Vital
Blog
June 28th, 2022

Technology Boosted Care Coordination

David Wright
Written byDavid WrightChief Operating Officer

Vital’s ERAdvisor solution addresses gaps in care coordination for patients following their visit to the Emergency Room.

Care Coordination during and importantly, following a member’s visit to an emergency room is one of the most effective ways to reduce unnecessary hospital admissions or a return to the Emergency Department (ED) within 30 days. Effective and timely care coordination improves the experience, outcomes, and cost of care for the patient, the ACO/MCO, and its aligned health systems.

Yet, the nature of emergency care makes it challenging for Accountable Care & Managed Care Organizations (ACOs/MCOs) to provide real-time care coordination for members who present to the ED. Disparate EHRs and the existing systems among providers are not equipped to simultaneously alert and connect members, hospital staff, and care coordination teams to ensure appropriate follow-up care.

Ensure Safe, Appropriate, and Effective Care 

AHRQ notes that care coordination can ensure that patient needs and preferences are known and communicated at the right time, to the right people to “guide the delivery of safe, appropriate and effective care”. For that to occur, care coordinators need to be made aware that an ACO/MCO member has presented to the ED, the reason for the visit and as the visit progresses, the disposition of the patient. Equally important is connecting the member with their primary care physician and where available, a care coordination team associated with the ACO/MCO and/or participating health systems to ensure the patient has easy access to and receives the most appropriate follow-up care.

ACOs commonly report that members choose to use the emergency room either because they are unaware of the primary care physician they are assigned to or even that they are a member of the ACO/MCO.  Further care coordination teams in hospitals do not always know that a patient presenting in their ED is part of an ACO or Managed Care organization. In either case, care coordination during and after the visit may not occur and the result may be higher cost due to unnecessary use of health services, accessing care out of network and/or increasing patient acuity in the absence of appropriate follow-up care.

Real-Time Communication is Key 

When a member’s primary care physician or the ACO/MCO care coordination team are involved early on during the patient’s visit to an emergency room, care coordination can begin as early as in the waiting room of the ED to ensure the patient is receiving the most appropriate level of care.  Communication and joint planning between the hospital’s care coordinators and the ACO/MCO care coordination team and/or primary care physician also occurs real time enabling guidance and direction on the most appropriate disposition for the patient based upon what is known about them.

Driving Care Coordination with Data 

Further, with the use of AI algorithms and natural language processing, technology can support care coordination by providing recommendations on the most appropriate level of follow-up care including finding a provider that best matches the patient’s needs and preferences.

There is a tremendous opportunity to leverage AI-driven digital health technology to boost the active care coordination intervention that is needed to ensure all patients receive the most appropriate level and timely follow-up care. Vital’s recently released ACO/MCO care coordination solution does just that.  

Vital Enables Real-Time Interventional Care Coordination

Vital provides a unique solution that supports real-time interventional care coordination between patients, hospitals, and Accountable Care & Managed Care organizations during and after a visit to the ED.

Vital’s AI-enabled ERAdvisor solution automatically identifies and notifies the patient, hospital staff, and the care coordination teams that the patient is a member of an ACO, triggering relevant and real-time data flow directly to the care coordination teams and hospital staff. Vital’s care experience platform uses SMS messaging to notify and alert, leverages machine learning for status predictions, and provides EHR data for informed decision making. The result? Improved member satisfaction, advanced clinical outcomes for at-risk populations, and greater likelihood that members receive appropriate needed follow-up care with in-network providers.

The benefits are clear:

  • Achieve value-based metrics

  • Improve quality through rapid care coordination

  • Assure members receive timely follow-up care

  • Engage high-risk members 

  • Reduce unnecessary or inappropriate utilization of services

  • Provide quality care at a lower cost

  • Improve member satisfaction

For more information about the new capability for health system aligned ACOs/MCOs and Direct Contracting Entities, check out this document, go to vital.io, or feel free to reach out to me at david.wright@vital.io.