Health Plans

Coordinated care through a more complete view of the member

Increasingly, Health Plans are reliant on data to better identify high-risk members, manage their care and improve member satisfaction and outcomes.

We are the largest public health information exchange (HIE) in the nation, maintaining data of over 16 million patients in New York City and Long Island.

We deliver actionable patient data, in real time, to help:

  • Prevent unnecessary admissions and avoidable re-admissions
  • Track patient discharges to facilitate follow-up care and member coaching
  • Manage care for patients with chronic illness as well as those who are trending towards illness
  • Ensure proper referrals within the health plan and avoid non-par expenses
  • Support medical home care coordination programs
  • Improve member satisfaction and outcomes.

Healthix delivers clinical event notifications for admisions and discharges at emergency rooms, hospital inpatient units and nursing facilities – as well as incarceration and release from the New York City Correctional Health Services.

By adding a members’ clinical data to the health risk assessment or claim history, Healthix will deliver a more complete picture of new members who may require care management.

Healthix delivers current and historical patient data:

  • Pre-dates the member joining the plan
  • Displays clinical detail not often available in claims data
  • Delivered as it occurs, before a claim is filed

Support for HEDIS Reporting

Healthix supports compliance with HEDIS and New York State’s Quality Assurance Reporting Requirements (QARR) since it is a repository for data metrics received from hundreds of health systems, hospitals and providers. Results from HEDIS data collection serve as measurements for quality improvement processes and preventive care programs and may qualify for incentives.

Labor-intensive manual chart reviews used to be a necessity for compliance. We help lighten the load by delivering timely documentation of lab tests, diagnoses and other procedures and treatments required for HEDIS and QARR reporting.

Healthix helps Health Plans obtain better documentation of tests and treatments to enhance HEDIS and QARR measures and support accurate risk scores.

The bigger picture:  Healthix is a member of SHIEC

We are a member of SHIEC, the Strategic Health Information Exchange Collaborative, a not-for-profit industry trade association that includes 34 state and regional HIEs, spanning the nation from Vermont to California, that maintain health data of over 110 million people SHIEC seeks to partner with Health Plans to provide consistent access to data and reduce the number of connections needed to access data across HIEs.