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Improving health and healthcare one network connection at a time... Copyright 2011, Sooner Health Access Network.

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Presentation on theme: "Improving health and healthcare one network connection at a time... Copyright 2011, Sooner Health Access Network."— Presentation transcript:

1 Improving health and healthcare one network connection at a time... Copyright 2011, Sooner Health Access Network

2 The Opportunity Need to increase access to care – Build a network of SoonerCare Providers Primary Care All Specialties (including behavioral health) Other Services Poor consumption of social services – Incorporate Social Services into: Clinical Practice Everyday lives Copyright 2011, Sooner Health Access Network

3 The Opportunity SoonerCare Patient Centered Medical Home Reduce barriers to achieve tier status Tools to enable practices Operational Design Assist practices with PCMH audits QA / QI Projects at macro and micro level Health Literacy Care Coordination Disease Management & Interventions Prevention Copyright 2011, Sooner Health Access Network

4 The HAN: What is it? An organization selected by OHCA to: Increase Member access by assembling a network of SoonerCare Providers that incorporates Social Services Assist Providers with meeting Tier 3 PCMH Status and Achieving Meaningful Use Provide technology and support to achieve those goals and improve patient care quality Provide improved access to specialists and specialty care for their SoonerCare patients Provide targeted Care Management for selected populations Copyright 2011, Sooner Health Access Network

5 Care Coordination Loop Closure Lack of care coordination, especially surrounding care transitions – Relationship between PCP and specialists has eroded – Volume drives workflows on both sides – Non-clinical personnel drive much of the referral process – Significant numbers of unnecessary visits happen, and important necessary visits are delayed or missed entirely – No effective way to monitor quality surrounding care transitions

6 Care Coordination Provide free software tool to improve care coordination Two components: – Clerk2Clerk: provides accurate and easy management of patient referrals and tracking, 24/7 access to specialists – Doc2Doc: Enables direct provider to provider conversations about patient cases... Some of which are eligible for reimbursement Copyright 2011, Sooner Health Access Network

7 Visit Requests (Referrals) require 25 unique states Accepted by Receiving Provider, Awaiting Scheduling Accepted by Receiving Provider, Awaiting Scheduling. Receiving provider to notify patient. Accepted by Receiving Provider, Awaiting Scheduling. Sending provider to notify patient. Awaiting Insurance Authorization Awaiting More Information from Sending Provider Awaiting Receiving Provider Response Cancelled Cancelled by Receiving Provider Cancelled by Sending Provider Complete per Sending Provider Doc2Doc Consult Pending Draft Failed Appointment Patient to Manage Pending Send to Receiving Provider Rejected by Receiving Provider Request sent to Receiving Provider, Response Not Expected Scheduled, Patient Notified Scheduled, Pending Patient Notification Scheduled, Pending Patient Notification. Receiving provider to notify patient. Scheduled, Pending Patient Notification. Sending provider to notify patient. Visit Complete - Report Pending Visit Complete - Report Received Visit Complete - Report Sent Copyright 2011, Sooner Health Access Network

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9 Telemedicine Interactions Currently under pilot Working with OHCA to gain approval for new fee schedule for Store and Forward Telemedicine – Get 24/7 access to specialists for online consultations – Gain insight into patient movements around the healthcare system– when to see them back – Get paid to have electronic consultations with specialists Copyright 2011, Sooner Health Access Network

10 The question/case is here. The answer is here. Specialist PCP Copyright 2011, Sooner Health Access Network

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12 Data, Data, Data Development of Clinical Analytics Platform Only group to have full claims data set Beacon, NQF, HEDIS Measures Ability to do meaningful and targeted performance improvement projects Mechanism for practices to define performance improvement projects and measure their own performance without investing the analytics resources Copyright 2011, Sooner Health Access Network

13 Better reporting: Data you care about Prospectively Identify Care Gaps: Identify those in need of screens, refills, treatments Follow up on ER visits Better communication between providers Improved efficiency in the office All drive & improve business, as well as improve patient outcomes Copyright 2011, Sooner Health Access Network

14 Enhanced Data Access Data provided by HAN from OHCA specific to your population: ER, cancer screening needs, etc. Copyright 2011, Sooner Health Access Network

15 What is happening to my SoonerCare enrollment over time? Where are my SoonerCare patients getting ED care?

16 Care Management Dedicated team of Care Managers to serve you and your patients. Focused on: Hemophilia Breast Cancer Cervical Cancer High Risk Pregnancy Persistent ER Utilizers Pharmacy Lock-In Copyright 2011, Sooner Health Access Network

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19 Lessons Learned Relationships are critical Behavioral comorbidities are key Social support is a necessity Clinical & community services must be aligned You have to go to them Tomorrow is more important than today Comprehensive view of member is required – MyHealth / Beacon Copyright 2011, Sooner Health Access Network

20 One Year In Approximate enrollment: 35,000 Members Over 689 Providers have joined Over 20,000 Referrals using Care Coordination Tool Completed or Active Care Management: 200 Establishment of Hemophilia Clinic 100% Viable Birth Rate in HROB Program Continued Growth of Network Expansion of Care Management Interventions Copyright 2011, Sooner Health Access Network

21 Who qualifies for this program? All Sooner Care Providers Appropriate licensures and certifications in place to practice Appropriate med-mal and other insurances in place Copyright 2011, Sooner Health Access Network

22 How do my members get service? 1.Complete the initial application form 2.Review the Sooner HAN Membership Agreement 3.Sign the Membership Agreement 4.Communicate your goals to HAN (increase Tier level, better manage specific populations, etc.) 5.Training of staff and providers 6.Participate Copyright 2011, Sooner Health Access Network

23 More Information? Matthew Clark OU School of Community Medicine Copyright 2011, Sooner Health Access Network


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