Transcript Navigator_presentation

Transylvania Regional Hospital
Health Resources
Navigation Program
Navigate-To Steer; To Travel; To find one’s way
and keep one’s course
Program Mission:
To identify uninsured, low-income Transylvania
county residents that frequently utilize the
emergency department for non-emergent, or acute
care as a result of complications from chronic
medical conditions, and connect them with a
medical home, medication assistance, financial
assistance and any other community services that
will contribute to their overall wellness and
disease management.
Program Criteria:
Uninsured residents of Transylvania County
between the ages of 18 to 64 at or below
200% of the federal poverty level who come
to the Emergency Department at least three
times in a six month period.
Program Procedures and Policies:
Potential clients for the Health Resources
Navigation Program will be identified by:
 Report abstracted from Medical Records
 Daily ED reports from previous day’s
patients
 Referrals from the ED staff
Program Referral Process:
 Contact potential clients from abstracted list
by phone
 Meet with potential clients in the ED when
appropriate
 Weekly meeting with ED staff to review list
of potential clients
 Weekly meeting with financial counselors
Program Enrollment:
 Intake
 Eligibility determined
 Release and Agreement signed
 ID card issued
 Medical Provider assigned
 Appointment scheduled if necessary
 Community agencies contacted
Follow-up and Tracking System:
 Ancillary Care for clients will be scheduled
through Navigator
 Follow-up with Community Resources
 Client status, progress and ancillary care
tracked on database
Program Policy:
 Enrollment good for one year unless
circumstances change prior to anniversary
date
 Adherence to Patient and Pain Management
Agreement or client is disenrolled from
program
 If client is disenrolled medical provider’s
point person contacted and client receives
certified letter
Measurements of Success
Health Improvements:
 Decreased visits to
ED
 Patient compliance
with primary care
 Disease management
Financial Improvements:
 Decreased bad debt
 Decreased overall cost
of care for targeted
patients
 More efficient &
appropriate usage of the
ED
Patient profile: 6 Month Snapshot
 Most common diagnoses:
– Dental problems
– Acute URI
– Abdominal pain, headaches, bronchitis
 296 patients = 1665 visits in 6 months
 Average # of visits per patient: 5.6
Consistent Primary Care = one key
 Primary care can lead to successful disease
management
AND
 Overall wellness is achieved by identifying
additional issues impacting healthcare and
connecting the individual with resources to
address those needs
Primary Care Keys:
 TRH Physicians
 Free Clinic
 Etowah MAP (Medical Access Plan)
 Francis Ward Health Service
 Local Physicians
Many more hidden “keys” in the
community
 Alliance Counseling Services for Substance
Abuse and Mental Health
 Center for Women-Crisis pregnancy
 Children’s Center-Victim Assistance Fund
 American Red Cross-Community
Education, CPR for Everyone and First Aid
 WCCA’s Self-Sufficiency and SavingsPlus
Better Care Management =
Healthcare Efficiencies
 Annual targets have been set
– 100 patients in full “navigation”
– 100 patients receiving secondary navigation
service
– Reduce uninsured ED visits among targeted
patients by 300
 This is new – potential is very real. We will
monitor closely and adjust efforts as
needed.
