In the U.S. today, an aging population1 and increasing rates of chronic conditions2 all but guarantee a continued rise in healthcare costs—and of course, saving can't mean sacrificing patient experience. Instead, healthcare organizations of every kind must manage care to reduce per capita costs while improving the health of the populations they serve.
That means communication across healthcare is more crucial than ever. When patient data is siloed out of reach or out of sight, the everyday work of care management becomes slow and costly.
But when healthcare professionals and organizations can seamlessly exchange actionable intelligence on at-risk individuals and populations, the potential of care management flourishes. And we're starting to see it happen.
Read on to see how the Surescripts Network Alliance® is harnessing better clinical and medication data for more effective care management across the nation.
How better insights transform care management
One Patient's Journey
When Joyce M. moves from Detroit to Minneapolis to be near her grandchildren, she's sad that she can't bring along the doctor who's been helping to manage her Type 2 diabetes. But thanks to the Surescripts Network Alliance, Joyce's clinical and medication history can follow her to her new home—and all along her healthcare journey.
Note: Patient scenario and all related patient information are fictional and intended only to illustrate how Surescripts could support better care management.
A routine physical, better informed
Once she's moved in, Joyce makes an appointment with a new primary care provider. She's pleased to find that she doesn't have to unpack boxes of the file folders to supply all the details of past treatments and test results before she can get a medication refill. Instead, her new doctor can check this information directly.
Since she has a chronic condition, her doctor also selects a setting in the electronic health record (EHR) to get notifications on important care interactions Joyce might have with other providers in the future. This will help keep her care plan on track and help the physician's practice meet targets for a shared savings program with Joyce's health plan.
Insights in focus
In the course of a single year, a health system in Connecticut used Record Locator & Exchange to identify more than 6.8 million patient records from outside the state.1
A scary medical event, But a smooth care transition
At a family cookout, Joyce is playing with her grandchildren when she suddenly has to sit down. She can't seem to catch her breath. Her family brings her to the nearest emergency department, where she is given treatment—and a diagnosis of congestive heart failure. It's frightening news, but by the time she's discharged, Joyce feels her care is in good hands.
Meanwhile, the hospital automatically notifies Joyce's primary care provider about her visit and sends over a discharge summary.
Insights in focus
Medication History for Reconciliation enriches the average patient-reported history by 28%, adding 1.1 drugs per patient that would have otherwise been missed.2
A large health system in Texas has used Surescripts Medication History in a program that reduced 30-day readmissions by 27% for high-risk patients. 3
A new care plan & more care management support
Once Joyce is discharged, her doctor quickly reaches out to set up an appointment. Together, they review the discharge summary from her emergency visit and establish an updated care plan.
Because of Joyce's new diagnosis, a care manager on the health system's population health team adds her to a cohort of patients with congestive heart failure for extra monitoring and medication adherence support.
Insights in focus
More than 745,000 healthcare organizations and professionals used Clinical Direct Messaging in 2021, aiding continuity of care across many different clinical scenarios.4
Vaccination brings peace of mind
As COVID-19 vaccines become available, Joyce makes an appointment at her local pharmacy. Once she's been vaccinated, the pharmacy sends an immunization notification to her doctor—who's relieved to see it, since Joyce's diabetes puts her at a higher risk of serious illness. Practice staff can remove Joyce from their list of high-risk patients to contact about getting a vaccine.
Insights in focus
In addition to aiding continuity of care, in 2021 Clinical Direct Messaging has delivered more than 8 million COVID-19 immunization notifications to primary care providers nationwide.5
A phone call helps avoid readmission
Months go by, and Joyce is doing well on her new care plan. But when her schedule changes at work, she has trouble getting to her local pharmacy before it closes.
Luckily, her care manager gets notified that Joyce has missed a refill and places a reminder call. Together, they identify a pharmacy location with more convenient hours where her prescriptions can be transferred. Joyce gets her medication, and her congestive heart failure and diabetes stay under control.
And of course, avoiding readmission also means savings for Joyce's health plan and primary care provider.
Insights in focus
In Texas, a population health program at one health system used Medication History for Populations to more accurately identify patients in need of outreach and cut the need for 90-day follow-up calls by approximately 20%.6
One accountable care network used Medication History for Populations to reduce false positives for medication nonadherence by 26%.7
One health system in New York is using Medication History for Populations patient notifications to manage the support of more than 10,000 patients' improving medication management and powering value based care programs.8
- Securely share and efficiently compile clinical information across organizations to better coordinate care
- Improve quality performance and value-based care outcomes
- Comply with requirements to electronically send admission, discharge and transfer notifications
- Meet CMS Quality Payment Program requirements for ambulatory care providers to demonstrate interoperability
"Sometimes it can take hours to try to get records from different places. Not only are they busy in the ED, but so are pharmacists and pharmacy technicians in retail pharmacy locations. If you're calling and trying to get information from them, they have to also pull away from their customers and they're short-staffed as well. And so having a network that has so much information in one place is really important."
Director, Center for Innovation and Value,
Parkland Hospital System
- Deliver medication insights directly to provider workflows, reducing the need for retrospective compliance initiatives and helping issues like nonadherence get immediate attention
- Securely communicate with providers and deliver important updates about formulary changes, drug safety notices and gaps in care
- Give care managers timely insight into where members have received care and access to clinical documentation
- Alert care managers to key events for patients in their programs, such as a doctor visit, admission, discharge or receiving medication
"Payers need to be able to look at populations taken care of by providers to see what we are getting for our money. These are also important tools when we think about the research that's going to allow us to actually get better at treating some of these diseases, or all diseases."
Don Rucker, M.D.
former National Coordinator for
Health Information Technology
Pharmacies & pharmacy tech vendors
- Make prescription fill data available to other healthcare partners for better care management
- Give pharmacies better communication tools for use in areas like medication management, collaborative practice agreements and addressing controlled substance abuse
"We are committed to our customers and communities to deliver timely healthcare solutions, including administering COVID-19 vaccinations. We have administered over 55 million COVID-19 doses and used Surescripts' direct messaging service to report many of them to our customers' primary care providers."
Senior Vice President, Pharmacy and Health
Health technology vendors
- Implement solutions that help customers stop tracking down clinical and medication history data the hard way
- Empower care providers to securely share and efficiently compile the clinical and medication information they need most
- Give customers greater access to critical clinical data at the point of care, during care transitions and between patient encounters
"As an industry, we have an obligation to empower providers with the best possible clinical information at the time of care. NextGen Healthcare's integration with Carequality and Surescripts Record Locator & Exchange is another example of our commitment to creating an even greater level of interoperability within our healthcare system, ultimately resulting in improved care and outcomes."
- Surescripts, "2018 Impact Report: Clinical Interoperability," 2019, p. 6.
- Kin Wah Fun et al., "Comparison of Electronic Pharmacy Prescription Records with Manually Collected Medication Histories in an Emergency Department," Annals of Emergency Medicine 62, no. 3 (May 20, 2013): 205—211."
- Surescripts, "Case Study: How Medication History Helps Parkland Health & Hospital System Avoid Readmissions and Pinpoint Nonadherence," January 2021, p. 1.
- Surescripts, "2020 National Progress Report," April 2021.
- Surescripts, internal network data, August 2021.
- Surescripts, "Case Study: How Medication History Helps Parkland Health & Hospital System Avoid Readmissions and Pinpoint Nonadherence," p. 1.
- Surescripts, "Case Study: How Aledade Improved Quality Scores and Star Ratings With Medication History," May 2020, p. 1.
- Unpublished communication from a Surescripts customer, September 2021.