Reform-Minded Care Coordination For the Low-Income Uninsured SCHA Reengineering Committee Meeting February 11, 2011 - PowerPoint PPT Presentation

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Reform-Minded Care Coordination For the Low-Income Uninsured SCHA Reengineering Committee Meeting February 11, 2011

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Reform-Minded Care Coordination For the Low-Income Uninsured SCHA Reengineering Committee Meeting February 11, 2011 * * 155 white, 108 black, 10 Hispanic, 7 Asian, 1 ... – PowerPoint PPT presentation

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Title: Reform-Minded Care Coordination For the Low-Income Uninsured SCHA Reengineering Committee Meeting February 11, 2011


1
Reform-Minded Care Coordination For the
Low-Income UninsuredSCHA Reengineering
Committee MeetingFebruary 11, 2011
2
An effective Delivery System
  • Primary Care
  • Medications
  • Specialist Care
  • Urgent/Emergent Care
  • Hospitalizations
  • Ancillary Services
  • Home Care
  • Dental Care
  • Mental Health Services
  • Health Education

3
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

4
Societal Factors
  • Education lt 20 Adults have College Degree
  • Poverty gt 14
  • Unemployment gt 10

5
  • AccessHealth South Carolina
  • The Duke Endowment
  • Helping Communities Build Networks of Care for
    the Uninsured

6
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

7
  • A Coordinated Community Approach
  • to
  • Caring for the Uninsured

8
An effective Delivery System
  • Primary Care
  • Medications
  • Specialist Care
  • Urgent/Emergent Care
  • Hospitalizations
  • Ancillary Services
  • Home Care
  • Dental Care
  • Mental Health Services
  • Health Education

9
9
10
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
11
Program Overview
  • Clients
  • Uninsured
  • Spartanburg County residents
  • 150 Federal Poverty Level or below
  • Ages 19 to 64

29,183 potential participants!
12
Program Overview
  • 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)

12
13
Program Outcomes
  • 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

14
Structure
  • Separate Non-profit
  • 10 Community Partners
  • 5 Member Board
  • Currently seeking 501 c 3 status

15
Community Partners
  • 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

16
Program Staff
  • Director
  • Eligibility Specialist
  • RN Care Navigator
  • LBSW Care Navigator
  • Americorps VISTA

17
Capacity with Internships
  • Multiple college partnerships
  • Virginia College
  • USC Upstate Mary Black School of Nursing
  • Limestone College
  • Converse College
  • Multiple roles to fulfill

18
Capacity with Volunteers
  • 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

19
Volunteer Provider Network
  • Physician Recruitment
  • Primary care and Specialists
  • Whats in it for me?

20
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
21
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

22
All Aboard or derailment
Doctors
Hospitals
Social services
23
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

24
Progress to Date
  • 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!

25
Progress to Date
  • 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)

26
Client Demographics
  • Race

26
27
Client Demographics
  • 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

27
28
Client Demographics
  • Location
  • 160 live in the
  • City of Spartanburg (56.7)

28
29
Client Demographics
  • Poverty level

29
30
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

31
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

32
Self-Pay Hospital Outcomes Model with and without
AccessHealth, Controlled for size of group
Self-Pays w/o AccessHealth
All Self-Pays
Annual Charges or visits Among elf -Pays
AccessHealth Clients only
18mo pre-AccessHealth AccessHealth Start
3yrs post-AccessHealth
33
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

34
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.

35
First Annual Report 30-365 days pre-post Welvista
enrollment Decreases in Visits Charges
-23,755/Patient
-1,126/Patient
9/1/2009 thru 7/1/2010 (138 IP or ER
patients Enrolled in 12 months)
90 Pre
90 Pre
90 Post
90 Post
Emergency (-25 reduction in visits)
Inpatient (-60 reduction in visits)
36
Comparative Sample Self-pays (no Welvista)
30-365d pre-post Increases in Visits Charges
596/Patient
8,579/Patient
(501 IP or ER patients in 9 months)
90 Pre
90 Pre
90 Post
90 Post
Emergency (14 increase in visits)
Inpatient (62 increase in visits)
37
Welvista Patients vs. Comparative Sample with no
Welvista Pre-Post Charge Comparison
all before-after ?2 tests sig. at plt.001
38
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
39
Challenges
  • Continued partner engagement
  • Uncovering system failures
  • Fundraising

40
United Ways Safety Net Council
  • Community agencies
  • Case submissions each month
  • Grand rounds
  • Case follow up

41
Whats missing?
  • System Issues
  • Patient-centered Medical Homes
  • Chronic Disease Mgt Strategy
  • Mental Health resources
  • Dental Care

41
42
Get to know a patient
  • 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, acceptedclient
    graduated

42
43
Get to know a patient
  • 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

43
44
Questions?
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