ICA and Upper Peninsula Health Plan (UPHP) Collaborate to Improve Key Metrics Tied to Care Coordination

Share Article

Through CareAlign® Connect direct messaging and SmartAlerts, ICA is delivering intelligent automation to improve care for UPHP’s Medicaid and Dual Eligible populations.

ICA, a leader in strategic interoperability, and Upper Peninsula Health Plan (UPHP), one of the nation’s leading Medicaid health plans, today announced their pilot program designed to improve UPHP member care coordination following hospital discharge.

One of the key performance metrics for UPHP focuses on contacting patients within 48 hours of discharge. Achieving this metric without accurate, timely information has been a consistent challenge and one UPHP expects to significantly impact with ICA’s SmartAlerts. Before the ICA pilot project, UPHP care managers depended on hospital discharge planners to notify UPHP of member discharges. This occurred via phone or fax communication. “To better serve its covered population and provider network, UPHP wanted to enhance its care coordination by improving time-consuming and costly workflow processes required to manually verify inpatient and discharge status of its members,” said Gary Zegiestowsky, chief executive officer, ICA. “To meet this need, UPHP leveraged their existing Health Information Exchange, ICA CareAlign, expanding the health plan’s Direct messaging capabilities by adding our intelligent care coordination solution, SmartAlerts.”

According to Zegiestowsky, with SmartAlerts, UPHP was able to get tailored, event-based notifications that automate population identification and risk stratification to provide the right care coordinator the right information on the right patient at the right time.

“Using the ICA’s CareAlign Interoperability Platform, with Direct messaging and SmartAlerts, and accessing the member data through the CareAlign portal, we have been able to provide optimal transition of care follow up for our members,” Nicole Sandstrom, BSN, RN UPHP Clinical Services Manager – Case Management said. “Now instead of verifying member discharge by conducting daily phone calls to our network of providers or waiting for them to contact us, care teams are electronically notified in real time. This has meant that our care managers can immediately make sure appropriate care providers have the patient-specific information needed to begin coordinating member care to ensure a safe transition after a hospitalization or emergency department visit.”

Sandstrom further explained that in addition to the discharge alerts being delivered, care coordinators are also using the CareAlign portal to gain access to patient health records in the same system that delivers the alerts. “This has the added benefit of requiring one less system to access which improves workflow for our care teams and saves them additional time during the work day.”

Through SmartAlerts UPHP now has the ability to:

  •     Define risk sub-populations to better align its care programs with member needs; and,
  •     Sort members by hospital admissions or discharges to optimize phone time when coordinating with discharge nurses.

About ICA

ICA is a leading provider of strategic interoperability and intelligent care coordination solutions for the healthcare market – providers, payers, and accountable care organizations; and is one of the few independent HIE vendors. With its state-of -the-art CareAlign® platform, ICA offers true care coordination technology that connects disparate healthcare enterprises regardless of the technologies already in place. CareAlign delivers a flexible architecture to connect, collect, consume and intelligently distribute patient information through standard data transport protocols and custom methods for use in EHRs, third party applications,and ICA’s proprietary applications. CareAlign aggregates a wide range of information and supports analytic needs associated with population health management, transitions of care communication, readmissions reduction, meaningful use requirements and PCMH/ACO operations.

About the Upper Peninsula Health Plan

The Upper Peninsula Health Plan is a managed-care and provider-service organization based in Marquette, Michigan. Its mission is to provide high-quality health care services to Upper Peninsula residents and employers. The health plan manages the health care of more than 35,000 Upper Peninsula residents enrolled in multiple health plans.

The health plan also offers administrative services related to health care to employers and other purchasers of such services. It develops and maintains provider networks for insurers by negotiating contracts with regional physicians, hospitals, and other providers. Through these networks, the health plan serves as the hub for all commercial managed-care and preferred-provider organization activity in the Upper Peninsula.

Share article on social media or email:

View article via:

Pdf Print

Contact Author

Kathy Gill
+1 (615) 425-5388
Email >
Visit website