CICOA Aging & In-Home Solutions is a not-for-profit agency and one of 700 Area Agencies on Aging nationwide.
Prior to e-MR, care managers often didn’t know about changes in health status between quarterly visits, making it difficult to coordinate the best care and access to available services. Now, CICOA’s managed care options counselors (MCOCs) will be the first staff to use this system to coordinate services simultaneously with Anthem care managers. MCOCs will know immediately if one of their clients has been hospitalized, visited the emergency department, discharged from the hospital, visited their physician, or is prescribed a change in medication. CICOA plans to roll out this same system in the future with its in-home services care management staff.
The e-MR interfaces with the Indiana Health Information Exchange. This allows CICOA’s hospital-embedded health care collaboration staff, who determine transitional services for at-risk seniors before discharge, to communicate more efficiently and effectively with hospital staff about their plan of care. The goal is to ensure patients don’t end up back in the emergency room or re-hospitalized within 30 days because of lack of support at home.
“The ability to provide real-time, up-to-date information is the e-MR’s biggest value,” said Paul Watkins, CICOA’s director of health care collaboration. added. “It allows us to better coordinate services to help people stay at home in better health, with better care, and at a lower cost.”
The e-MR system is being piloted with Anthem Indiana Medicaid patients who are at high risk of hospital re-admission by providing 30-day care transition services. CICOA anticipates that the e-MR will be fully implemented for all referred Anthem Indiana Medicaid clients by the end of February. The service will extend to Anthem’s Hoosier Care Connect Aged Blind, or Disabled patients beginning in early April.
Fifteen other Indiana Area Agencies on Aging have expressed interest in bringing the e-MR system to their markets. CICOA currently is investigating how to best scale the program statewide to guarantee uniformity and HIPAA compliance.
“This is a very significant step forward in terms of integrating care managers in the overall care and health of our seniors,” Watkins said.
MavenSphere worked with CICOA to develop this software and successfully implemented with all 16 AAAs in the State of Indina.