Shawn Bassett, Executive Director Collaborative Health Systems at WellCare Health Plans, discusses how MemberMatch alerts allowed them to reach out to patients immediately after discharge to schedule an office visit and address gaps in care, as well as reduce unnecessary ER visits.
While population health and episodic care management are important in reducing hospitalizations and emergency room (ER) use, inevitably 20 to 30% of members are admitted each year. Many more will visit an ER. Left unmanaged, these members may end up in more expensive clinical settings, for longer durations, and/or incur higher readmission rates. They may also experience less-than-optimal outcomes.
MemberMatch® lets Accountable Care Organizations (ACO), ESRD Seamless Care Organizations (ESCO), and health plans actively manage members’ high-cost clinical episodes by alerting care managers to a member’s admission, discharge, or ER visit, all in real-time. MemberMatch is used by over 60 ACOs and health plans nationwide.
MemberMatch matches admission and discharge data passing through the Experian Health eligibility clearinghouse from nearly 3,000 hospitals with client Accountable Care Organizations (ACOs), End Stage Renal Disease (ESRD) Seamless Care Organizations (ESCOs) and health plans. When a match is made, Experian Health puts out an alert (email or text) to care managers sharing key data that enhances episode management.
Real-time notification of member activity facilitates management of care. Members are less likely to end up in more expensive clinical settings, for longer durations, and/or incur high readmission rates. MemberMatch provides the timely information that improves the odds for optimal outcomes.