Snapshot of potential efficiencies:
100 patients
Patient
Emergency
Department
(before
enrollment)
Navigation
patient in
Primary Care
Average
Charge
$450/visit
(excludes ancillaries)
$120/visit
(excludes ancillaries)
Average # of
Visits/Year &
Total
Charge/Patient
12 visits/year
$540,000
4 visits/year
$48,000
Transylvania Regional Hospital:
Health Resources Navigation
Program
2008-2009 Results
Annual Targets Set for First
Year:
 100 patients in full, Primary Navigation
 100 patients receiving Secondary
Navigation-those they don’t fit criteria, but
receive resources
 Reduce uninsured ED visits among targeted
population by 300
October 1, 2008-September 30, 2009
Results:
 98 patients in Primary Navigation
 94 patients received Secondary Navigation
 Uninsured ED visits among targeted
population reduced by 311 visits
October 1, 2008-September 30, 2009
 Total number of patients navigated in
Primary Navigation- 98 (Target was 100)
 Total number of ER visits of these 98
patients six months prior to Navigation-422
 Average number of visits per patient: 4.3
 Total number of visits after primary
navigation-106 visits-average 1 per patient
Secondary Navigation Results:
 94 people who had a total number of 155
ER visits prior to receiving resources
 After receiving resources these people had a
total of 85 visits
 Total of 114 referrals made which included
community agencies and other departments
of the hospital needing resources for
someone
Participant ED visits:
Total # of visits Average # visits
Six months
Per patient
prior to
enrollment
422
4.3
Total charge
for visits in 6
months prior to
enrollment*
$257,420
*Excludes
ancillaries
Secondary Navigation ED Visits:
Total # of visits
to ED prior to
receiving
resources
155
Total # of visits
to ED after
receiving
resources:
85
Total charge
for visits before
and after
receiving
resources:
Before:
$94,550
After:
$51,850
Participant PCP/ED Visits:
Total # of Total # ED Average #
PCP visits visits since of visits per
since
Enrollment enrolled
enrollment
patient
since
enrollment
ED: 1
324
97
PCP: 3.3
Total
charges for
visits since
Enrollment
(Does not
include
ancillary)
ED:
$59,170
PCP:
$41,200
Charge Comparison for Primary
Navigation Patients
Total ED
charge for
patients 6 mos.
Prior to
enrollment:
Total charge
for patients
10/1/089/30/09:
$257,420
$152,121.31
@$610 per visit (includes
ancillaries)
(no ancillary)
Variance
(System-wide):
$105,298.69
plus secondary:
Total Savings:
$153,608.65
Additional Measures:
10 participants enrolled in Medicaid
1 participant got private insurance
through her employer
Who do we thank?
 Dr. Frederick Bahnson-donated
consults,discounted procedures
 Dr. Leland Berkwits-discounted rates
 Dr. Carmello Hernandez-donated consults
 Dr. Gerald Martin-seeing patient
 Dr. Dale Nash-advisory role, seeing patient
 Dr. Minerva Pinerio-seeing patient
 Dr. Emily Sawyer-advisory role
And more…




Asheville Radiology-for discounts
Asheville Cardiology-for donated echocardiograms
Brevard Racquet Club-a 6 week scholarship
Children’s Center of Transylvania County-Victim
Assistance Fund for counseling
 Carolina Mountain Gasroenterology-for a consult
 PML Lab for donating all pap smears to Navigation
patients
 Toxaway Charities-Medications, diagnostics, labs and
specialty care for Dr. Buehler’s patients who are Toxaway
residents
All the scheduling people and office staff in the practices
for fitting patients in that would have otherwise gone to the
ED
What have we learned?
 To be more aware and discerning when
interviewing potential Navigation patients
in relation to chronic pain issues
 Educating potential clients more about the
limitations of the program (Specialty care)
 More reminders to clinical assistants about
what resources are low cost or free to the
uninsured such as pap smears at the health
department, discounted medications,etc.
What’s Next?
 Meeting with other area providers of the
uninsured to brainstorm about a regional
approach to specialty care
 Transitioning Navigation clients after their
first year of care into the Patient Assistance
Program
 Emphasis on preventative approach and
secondary navigation in ED during first or
second visit
Targets for Primary and
Secondary Navigation 2010
Primary Navigation
October-September
2009-2010:
 25 new patients
enrolled as of 6/22/10
 Target for 2010:
50 new enrollees
Secondary Navigation
October-September
2009-2010:
 332 patients seen and
given resources in
the ED during first or
second visit as of
6/22/10
 Target for 2010:
300 patients
Any Questions?
Di Ucci, MA Ed., LPN
Transylvania Regional Hospital
260 Hospital Drive
Brevard, NC 28712
828-885-5732
[email protected]
828-883-5111 Fax
Thank you again!