PHILADELPHIA – When Keystone Mercy Health Plan deployed its EHR pilot to a group of providers and hospital systems with high-volume emergency departments, it wanted to reduce redundant testing and unnecessary admissions.
Nearly one year into the pilot, the largest Medicaid managed care plan in Pennsylvania is seeing a reduction in medical costs for inappropriate and duplicative care by giving providers a patient clinical summary of its Medicaid members.
Jay Feldstein, DO, chief medical officer for Keystone Mercy, highlighted a case in which the patient clinical summary was able to identify an abuse of the system – a single patient seeking narcotics had made 450 visits to hospitals’ emergency departments in one year.
“The challenge for Medicaid is much, much more different than the commercial population,” said Henry DePhillips, MEDecision’s chief medical officer.
Patient clinical summaries provide better information at the point of care that prevents narcotic-seeking patients or those who use the emergency department for food and shelter from “gaming” the system.
“By taking away from people who don’t need it, you make the whole healthcare delivery system more efficient,” DePhillips said. Resources are distributed where they are actually needed, he added.
Lynn Dunbrack, program director for Health Industry Insights, an IDC company, highlighted another problem with the Medicaid population: Continuity of care is a huge issue because enrollees typically enroll and disenroll based on eligibility.
“Aggregating their data gives a more comprehensive view of the patient to care providers,” she said.
In July 2006, Christiana Care Health System in Delaware released results of an independent study done on its deployment of patient clinical summaries in emergency departments. Among other findings, the health plan reported a reduction of nearly 10 percent in emergency department lengths of stay.
Keystone Mercy is assessing clinical decision impact through surveys and will do a comparison of emergency department visits for members who have patient clinical summaries vs. those who do not have summaries. The health plan wants to determine rates of admission, testing, prescription use and repeat emergency department visits between the populations.
Feldstein said the health plan has received positive feedback from providers. Currently, six hospitals are using patient clinical summaries.