Ever Heard of Interoperability?
Long word, long process; here’s the short story
Unless you work in the healthcare industry, you’re probably living your life without knowing what interoperability means. But soon, if you use health and wellness services at all, you’ll need to know at least a little bit about what it means.
Good to Know
Interoperability means that healthcare information and data can be connected among doctors, facilities, service providers, insurers, and others so that you have access to your health information wherever and whenever you need it. If you’ve ever changed providers or needed to see a specialist, you know that your medical records can take a while to catch up with you. That’s all going to change.
To get technical about it, this transfer of data will happen through application programming interfaces (APIs). Eventually, rather than waiting weeks for your medical records to move between providers’ offices, files will transfer almost instantaneously. That’s progress!
Need to Know
Opening these channels of information is actually a federal requirement for businesses in healthcare. So, as an insurance company, we’re required to create a secure information network that gives you access to your health information in real-time. This kind of accessibility helps you get more efficient and accurate care. It will enable your providers to identify problems more quickly and allow them to make quicker and more informed decisions.
Interoperability is a huge change in how the entire health industry works, and it won’t happen overnight, but the first steps are about to begin. In early July, 2021, Health Options will support electronic access to your claims through third-party applications in your mobile device or browser. For additional information, please click here.
But don’t worry. You’re still in control. Health data applications that you choose to connect will have access to your name, date of birth, plan information, providers used, medical, pharmacy and lab claims, and other data. See a list of the healthcare applications here. If you choose not to share your access – your information remains private. You turn data sharing on and off via your health and wellness application on your personal device. If you don’t download an app and turn on permission, nothing changes.
More to Know
You might never have given a single thought to healthcare data connections, or maybe you thought all your data dots were connecting behind the scenes already. Either way, knowledge is power. At its very basic level, this data sharing will help you and your providers make informed choices, eliminate wasted time and resources, and streamline healthcare services. This might mean fewer redundant blood tests and X-rays in the future, and we can all connect with that idea.
Beyond routine care and wellness, one of the major reasons for having health insurance is to protect yourself and your family in case of serious illness or injury. At Health Options, our medical management approach ensures that you also have a team of healthcare experts at your side in times of a serious medical crisis. In addition, our Care Managers are here for everyday wellness questions and at every step of recovery after a major medical incident.
Our Care Management Team partners with local agencies to find the help our Members need, from financial assistance to transportation, housing, and other issues affecting wellness and recovery. On-staff medical, pharmacy and healthcare experts help Members access medication and durable medical equipment, receive authorization support and assistance with provider outreach, and drug formulary education. The team also makes outbound calls to our Members to assist with chronic illness support or to provide post-discharge coordination from hospital stays. This collaborative approach to medical management focuses on improving care, creating positive health outcomes, and reducing the total cost of care.
What does a medical management approach look like to our Members? On a day-to-day basis, our in-house pharmacy team keeps Members updated about drug recall changes in medication availability and ways to access prescription medications at lower costs. Our team will also reach out to encourage immunizations, wellness visits, and other low-cost, or $0 cost-share benefits that can help our Members live their healthiest lives. In cases of hospitalizations and transitions to home, our medical management’s Site of Care Program offers Members the option to transition certain medications and infusions to a preferred site of care, including in-home care.
If a Member needs extra care for a particular condition, our team is instrumental in securing assistance. For example, one Member of our asthma outreach program had concerns about her condition combined with possible COVID-19 symptoms when the virus first emerged. Her COVID-19 symptoms kept her from seeing her primary care provider. After using a walk-in clinic for testing to determine she was COVID-19 negative, she continued to have a cough, low-grade fever, and fatigue. Our Care Management team was able to quickly find her an in-network pulmonologist who treated her with antibiotics for suspected pneumonia. She also had her asthma medications adjusted, and her condition improved.
Our hands-on strategies have resulted in more than $12.1+ million saved through Care Management programs since 2017, a 48 percent total reduction in our hospital readmission rate from 2018 to 2020. Our Script Saver program, led by in-house pharmacists, provided personal outreach to Members that led to out-of-pocket savings of $98,000 on medications in 2020. All of these efforts combined help improve health and reduce costs for our Members.
Call us if you have a question about prescription drug costs, need support for an upcoming medical procedure, or have a serious medical crisis. Our medical management team is in your corner, and they can be reached through Member Services at (855)624-6463, or use our secure email messaging.