Communicating necessary and timely information to providers across the continuum of care is central to providing coordinated care. This report focuses on the information exchange processes of integrated care models that provide care for populations with long-term service and support (LTSS) needs. Individuals with LTSS needs require a number of people to be involved to provide care and support, and all of these providers require specific information elements about each individual. Integrated care models' primary focus is on care coordination among a large range of provider types. Organizations providing integrated care have invested substantial effort in developing approaches that support information exchange among the continuum of providers.
To gather details on information exchange content and processes in integrated care models, RTI International conducted a comprehensive environmental scan, convened a technical advisory group (TAG), interviewed subject matter experts (SMEs), and conducted case studies of three established systems administering integrated care models. Findings from the project will help to identify areas for improvement as well as promising practices that may be useful to promote effective information exchange practices in integrated care models. The full report includes several appendices. Appendix A is the environmental scan describing a range of integrated care models throughout the United States. Appendices B, C, and D provide more detailed descriptions of the three case study sites and how information flows in those sites: Geisinger Health System in Pennsylvania; Minnesota Senior Health Options, Special Needs BasicCare, and HealthPartners in Minnesota; and Community Care, Inc. in Wisconsin.