CareOregon Uses Real-Time Data to Reduce Readmission Rates and Save Time

Leverage PointClickCare’s Care & Utilization Optimization to identify high-risk member events in real time, enhancing care coordination efficiency and member experiences during transitions.

Challenge

Difficulty effectively implementing and scaling CareOregon’s transitions-of-care model due to the labor-intensive administrative work required to identify members admitted to or discharged from facilities in their network.

Solution

Care & Utilization Optimization solution provides health plans access to the data they need to collaborate across the health care ecosystem to ensure their members gain access to the right care, by the right provider, in the right setting and level of care.

Outcome

50% reduction in readmissions after the first year of implementation
More than three hours saved daily on time spent identifying and gathering patient information

CareOregon

Non-Profit Managed Health Care Company

543,000 members
$2.37 billion in total revenue
$1.27 billion total assets

Serving Medicare Advantage and Oregon Health Plan members

“With PointClickCare, we have access to real-time member data as soon as they are discharged. This eliminates the need for cumbersome back-and-forth exchanges and waiting or census reports to be faxed from hospitals. It empowers our nurses to engage in direct care coordination promptly, affording them additional time to connect with our members swiftly after discharge, even facilitating in-person meetings within the community or at their homes if necessary.”

Summer Sweet,
Triage and Data Integration Manager

CareOregon

The Challenge

CareOregon, a non-profit health plan providing health insurance to 543,000 members in Oregon, has a mission to create quality and equity in individual and community health. To achieve these goals, CareOregon aimed to enhance visibility into member care transitions and move away from labor-intensive manual processes such as exchanging faxes to collaborate with hospitals around patient care. By improving operational efficiencies, CareOregon can further enhance the care experience and outcomes for its members.

To support their members with seamless care coordination, CareOregon needed to easily track their healthcare journey. The lack of clear visibility into patient status made it challenging to manage home transitions with timely, face-to-face care coordination after hospital discharge.

Without this support, members frequently returned to the hospital for care, often in higher numbers than necessary. Recognizing this opportunity to improve patient outcomes, CareOregon began searching for a solution.

The Solution

CareOregon chose the Care & Utilization Optimization product from PointClickCare to help care managers reduce the time to intervention for high-risk members using real-time data insights. By immediately identifying high-risk members in acute care settings and proactively engaging providers to intervene by sharing pertinent care management information, CareOregon could better ensure their members gained access to the right care, by the right provider, in the right setting and level of care.

“We look at incorporating tools to benefit the members,” explains Summer Sweet, Triage and Data Integration Manager for CareOregon. “We use Care & Utilization Optimization every day. It provides us real-time information.”

Along with improved transitions and better collaboration, this solution promotes patient and population health by helping organizations like CareOregon intercept and proactively engage members with high and rising risk or utilization patterns, reducing the total cost of care.

The Outcome

Prior to implementing Care & Utilization Optimization, Sweet notes, “It would take about three hours of administrative work to identify all of our members who are admitting to these different facilities.”

With PointClickCare, Sweet says, “We now receive real-time data feeds, allowing us to quickly identify when a member has been discharged. This eliminates the need for faxing census reports back and forth with hospitals. It also enables our nurses to coordinate care more efficiently, giving them more time for at-home visits, which aligns with our transitions-of-care model.”

CareOregon not only reclaimed time for improved care coordination, but also saw better patient outcomes. Timely interventions helped reduce hospital readmissions by 50% after their first year of implementation. “Receiving more information can feel overwhelming, but if you have a targeted way to use it, it will significantly improve your outcomes,” Sweet shares.

“PointClickCare has been with us for a long time, and we see them as an innovative partner. They’re always willing to hear our feedback and step up their game.”

Learn More

If you’re interested in implementing Care & Utilization Optimization to help your organization achieve results like those experienced by CareOregon, contact our team for more details.

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