Transcript Slide 1

Innovations in Community
Collaborations: Reaching 100%
Access to Care
Rural Health Network of
South Central New York
October 2005
Diana Resnik
Our System
Ascension Health is the largest Catholic health system, the largest
private non-profit system and the fourth largest system in the United
States operating in 20 states and the District of Columbia.
2020 Goal of Healthcare That
Leaves No One Behind= 100%
Access
What, and for whom, is 100% Access?
100% access means that all persons,
particularly those persons who are
uninsured or underinsured, receive health
care services that:
2020 Goal of Healthcare That
Leaves No One Behind= 100%
Access
1. Create, and support the journey to
improved Health outcomes for each
individual, and
2. Are funded in an adequate and
sustainable fashion.
Ascension Health’s Call to Action
Together We Promise:
Healthcare that Works
Healthcare that is Safe, and
Healthcare that Leaves No One Behind…
Serious Gaps in the Healthcare
Safety Net
Immigrants
Migrant Workers
Uninsured Workers
Frail Elderly
Homeless Adolescents
Affordable
Drugs
Available Dental
Services
Access to
Mental Health
Services
Private Providers = U.S. Safety Net
• Safety net means where the uninsured receive health services.
• Private providers provide over half of all uncompensated care.
• Among the largest providers of uncompensated care, 82% are
private.
• 72% of Medicaid patient days are provided in private hospitals.
Public
Private
Ascension Health Virtual Access Institute:
The Picture in 2020
A. National
Legislative
Leader
At least $100
million
of federal funds
that is directed to
achieving 100%
access for
patients served by
private not-forprofit safety net
providers
B. Access
Model
Catalyst
Achievement
Of 100% access
in every
Ascension
Health
community
catalyzed by
the Ascension
Health Ministry
C. Voice of
the
Voiceless
Threshold
change in
public perception
supporting a
national policy to
assure
access for all
D. National
Public
Policy
Partner
National health
reform passes
assuring every
American
healthcare
access
Federal and Matching Funds for Ascension Health
HCAP Projects
1999
2000
2001
2002
2003
Ascension
Health Submits
National Unified
CAP
Application for
Multiple Sites
and Commits to
Matching $ of
Approximately
$7 million over
five years
Austin
$900,000
Detroit
$900,000
New Orleans
$899,357
Austin
$675,000
Detroit
$675,000
New Orleans
$674,518
Binghamton
$631,374
Dumas/Gould
$819,264
Flint
$827,230
Indianapolis
$995,815
Nashville
$1,080,819
Austin
$472,500
Detroit
$427,500
New Orleans
$472,000
Binghamton
$442,000
Dumas/Gould
$572,000
Flint
$579,000
Indianapolis
$697,000
Nashville
$757,000
Saginaw
$961,995
Austin
$998,674
New Orleans
$330,000
Binghamton
$309,353
Dumas/Gould
$440,632
Flint
$405,343
Indianapolis
$487,950
Nashville
$529,601
Saginaw
$672,921
Tawas City
$972,670
Pottsville
$250,000*
*appropriations
Total Dollars
Federal Funds to Matched Sites = $24,138,561
Ascension Health Match = $7,072,485
Federal and Ascension Health Match = $31,211,046
2004
Austin
$699,072
New Orleans
$1,200,000
Flint
$483,379
Saginaw
$471,045
Tawas City
$680,869
Pasco
$997,680
Pottsville
$500,000*
*appropriations
pending
St. Joseph Hospital, Tawas City, MI
Models for 100% Access
Genesys Health System
Flint, MI, Genessee
County CAP (GCCAP)
Lourdes Health
Network, Pasco, WA
Rural Prevention Network
St. Mary’s Medical Center, Saginaw, MI
Healthy Futures
St. John Health System Detroit, MI
BFCHA
Voices of Detroit Initiative (VODI)
Our Lady of Lourdes
Memorial Hospital
Binghamton, NY
Southern Tier Family
Health Link (FHL)
Carondelet Health
Network, Tucson, AZ
Pima County Access
Program
Good Samaritan Regional
Medical Center
Pottsville, PA
Highway to Health
Central Indiana Health Systems
Indianapolis, IN, Rural
Underserved Access to Health
(RUAH)
11
Daughters of Charity Services of New Orleans
SETON Healthcare
Network, Austin, TX
Indigent Care
Collaboration (ICC)
St. Thomas Health Services
Nashville, TN, Nashville
Consortium of Safety Net
Providers
Delta Healthcare Consortium
Dumas/Gould, AR
New Orleans, LA
New Orleans Partnership
for Care of the Uninsured (NOPCU)
© Ascension Health 2003
Ascension
Health’s
5-Step Access
Model
SYSTEMIC CHANGE =
100% ACCESS
1.
Formal Infrastructure
•
Leadership Coalition
•
Shared Information
Systems
•
Catalyst Funding
2.
Service Gaps Filled
•
Dental/Pharmaceutical
/Mental Health
3.
Uninsured: Care Model
4.
Private Physicians Volunteer
as Medical Home
5.
Sustainable Funding
•
State, Local
Govt./Business
© Ascension Health
Ascension Health’s Commitment to Producing
Outcome Measures as a Path to Sustainability
• Reduction of
unnecessary emergency
room visits by the
uninsured
• Reduction in
unnecessary
hospitalizations by the
uninsured
• Increase in number of
previously uninsured
enrolled in public or
private insurance
programs
• Increase in number of
uninsured with a primary
care home
• Increase in number of
uninsured participating in
pharmaceutical assistance
programs
• Increase in dollar value of
needed pharmaceuticals
provided to the uninsured
• Improved health outcomes
in asthma, diabetes, and
hypertension in the
uninsured
Local Access Model
Leadership – 100% