Transcript Community Case Management - Celebrating Rural Georgia

Emanuel Medical Center
Case Management
By: Deadre Hadden, RN
Emanuel Medical Community Case
Management History:
• Program started May 2000.
• Program started to target the costly
uninsured “frequent flyers” of ER.
• Programs initial “frequent flyer” charges
reduced $112,586.94 in the 1st year.
• 382 patients enrolled in Case Management
since 2000.
What are the benefits for the
hospital?
•
•
•
•
Decrease in re-admissions.
Decrease in unnecessary ER visits.
Patient compliance.
Healthier community.
Why are patients referred?
•
•
•
•
•
•
•
Non-compliance of medical treatment
Frequent ER visits
Education
New diagnosis
Diabetes Education
Medication non-compliance
Medication assistance
What does the case manager do?
•
•
•
•
•
•
•
Initial home visit
Education
Screening for needed services
Transportation to appointments
Frequent phone calls
Home visits as needed
Food drives
Assistance for Case Management
Patients
• A small food bank was established
• A handicap van was purchased to
transport patients to various services
• Coordinated care with Primary Provider
• Individualized care plan
• Individualized health education
• Blood glucose testing machines and strips
Continued
• Free medication through Prescription
Assistance Programs
• Screening for the following services:
– Medicaid
– Food Stamps
– Energy Assistance
– Meals on Wheels
– Access Emanuel
– Transportation to Appointments
– DFACS Caseworker
What is tracked financially?
•
•
•
•
•
•
Emergency Room visits
Emergency Room charges
In-Patient visits
In-Patient charges
Out-Patient visits
Out-Patient charges
How does this work?
After being referred into the program, a
home visit is scheduled. The date of the
home visit is the initial assessment date.
Hospital information is collected on the
patient for 1 year back. This is their prior
year information which is used as a
baseline to determine progress.
Actual Charges for
the Patients in
Case Management
Patient Success
The most successful patient was a
26 year old female with Diabetes
Mellitus Type 1 with complications
of depression, blindness,
neuropathy and gastroparesis. She
was uninsured. With the assistance
of Case Management she was
approved for Medicaid.
Prior year to implementation of
Case Management
Actual Charges
• 14 ED visits - $19,395
• 10 Inpatient stays - $110,615
• 4 Outpatient visits - $6,636
• Total prior year charges: $136,646
Charges after 1 Year of Case
Management
• 9 ED visits - $4,510
• 2 Inpatient stays - $19,284
• 4 Outpatient visits - $4,265
• Total charges for year 1: $28,059
Case Management Year One (1)
• Prior Year Charges - $782,777
• Case Management charges - $414,439
• 76% of the patients experienced
reductions in charges at Emanuel Medical
Center
Case Management Year Two (2)
• Prior year charges - $575,291
• Case Management charges - $421,185
• 64% of the patients experienced
reductions in charges at Emanuel Medical
Center
Case Management Year Three (3)
• Prior year charges - $685,263
• Case Management charges - $386,834
• 71% of the patients experience reductions
in charges at Emanuel Medical Center
Case Management Year Four (4)
• Prior year charges - $1,033,774.34
• Case Management charges - $622,827.27
• 70% of the patients experienced
reductions in charges at Emanuel Medical
Center
What is the criteria to be referred?
• The patient must be under the care of a
Physician on Emanuel Medical staff.
• The patient must have a chronic health
condition.
Clinical tracking
•
•
•
•
Hemoglobin A1c
Total Cholesterol
Gestational Diabetes/Birth Wt
Any pertinent lab values
Clinical Results
Hemoglobin A1c
• Initial HbA1c 10.6
• Current follow-up HbA1c 8.37
Clinical Results
• Initial Total Cholesterol 230.29
• 1st follow-up Total Cholesterol 202.33
Clinical Results
Average birth weight at EMC of neonates
born to Gestational Diabetic mothers
6.96 lbs.
(The national average is 9.1lbs.)
Other Components:
Prescription Assistance programs
Most pharmaceutical companies offer
free medications to individuals that do
not have prescription insurance and
financially qualify based on the Federal
Poverty Guidelines.
Our Rx Assistance Program
• Individual must see a participating physician in
Emanuel County.
• Individual must have no prescription drug
coverage.
• Individual must provide proof of income.
• Medications are ordered by the Case
Management Department and shipped to the
physicians office where they are dispensed.
• Case Management is responsible for reorders.
Since 2001
• $6,124,791.12 in retail value of
prescription medications given to the
uninsured of Emanuel County.
• 827 individuals served since inception of
program.