Transcript Slide 1

Reform-Minded Care Coordination
For the Low-Income Uninsured
SCHA Reengineering Committee Meeting
February 11, 2011
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An effective Delivery System
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Primary Care
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Ancillary Services
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Medications
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Home Care
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Specialist Care
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Dental Care
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Urgent/Emergent Care
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Mental Health Services
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Hospitalizations
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Health Education
Access Gaps Identified
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3 Safety Net providers – all at capacity
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Limited Specialist availability for uninsured
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No Adult Dental Care for uninsured
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ERs: 48% visits, non-emergent
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Frequent utilizers: 3 contacts/month/person
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$116 million charity care 2009
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Societal Factors
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Education: < 20% Adults have College
Degree
Poverty: > 14%
Unemployment: > 10%
AccessHealth South Carolina
The Duke Endowment
Helping Communities Build Networks of
Care for the Uninsured
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Timeline
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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
A Coordinated Community Approach
to
Caring for the Uninsured
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An effective Delivery System

Primary Care

Ancillary Services

Medications

Home Care

Specialist Care

Dental Care
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Urgent/Emergent Care
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Mental Health Services
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Hospitalizations
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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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Program Overview
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Clients:
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Uninsured
Spartanburg County residents
150% Federal Poverty Level or below
Ages 19 to 64
29,183 potential participants!
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Program Overview
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Services:
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Eligibility for Fed/State/Local programs
Initial Assessment
Connection to medical homes and specialty services
Care coordination
Approach: Team-oriented, Holistic, Patient-centered
Focus:
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Measurement-based Outcomes
Community provider IT connectivity
( a minimal risk testing ground for Healthcare Reform-Redesign)
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Program Outcomes
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Engaged community partners
Better Use of Local Resources
Improved health status
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More efficient care and reduction in healthcare costs
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Shift from “crisis care” to “ prevention, early intervention
and disease management”
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
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Structure
•Separate Non-profit
•10 Community Partners
•5 Member Board
Currently seeking 501 c 3 status
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Community Partners
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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
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Program Staff
Director
Eligibility Specialist
RN Care Navigator
LBSW Care Navigator
Americorps VISTA
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Capacity with Internships
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Multiple college partnerships
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Virginia College
USC Upstate Mary Black School of Nursing
Limestone College
Converse College
Multiple roles to fulfill
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
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Volunteer Provider Network
• Physician Recruitment
• Primary care and Specialists
What’s in it for me?
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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
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Provider Network
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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
Technology Component
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Care Management software (Care Scope)
Coordinated Eligibility program (Benefit Bank)
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web-based platform
Federal, State, and Local Services
Community Health Information Exchange
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Mechanism for providers to access health
information about shared patients
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Progress to Date
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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!
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Progress to Date
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Referrals
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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)
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Client Demographics
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Race
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Client Demographics
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Age
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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
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Client Demographics
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Location
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160 live in the
City of Spartanburg
(56.7%)
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Client Demographics
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Poverty level
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AccessHealth Measurement System
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Case Management Software
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State Level Data Warehouse
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Stores Client Case Files & Record of Encounters
Potential to Connect with Other Systems… HIE
Connectivity among Hospitals
Data Warehouse Assigns Unique Identifier to
Records, so Anonymity is maintained
In-House Tools
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Return on Investment Calculators with Excel & Access
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AccessHealth Measurement System
Feeds Logic Model
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Measuring Inputs
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Number and Types of Volunteer Physicians
Number of Medical Homes
Outlets for Obtaining Prescriptions
Dollars Invested & In-Kind Contributions
Measuring Outputs
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Number of Appointments Made & Number Kept
Types and Counts of Services Provided
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AccessHealth ROCI
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Investments
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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
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ER & IP Cost Savings
Economic Value of Health Behavior Changes
Economic Value of Employable Clients
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AccessHealth ROCI
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Investments
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Outcomes/Returns
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Total Year 1 = $480,000
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.”
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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 Post
Emergency (-25% reduction in visits)
90 Pre
90 Post
Inpatient (-60% reduction in visits)
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 Post
Emergency (14% increase in visits)
90 Pre
90 Post
Inpatient (62% increase in visits)
Welvista Patients vs.
Comparative Sample with no Welvista
Pre-Post Charge Comparison
$9,000,000
$8,000,000
$7,000,000
$6,000,000
Welvista ER
$5,000,000
Welvista InPatient
$4,000,000
Comparative Sample ER
$3,000,000
Comparative Sample
InPatient
$2,000,000
all before-after 2 tests
sig. at p<.001
$1,000,000
$0
CHARGES
30-365 DAYS PRE
CHARGES
30-365 DAYS POST
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
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Continued partner engagement
Uncovering system failures
Fundraising
United Way’s Safety Net Council
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Community agencies
Case submissions each
month
“Grand rounds”
Case follow up
What’s missing?
“System Issues”
 Patient-centered Medical Homes
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Chronic Disease Mgt Strategy
Mental Health resources
 Dental Care
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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, accepted…client graduated
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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
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Questions?
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