The Availity ® Health Information Network: Capabilities and Connectivity Supporting the Next...
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Transcript of The Availity ® Health Information Network: Capabilities and Connectivity Supporting the Next...
The Availity® Health Information Network:
Capabilities and Connectivity
Supporting the Next Generation Revenue Cycle
Good for Health Plans,
good for Delivery Systems,
and good for Patients
Migration to value-based programs and payment models demands:
Inpatient Information• Admissions• Concurrent Review• Lab Results• Discharge Information
Medical Attachments
Clinical Summaries
As well as expanded integrationand connectivity with:• HIEs• Hospital/physician systems• Health plans
Tomorrow’s InformationNeeds
Today’s InformationExchangelargely consists of:
EDI/HIPAA Transactions• Claims• Eligibility & Benefits• Claim Status• Remits
Physician Self Service• Web portals• Real-time information• Care management tools
Revenue Cycle Management• Advanced claims management
for physicians and health plans
Focus on Impact
Impact Requires Provider AdoptionProvider Adoption Requires Demonstrable Value and Simplicity
Simplicity is Achieved via Workflow IntegrationWorkflow Integration is Accelerated by Use of Standards
Adherence to Standards Can Drive Impact
Overview
ProvidersHospitalsMedical AttachmentsClinical SummariesEMR Integration with
Availity® CareProfile®
The Availity Network
Health Plan
AdmissionConcurrent ReviewLab ResultsDischarge InformationMedical Attachments
Clinical Data
Clinical Data
Clinical Data
Clinical Data
Clinical Data
Integrated Clinical Documentation Value Propositions
Cost / Quality / Compliance
Care CoordinationRevenue Cycle
Care ManagementPCMH / ACO
Risk ManagementHEDIS / Stars
Administrative Savings
Integrated Authorizations
Displays status of authorization
Displays Patient Acct #, Patient Name, Medical Record #
Displays facility name, health plan info Quick
search
Displays Patient Class, admit date, discharge date, diagnosis
Displays auth responses, ADT message data, user comments by patient
Refresh screen
Exports to .csv file Allows user to set filters
by facility, date, auth status or health plan
Clinical Summaries for Care Managers
• Provider NPI, Name, Group Name
• Patient Name, DOB, Member ID
• Allergies
• Date of Service
• Chief Complaint
• Problem List
• HPI
• Review of Systems
• Assessment and Plan
• Medications
• Progress Note
• Diagnoses
• Consult
• Procedure Codes (CPT, HCPCS)
EMRsAllscripts
Athenahealth
eClinicalworks
Epic
GE Healthcare
Greenway
MedPlus
NextGen
Vitera
Structured data CCDc32
Integrated Clinical Documentation Value Propositions
Cost / Quality / Compliance
Care CoordinationRevenue Cycle
Care ManagementPCMH / ACO
Risk ManagementHEDIS / Stars
Administrative Savings
The Availity® Health Information Network:
Capabilities and Connectivity
Supporting the Next Generation Revenue Cycle