PHILADELPHIA – The AmeriHealth Mercy Family of Companies, a Philadelphia-based organization of Medicaid managed care plans, has implemented a new service in two of its health plans that will help physicians identify gaps in their patients’ care.
AmeriHealth Mercy implemented a real-time healthcare communications network developed by Cambridge, Mass.-based NaviNet, last year to enable providers to check a patient’s insurance eligibility prior to an appointment.
The deployment of NaviNet Clinical Messaging allows clinical information on unmet healthcare services to be displayed to providers along with the patient’s eligibility information. This allows providers to know immediately what preventive and recommended healthcare services a patient needs and gives them the ability to act on that information during an upcoming appointment.
“This is a perfect example of how the health plan and the provider can use technology to improve patient care. I wish all the health plans were doing this,” said Stephen Diamantoni, a manager of a multi-office primary care practice in the Lancaster, Pa., area.
NaviNet Clinical Messaging reporting features also allow primary care providers (PCPs) to manage their patients from a population perspective. PCPs can use the information to identify all patients with a specific condition, such as diabetes or asthma. PCPs can retrieve the information as a printable report or an electronic download.
“By leveraging an existing process found in virtually every provider office, the checking of eligibility, we are getting information to the provider that can have a positive impact on our members’ care without creating an additional burden to an already busy physician practice,” said Joe Miller, director of e-business for AmeriHealth Mercy Health Plans.
“This fills in some of the gaps in paper-based medical records and will improve the health and wellness of our members,” Miller added.
NaviNet plays a significant role when providers don’t have EMRs, agreed Lynne Dunbrack, program manager at Health Industry Insights.
