Studies show a strong relationship between a patient and their primary care physician is critical to reducing repeated trips to emergency rooms and hospitals. But one of the challenges these doctors have is that too often they are unaware of treatment their patients may be getting outside of their office.
To help solve this problem, Blue Cross and Blue Shield of Alabama (BCBS Alabama) launched the Care Alerts program in 2018 as a way to help physicians keep track of their patients’ health, improve patient outcomes and reduce repeated ER visits. The data can lead to better follow-up care and healthier outcomes. In its first year, nearly 10 percent of the BCBS Alabama’s 8,000 primary care providers have signed up for Care Alerts.
“The continuity of care is where a lot of things break down,” says Dr. Darrel Weaver, Vice President, Healthcare Network Services, BCBS Alabama. “If you send the average person home from the hospital and they don’t get around to seeing a personal physician, they can end up back in the ER.”
The Care Alerts System – how it works
When a patient seeks treatment at an emergency room, is admitted or discharged from a hospital, or is admitted to a post-acute facility (i.e. nursing home, rehab center etc.), BCBS Alabama sends a care alert as a direct message to the personal physician via the doctor’s electronic health record (EHR). It’s similar to email, but it is authenticated and encrypted to protect sensitive patient data.
For years, hospitals have had the ability to routinely transmit this type of information to insurance companies, but not doctors. BCBS Alabama identified a way to simplify that existing data and share it electronically and securely with physicians in real time.
“It’s a long-term objective,” says Weaver. “Knowing in real time that your patient is repeatedly in the ER gives doctors the tools they need to make appropriate adjustments in patient care which can lead to better outcomes.”
To measure the program’s effectiveness, the insurance company surveyed 60 practices that represented over 200 doctors who receive the alerts. More than 70 percent of those doctors reported using the new data to develop a process to follow up with patients that have been discharged or visited an emergency room. “Care Alerts are taking patient care to the next level of improved health outcomes,” said David Uptagrafft, strategy director, Innova Primary Care. “Getting this information directly from Blue Cross and Blue Shield of Alabama is much more timely and consistent than what we have typically received in the past from other sources.”
The future of Care Alerts
BCBS Alabama is looking to expand the amount of information provided in the Care Alerts beyond admissions, transfer and discharge data. For example, Weaver says, they would like to include each patient’s lab results, gaps in care and other information that would assist the primary care provider with the patient’s transition in care. At the same time, BCBS Alabama continues to recruit more providers to opt into the program to improve patient care.
Learn how another BCBS company is solving for continuity of care by helping patients find Dr. Right.
Watch this video about a BCBS Alabama patient care coordinator on a seminal phone call with a member.
Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies. Innova Primary Care, PC is an independent company offering healthcare clinical services in Alabama and is in no way associated or affiliated with the Blue Cross and Blue Shield Association.