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Reform-Minded Care Coordination For the Low-Income Uninsured SCHA Reengineering Committee Meeting February 11, 2011. Primary Care Medications Specialist Care Urgent/Emergent Care Hospitalizations. Ancillary Services Home Care Dental Care Mental Health Services Health Education. - PowerPoint PPT Presentation
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Reform-Minded Care Coordination
For the Low-Income Uninsured
SCHA Reengineering Committee MeetingFebruary 11, 2011
An effective Delivery System
Primary Care
Medications
Specialist Care
Urgent/Emergent Care
Hospitalizations
Ancillary Services
Home Care
Dental Care
Mental Health Services
Health Education
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Access Gaps Identified
3 Safety Net providers – all at capacity
Limited Specialist availability for uninsured
No Adult Dental Care for uninsured
ERs: 48% visits, non-emergent
Frequent utilizers: 3 contacts/month/person
$116 million charity care 2009
Societal Factors
Education: < 20% Adults have College Degree
Poverty: > 14% Unemployment: > 10%
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AccessHealth South Carolina
The Duke Endowment
Helping Communities Build Networks of Care for the Uninsured
Timeline
March 2009 Application for year long planning grant
July 2009 Planning Grant awarded October 2009 Application for Implementation
grant December 2009 Implementation Grant
awarded July 2010 Doors open
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A Coordinated Community Approach
to
Caring for the Uninsured
An effective Delivery System
Primary Care
Medications
Specialist Care
Urgent/Emergent Care
Hospitalizations
Ancillary Services
Home Care
Dental Care
Mental Health Services
Health Education
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Mission
To improve access to healthcare for the uninsured of Spartanburg County through sustainable health system change that will result in better health outcomes and 100% access to effective, efficient, safe, timely, patient-centered, and equitable healthcare.
Access to Care = Improved Outcomes + Decreased Costs
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Clients: Uninsured Spartanburg County residents 150% Federal Poverty Level or below Ages 19 to 64
Program Overview
29,183 potential participants!
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Services: Eligibility for Fed/State/Local programs Initial Assessment Connection to medical homes and specialty services Care coordination Approach: Team-oriented, Holistic, Patient-centered
Focus: Measurement-based Outcomes Community provider IT connectivity
( a minimal risk testing ground for Healthcare Reform-Redesign)
Program Overview
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Engaged community partners Better Use of Local Resources Improved health status
Shift from “crisis care” to “ prevention, early intervention and disease management”
More efficient care and reduction in healthcare costs Reduction in inappropriate EC and IP use Reduction in hospital readmission rates Coordinated entry into program at time of discharge
Reduction in demand for taxpayer-funded services
Program Outcomes
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Structure
•Separate Non-profit
•10 Community Partners
•5 Member Board
Currently seeking 501 c 3 status
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Public Health Department Both Hospital Systems FQHC Free Medical Clinic Department of Mental Health Alcohol and Drug Abuse Commission Welvista (Statewide Medication Program) Spartanburg County Medical Society USC Upstate
Community Partners
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Director Eligibility Specialist
RN Care Navigator LBSW Care Navigator Americorps VISTA
Program Staff
Capacity with Internships
Multiple college partnerships Virginia College USC Upstate Mary Black School of Nursing Limestone College Converse College
Multiple roles to fulfill
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Falls under the Americorps VISTA Development of Volunteer Manual and Orientation Recruitment Strategy 3 volunteers currently; 4 additional needed Duties include reception/front office, answering phones, data entry, assisting with Gift in Kind, creating client cards
Capacity with Volunteers
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• Physician Recruitment
• Primary care and Specialists
What’s in it for me?
Volunteer Provider Network
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Provider Network
What Primary Care Providers want:
Case management support to assist patients with psychosocial needs and barriers to care
What Specialists want:
Buy in from Primary Care, medical homes for current patients
Provider Network
Current count of PCPs in network: 108 Current count of Specialists: 166 Efforts by Regional Physician Network and Mary
Black Hospital practices
Model: No reimbursement for services
All Aboard or derailment
DoctorsHospitalsSocial services
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Technology Component
Care Management software (Care Scope)
Coordinated Eligibility program (Benefit Bank) web-based platform Federal, State, and Local Services
Community Health Information Exchange Mechanism for providers to access health
information about shared patients
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285 client participants enrolled in pilot 385 eligibility screenings performed 193 medical home assignments 38 Specialist Referrals to date 1,855 appointments made 112 Rx program enrollment and/or assistance 104 applications for benefits through The Benefit Bank 37 clients in smoking cessation programs 7 GRADUATES!
