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Closing the gaps

AmeriHealth Mercy to pilot sending mobile care alerts to providers for Medicaid patients

PHILADELPHIA – AmeriHealth Mercy, one of the largest Medicaid managed care plans in the country, has teamed with Boston-based healthcare communications network company NaviNet on a pilot program that will push prescription and clinical patient information to providers’ handheld devices.

The six-month pilot comprises 167 doctors in the AmeriHealth network who see a high percentage of Medicaid patients. Communication of patient-specific health and prescription information from AmeriHealth will be sent to providers via NaviNet Mobile Connect enabling doctors to immediately act to close gaps in care or to work with the patient to achieve better medication adherence.

“Medicaid patients, in general, have a lot more care gaps per member than does the commercial population,” said S. Michael Ross, MD, chief medical officer of NaviNet. “It is a more challenging population that is often sicker and often they are harder to reach. So the opportunity once they are in the office to act upon these patients is particularly important from AmeriHealth Mercy’s perspective.”

AmeriHealth Mercy has been sending similar care reports to its providers via NaviNet for the past two years. But this information was being sent to practice management systems and not directly to individual providers.

“The most important thing for this pilot is to see if putting the information directly in the exam room will increase utilization of that information by the providers and drive action,” said Jay Feldstein, DO, AmeriHealth Mercy northern division regional president.

These direct doctor-to-patient interactions based on the most current information can have a significant impact on both patient health and reduced healthcare costs. In addition, doctors in the pilot will have e-prescribing capabilities via their mobile devices, which removes another potential barrier to medication adherence.

The pilot should get off to a quick start. The 167 providers were recruited by NaviNet from a pool of more than 800 engaged in a similar program for Capital Blue Cross’ commercial health plans in central Pennsylvania.

“Our ROI is coming from both increased medication adherence and also from increased generic utilization,” said Kent Whiting, VP information technology, Capital Blue Cross in a video describing the program.

Because of this, the doctors in the Amerihealth Mercy pilot are already familiar with the medication alerts and e-prescribing. The care gap alerts were added to the pilot because it is typically more of an issue with Medicaid beneficiaries than it is with private plan members.

Better management of its Medication population is in the hands of doctors, but AmeriHealth knows that it can be a care partner by providing the most relevant patient information to those doctors, in real time.

“The plan’s ability to influence patient behavior is limited,” noted Ross. “The whole notion here is to support the doctors with third party data that they don’t normally have visibility into, like what other doctors are prescribing or what sorts of imaging studies have been done elsewhere. (This information) can help put the doctor be front and center in managing that patient’s care.”

Further, Feldstein added, providing this information to doctors in its network help AmeriHealth deliver on it mission.

“One of our mottos as a company is to make every member contact count. When we have that captured moment when the patient is in with the physician to be able to deliver the maximum amount of information to maximize that encounter is very important,” he said.

If the pilot is successful, AmeriHealth intends to launch the program next in southeastern Pennsylvania in order to potentially reach all 400,000 of its Medicaid members in the state.

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