Pennsylvania HIE Targets Seniors With Diabetes, Well being-Associated Social Wants

A brand new undertaking from Southeast Pennsylvania well being data trade HealthShare Change will create a real-time knowledge sharing and notification platform to establish individuals 65 and older with pre-diabetes or diabetes and health-related social wants.

The undertaking, NESSTS (Community for Enhancing Social Service Transitions for Seniors), was created with help from the Independence Blue Cross Basis’s Institute for Well being Fairness.

NESSTS, which can facilitate referrals to social providers and social advantages applications, builds on new capabilities created by PA Navigate, a statewide neighborhood data community designed to handle well being and social care wants for Pennsylvanians by connecting them to neighborhood providers. PA Navigate is managed by HSX and three different state-certified HIEs and is funded by the PA Division of Human Providers.

By means of this initiative, HSX goals to enhance the well being of seniors with these continual situations by offering them with well timed and coordinated entry to evidence-based providers and advantages.“We’re excited to work with HSX on this vital initiative to allow options for larger well being fairness and enhance well being outcomes for seniors,” stated Lorina Marshall-Blake, president of the IBX Basis, in an announcement.

Working in collaboration with the IBX Basis Institute for Well being Fairness, HSX will convene a activity power of Philadelphia-area well being facilities, advantages program managers and community-based service suppliers that help seniors and might establish gaps and options to streamline care coordination.

“Whereas diabetes and pre-diabetes have an effect on individuals of all ages, they’re extra prevalent in seniors. Social components, reminiscent of meals and housing insecurity or transportation entry, contribute to increased illness burden and are extra determinant of well being outcomes than the scientific care these people obtain,” stated Greg Liptak, vice chairman, high quality enchancment and illness administration at HSX, in an announcement. “Our connections to healthcare stakeholders within the larger Philadelphia area and past uniquely place HSX to determine this program, collaborate with our native companions and assist drive higher well being outcomes and well being fairness for the neighborhood that HSX serves. We’re grateful to the IBX Basis Institute for Well being Fairness for his or her help of this initiative.”

PA Navigate is a collaborative effort amongst well being data organizations (HIOs) and brings collectively a number of state businesses, counties, native nonprofits and neighborhood organizations, healthcare entities, and social providers suppliers. HIOs taking part within the undertaking embody ClinicalConnect HIE, Central PA Join HIE, HealthShare Change, and the Keystone HIE.

 In September 2023, Austin, Texas-based findhelp was chosen because the PA Navigate platform. Current findhelp clients in Pennsylvania embody Penn Medication, Geisinger, Lehigh Valley Well being Community, AmeriHealth Caritas, PA Well being and Wellness, and Highmark Well being.

By means of a shared platform, healthcare suppliers and social providers organizations can monitor shopper referrals and higher perceive and help with a shopper’s particular person wants, serving to them entry providers and helps. The system will even enable healthcare and repair suppliers to evaluate a person’s wants throughout a doctor’s workplace or emergency division go to, when receiving case administration providers, or in search of help from a community-based group.

The device additionally will collect knowledge that may assist the Commonwealth and its companions higher perceive well being and social providers wants of Pennsylvanians and establish service gaps or alternatives for higher help throughout the state. By taking a look at essential social determinants of well being, together with employment, baby care, transportation, meals safety, entry to healthcare, and housing stability, Commonwealth businesses and companions on the county and native degree will help Pennsylvanians obtain higher long-term well being outcomes.