Currently, Medicaid HMOs and other payers may not become aware of their members' emergency department (ED) or other hospital visits until they receive the claim resulting from the visit - which can be up to 30 days after the event.  During this time, patients may have had even more hospital or ED visits.  The PAR-P is intended to help decrease the number of avoidable ED visits and related hospitalizations, decrease the number of duplicative emergency room and hospital tests and procedures, enable better care coordination, and connect targeted Medicaid and uninsured ED visitors with medical homes.
 

The PAR-P will be piloted with HMOs and populations selected by DHS. DHS' selection criteria included Medicaid HMOs in the Milwaukee area that are currently serving SSI members, with preference to HMOs expressing an interest in the Medicaid Complex Care Management Project.  Timelines for the pilot extend into 2015, and will depend on the pilot participants' cooperation. 
 

After the initial pilot, the PAR-P will be available to other HMOs for care management of their members.
 

The basic process for creating the PAR-P is outlined below, and illustrated in the diagram.

1. HMOs will provide a list of members (enrollment files) to WISHIN.
    
2. WISHIN will match hospital encounters submitted to WISHIN Pulse with the member demographics listed in the enrollment file.  If the insurance indicated in the encounter records match the HMO and the encounter was within the past 24 hours, a general description of the encounter will be added to the PAR-P.
    
3. WISHIN will package the PAR-P and it send securely to the HMOs care management team for follow-up.

HMOs interested in receiving the PAR-P that are not included in the pilot should contact WISHIN at 608-268-1841 to be added as soon as the pilot completes.