Progress to Date
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Referrals 5 Rehabilitation (Regional Rehabilitation Services) 6 Alcohol and Drug (SADAC) 7 Housing (Mostly to Housing Authority) 28 Financial Assistance 37 Counseling (10 to PACE, 10 SADMH, 17 to Westgate)
Progress to Date
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Race
Client Demographics
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Age Median Age is 46 years, 308 days Oldest: Born 6/30/1929, 81 years 193 days old Youngest: Born 11/29/91, 19 years 72 days old
Client Demographics
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Location 160 live in the
City of Spartanburg (56.7%)
Client Demographics
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Poverty level
Client Demographics
AccessHealth Measurement System Case Management Software
Stores Client Case Files & Record of Encounters Potential to Connect with Other Systems… HIE
State Level Data Warehouse Connectivity among Hospitals Data Warehouse Assigns Unique Identifier to
Records, so Anonymity is maintained
In-House Tools Return on Investment Calculators with Excel & Access
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AccessHealth Measurement System Feeds Logic Model
Measuring Inputs Number and Types of Volunteer Physicians Number of Medical Homes Outlets for Obtaining Prescriptions Dollars Invested & In-Kind Contributions
Measuring Outputs Number of Appointments Made & Number Kept Types and Counts of Services Provided
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AccessHealth ROCI
Investments Grant dollars in In-Kind Support (e.g., rent for donated space) Calculated value of physician office visits, labs, radiology,
scheduled OP surgery
Outcomes/Returns ER & IP Cost Savings Economic Value of Health Behavior Changes Economic Value of Employable Clients
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AccessHealth ROCI Investments
Total Year 1 = $480,000
Outcomes/Returns Total Year 1 Hospital Est. Cost Savings = $574,096 Total Year 1 Client Est. Benefit = $120,967 Total Year 1 Employer Est. Benefit = $12,472 Total Year 1 Community Est. Benefit = $9,094
149% Return on Community Investment “For every $1 invested in the program, there is $1.49
returned in benefits.”
First Annual Report30-365 days pre-post Welvista enrollment
Decreases in Visits & Charges
9/1/2009 thru 7/1/2010(138 IP or ER patientsEnrolled in 12 months)
Emergency (-25% reduction in visits) Inpatient (-60% reduction in visits)
-$1,126/Patient
-$23,755/Patient
90 Pre 90 Pre90 Post
90 Post90 Post
90 Post
Comparative SampleSelf-pays (no Welvista) 30-365d pre-post
Increases in Visits & Charges
(501 IP or ER patients in 9 months)
Emergency (14% increase in visits) Inpatient (62% increase in visits)
$596/Patient
$8,579/Patient
90 Pre 90 Pre90 Post
90 Post90 Post
90 Post
all before-after 2 tests sig. at p<.001
Welvista Patients vs. Comparative Sample with no Welvista
Pre-Post Charge Comparison
ROI
Welvista Charge savings = $3,433,655
Welvista Cost Savings = $515,048
Hospital Investment in Welvista = $250,000
ROI = 206%
+
Charge Avoidance = $904,388
Cost Avoidance = $135,658
Net Cost Return = $650,706
NROI = 260%
Challenges
Continued partner engagement Uncovering system failures Fundraising
United Way’s Safety Net Council
Community agencies Case submissions each
month “Grand rounds” Case follow up
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“System Issues”Patient-centered Medical Homes
Chronic Disease Mgt StrategyMental Health resourcesDental Care
What’s missing?
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“Tonya” Female, age 33 Dropped from Medicaid while 5 months pregnant Type I Diabetic Need for medical home, support services for Tonya and her children Medical home established, readmission of Tonya with OB Healthy baby born on (date) Medicaid application completed, accepted…client graduated
Get to know a patient…
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“Frank” Male, age 55 Resident of homeless shelter Need for medical home, suspected he had high blood pressure Assigned to medical home Provider diagnosed high blood pressure and diabetes Medication and education provided; health disaster prevented
Get to know a patient…
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Questions?