Eastpointe is a managed care organization (MCO) working with Medicaid recipients and the uninsured in eastern North Carolina who struggle with substance use, mental health, and/or intellectual and developmental disabilities (IDD). In partnership with community agencies, licensed independent practitioners and hospitals, Eastpointe helps its members get comprehensive and effective treatment.
pulseData supports Eastpointe’s care coordination team by identifying the members most at risk of admission or relapse to inpatient facilities. pulseData’s data analytics tools enable Eastpointe to continuously monitor the care and progress of their members.
Prior to the partnership with pulseData, Eastpointe’s care teams struggled to glean actionable insights from their data. “Before pulseData, we weren’t able to effectively use our members’ data to make care coordination decisions. pulseData provides great tools for us to look at our members holistically and derive insights from their history. We’re now able to identify those at risk and intervene appropriately.”
By integrating with Eastpointe’s care management platform, Altruista’s GuidingCare, pulseData presents its insights in the context of the care coordinators’ existing workflows with associated actions. Now, they can focus on providing the best level of service to their members with the information they need, where they need it.
The partnership between Eastpointe and pulseData currently centers around three main themes:
- Behavioral health hospital admissions and probability of re-admissions
- Monitoring and increasing Medication adherence
- COVID vulnerability and hospitalization
Behavioral health admissions
For those struggling with behavioral health, being discharged from inpatient care often presents a particular set of obstacles and challenges. Recognized by the Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMHDDSAS) for their transition efforts from state facilities into community living, Eastpointe focuses on following up with and supporting patients who are discharged from both state- and community-based behavioral health facilities as they return to their communities.
pulseData combines Eastpointe’s proprietary data with additional state data to identify members who are at high risk of hospital admissions that do not currently have a mental health substance use (MHSU) or IDD care coordinator. This ensures that the efforts of care coordinators are concentrated on the members who need it most.
In addition to identification of at-risk members without care coordinators, pulseData also identifies those who have a care coordinator who remain at high risk. This helps both management and individual care coordinators prioritize members within their portfolio.
Being proactive to the needs of its member population, Eastpointe recently introduced a new care coordination focus on medication adherence. Identifying patients who may require follow up care presents a major challenge because of the wide range of social and medical factors that can influence medication adherence, such as medication types, access to transportation and pharmacies, or community support.
In order to assist in Eastpointe’s efforts to deliver whole-person care for their members, pulseData combined data on past adherence, medication types, comorbidities, and demographics to create a risk score for non-adherence. Knowing who is at risk of non-adherence and who was recently prescribed a new medication allows care coordinators at Eastpointe to focus on members who have the highest need and to intervene at the most critical time.
Given the nature of the COVID pandemic, it was crucial that this partnership evolved to serve the needs of Eastpointe and its members during this critical time. To provide additional context to care coordinators, pulseData flagged members whose medical histories and comorbidities increase their risk of complications from the novel coronavirus. pulseData is well-equipped to respond quickly to time-sensitive analysis to support its partner organizations.
pulseData and Eastpointe are enthusiastic about the future of their partnership and the possibilities that lie ahead. Their collaborative partnership evolves with the needs of Eastpointe’s care coordination team and their member population.
“We love working with pulseData because they are always willing to work towards the ‘yes’ and figure out how we can get there together. We, at Eastpointe, continue to be excited about what pulseData can do!” - Lynnette Gordon, Clinical Director