Oscar Insurance Corp., the innovative health insurancecompany, is on a mission: It aims to use groundbreakingtechnology to better track, monitor and assist its mem-bers with their healthcare needs. As part of this effort,Oscar has partnered with Healthix, the largest regionalhealth information exchange in New York state. Healthixis dedicated to improving patient-centric care by seamlessly coordinating health information acrossManhattan, Brooklyn, Queens, Staten Island and LongIsland. The exchange connects more than 550 facilities,10 million patients and 10,000 clinicians.

Oscar stays one step ahead of the competition by tapping into the Healthix network and its real-timeClinical Event Notifications alert system. Alerts allowOscar to ensure that when members visit an emergencyroom or are admitted to or discharged from a hospital,they receive timely, comprehensive and cost-effectivecare management. When Oscar receives a notification,pursuant to member consent, the insurer’s in-houseclinical staff responds by providing essential informa-tion to care providers, such as Hospital DischargePlanners, hospital medical staff and, on occasion, theprivate medical doctor’s office. This quick educationand intervention is especially critical for patients withcomplex or chronic conditions.

The Healthix alerts also prompt Oscar to look into discharge activity and, if needed, help coordinate follow-up care and services. For example, a college student witha history of childhood kidney disease incurred a new pattern of visits to the emergency department (ED) andwas even admitted to the hospital after entering collegeand starting to live on campus. Oscar worked with themember and physicians to ensure effective follow-up and provide regular support. The Oscar nurse practitioner(NP) suspected that the new spate of ED visits and hospital admissions were related to the patient’s assum-ing primary responsibility for his catheter while away atschool. The Oscar NP arranged for a skilled nursing visitfrom a home-care worker, who taught the member howto properly care for his urinary catheter. This educationhelped to reduce subsequent ED visits.

Oscar also uses alerts to help members navigate thehealth system and manage their own costs by, for example, finding an in-network surgeon or coordinatingcare and services for oncology patients. Out-of-networktreatments and procedures can be very expensive forpatients, but a Healthix alert significantly reduced oneOscar member’s out-of-pocket costs by helping them getan immediate appointment with an in-network surgeonafter the ED had referred the patient to a doctor outsidetheir network.

Clinical Event Notifications Promote Well Coordinated,Patient-Centric Care for New York Health Plan Members

Oscar and Healthix

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Interoperability to Improve PatientOutcomes and Lower Costs

Healthix sends out over 5,000 Clinical EventNotifications each month to case managers around theNew York metropolitan area. Participating caregivers,health plans and provider organizations subscribe, andindividuals give signed consent to be added to theHealthix notification program. Oscar encourages itsmembers to sign up during the enrollment process aspart of its overall approach to customer service, secureinformation-sharing, and patient engagement.

With higher engagement levels and more informationavailable, Oscar can now do more to assist membersthrough education and counseling, identifying primarycare providers and specialists, providing informationon membership benefits and perks, and solving claimsand benefit issues. As a result, members are gettinglower costs and higher quality care, and are reportinggreater satisfaction since Oscar began using HealthixClinical Event Notifications.

The alert system is made possible by the InterSystemsHealthShare® health informatics platform, which is thetechnological foundation for all the data integrationand sharing activities that take place on the Healthixexchange. Interfacing with a wide range of electronichealth records and other clinical information systems,Healthix provides the interoperability to link hospitals,health systems, behavioral health organizations, nursing homes, rehabilitations centers, labs, radiologycenters, home-care agencies and public-health organizations, including New York’s prisons and organ donor network.

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Capturing Meaningful Data and UsingAnalytics to Manage Population HealthFor the Healthix member network, Oscar demonstrateshow health plans provide another set of relevant data for improving individual patient outcomes andpopulation health, and for contributing to more cost-effective care.

While many organizations contribute clinical data, prescription-claims data can provide indicators ofwhether patients are actually adhering to care plansand following evidence-based treatments. Such information is invaluable for identifying gaps in care,which is critical for generating meaningful analytics to measure outcomes and develop new models for managing population health.

Population health extends beyond high-risk patients to encompass all people. The company uses financialincentives and innovative technologies to encouragemembers to work on staying healthy and fit. In thisway, Oscar is right in step with both Healthix’s goal toincrease patient engagement and the CDC’s currentparadigm for public-health programs: wellness in every stage of life.

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