Fallon Chief Medical Officer Carolyn Langer Says Real-Time Notification Makes All the Difference

It is one thing to depend on claims that come in two or three months after a member has been hospitalized or gone to an emergency department. It is another thing to find out about it right away.

Carolyn Langer, M.D., senior vice president and chief medical officer of Fallon Health, prefers the latter.

“Having the real-time notification really enables us to be aware of these patients and engage them when they are at hospital” Langer said in a video interview with Managed Healthcare Executive.®

Fallon is getting those real-time reports from Collective Medical, a health IT company in suburban Salt Lake City that Fallon has been working with for about a month. Langer says Collective Medical sends notifications when members are admitted and discharged from the hospital and when they visit the emergency department.

The notifications help Fallon Health to “more proactively manage members and avert unnecessary ED visits and avoidable hospital stays.”

Fallon started using Collective Medical’s services this year. Langer says the timing was fortuitous because the navigators that Fallon had embedded at some hospitals and primary care practices could no longer work on site because of the pandemic. She adds in addition to notifying Fallon, Collective Medical supplies the health plan with some critical information about patients. Langer says even something as simple as having ab up-to-date phone number can make a difference in getting members follow-up care and services.

With only a few weeks of experience, Langer says it was too early to have any data on differences that Collective Medical might have made. She says that will come in six months to year. In meantime, she adds, “anecdotally, we are seeing some really amazing success stories.” Langer gave as an example a member who was dependent on a wheelchair who could go home after being discharged because a navigator had arranged for construction of a wheelchair ramp.

Langer says apart from Collective Medical, Fallon has “robust” clinical integration teams that include nurse case managers, social workers as well as navigators. She says those teams’ years of experience have shown that a wide range of interventions addressing the social determinants of health can be “very impactful.” Among the interventions she listed were arranging for a primary care visit after hospital discharge, medication reconciliation (Fallon has a team of pharmacists who do that), housing services for people without homes, and transportation assistance.