcomes and Lower Costs
Healthix sends out over 5,000 Clinical Event Notifications each month to case managers around the New York metropolitan area. Participating caregivers, health plans and provider organizations subscribe, and individuals give signed consent to be added to the Healthix notification program. Oscar encourages its members to sign up during the enrollment process as part of its overall approach to customer service, secure information-sharing, and patient engagement.

With higher engagement levels and more information available, Oscar can now do more to assist members through education and counseling, identifying primary care providers and specialists, providing information on membership benefits and perks, and solving claims and benefit issues. As a result, members are getting lower costs and higher quality care, and are reporting greater satisfaction since Oscar began using Healthix Clinical Event Notifications.

The alert system is made possible by the InterSystems HealthShare® health informatics platform, which is the technological foundation for all the data integration and sharing activities that take place on the Healthix exchange. Interfacing with a wide range of electronic health records and other clinical information systems, Healthix provides the interoperability to link hospitals, health systems, behavioral health organizations, nursing homes, rehabilitations centers, labs, radiology centers, home-care agencies and public-health organizations, including New York’s prisons and organ donor network.

Capturing Meaningful Data and Using Analytics to Manage Population Health
For the Healthix member network, Oscar demonstrates how health plans provide another set of relevant data for improving individual patient outcomes and population health, and for contributing to more cost-effective care.

While many organizations contribute clinical data, prescription-claims data can provide indicators of whether patients are actually adhering to care plans and following evidence-based treatments. Such information is invaluable for identifying gaps in care, which is critical for generating meaningful analytics to measure outcomes and develop new models for managing population health.

Population health extends beyond high-risk patients to encompass all people. The company uses financial incentives and innovative technologies to encourage members to work on staying healthy and fit. In this way, Oscar is right in step with both Healthix’s goal to increase patient engagement and the CDC’s current paradigm for public-health programs: wellness in every stage of life.