Solutions For Health Plans

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Risk Adjustment and HEDIS Quality Measurement

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Member Attribution and Care Team Relationship Tracking

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Interoperability and Patient Access Final Rule

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Population Health Analytics and Care Coordination

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Virtual and Telehealth Services

Access quality clinical data to better evaluate member risk, case manage, comply with regulations and streamline HEDIS

The benefits of effective Health Information Exchange (HIE) result in organized care coordination and accurate patient information across the continuum of care. Health plans in Michigan and nationwide are participating in our efforts to  improve the efficient delivery of quality care for their members.

Health plan contributions to MiHIN include sharing patient-provider attribution data for routing patient notifications to their attributed physician and distribution of quality metrics to providers based on claims analysis.

Health plans are utilizing MiHIN to receive clinical quality measures (labs, medications, diagnosis codes) traditionally captured via chart audits at the provider location.

 

 

Additionally, payers are realizing the benefits of receiving transition of care notifications for their members, to enhance utilization management and care coordination activities.

Market demands including quality ratings, performance incentive programs, population health, and accountable care organizations increase the importance of generating a holistic picture of a member’s clinical information.

Brake down the barriers to good health with MiHIN

Participate in Active Care Relationship Service™ (ACRS™)

Share with us your members and we’ll notify you when they are Admitted, Discharged or Transferred between sites of Care throughout thousands of Michigan facilities.

The Active Care Relationship Service™ (ACRS™) provides the ability to link patients with their care team members (providers who have declared an active care relationship with that patient). A provider may declare an “active care relationship” with a patient when the provider has seen the patient within the past two years and expects to see them again, or a patient is attributed to a practice/provider by a payer. ACRS™ promotes better-coordinated transitions of care by enabling physicians and care management teams to receive notifications when there are updates in a patient’s status. Better care coordination using ACRS™ enables the improvement of post-discharge transitions, prompt follow-up with patients and improved communication among providers to support patients, especially those with multiple or chronic conditions.

Receive Admission Discharge Transfer Notification (ADT)

ADT notifications in real time for your members and mobilize the internal resources available to get your members the assistance they need, where they need it.

Admission, discharge, transfer (ADT) notifications are widely regarded as a keystone to improving patient care coordination through health information exchange. ADT notifications are sent when a patient is admitted to a hospital, transferred to another facility, or discharged from the hospital. Notifications are then sent to update physicians and care management teams on a patient’s status, thus improving post-discharge transitions, prompting follow-up, improving communication among providers, and supporting patients with multiple or chronic conditions.

Receive Consolidated Clinical Document Architectures (C-CDA)

A C-CDA is a type of electronic document exchange standard for sharing patient summary information including demographics, medications, diagnoses, active problems, allergies, chief complaints, clinical results & additional care plan information; C-CDAs help those with an Active Care Relationship share a summary of a patient’s treatment information with care team members & organizations (Delivery via Interface, TOC Viewer, Direct Secure Message, API, SFTP)

 

 

Quality Measurement Information

Get the HEDIS data you need to determine areas of opportunity to improve Quality and STARS rating.

Electronic clinical quality measures (eCQMs), are specific clinical quality measures selected by CMS for use in programs such as Meaningful Use/Promoting Interoperability, MIPS, and CPC+ that are electronically captured or calculated locally in a clinical setting by Certified Electronic Health Record Technology (CEHRT).

Generating and submitting valid calculated eCQMs in the QRDA file format is mandated by several CMS programs including Meaningful Use/Promoting Interoperability. By sending eCQMs through the Michigan Health Information Network Shared Services (MiHIN) for State Medicaid, the quality measures are validated, and forwarded to State Medicaid or any other appropriate destination. State Medicaid can then assess the eCQMs to identify opportunities to improve care statewide and to assign credit and incentive payments for Meaningful Use attestation.

Submitting supplemental clinical data in the All-Payer Supplemental (APS) format to MiHIN’s Physician-Payer Quality Collaborative (PPQC) architecture allows the data to be
matched and routed to the appropriate payer(s) for use in calculating HEDIS and internal measures.

Payers can also take advantage of the architecture to submit and disseminate Gaps in Care reports to maximize opportunities to close gaps and improve patient care.

Interoperability Station

The InterOp Station is a streamlined solution that enables Health Plans and State Medicaid Agencies (SMAs) in their efforts to meet the 21st Century Cures Act goals of enabling member access to a consolidated view of their health and plan information in applications of member choice through FHIR® APIs.

  • Improves beneficiary access to health information
  • Reduces plan and beneficiary burden and improves accuracy
  • “Plug and play” platform that allows for easy compliance with requirements and standards
  • Built to augment existing services while addressing gaps in others
  • Aggregated across state subsystems and vendors – especially in a highly modularized MMIS environment
  • “On-ramp” to future interoperability strategies and initiatives (quality reporting, SDoH, TPL)
  • Low-cost/low-effort scalability through AWS SAM framework

By partnering with a smart, secure, and collaborative health data network like MiHIN, providers and health plans can access integrated claims and clinical data and more effectively transition to value-based care.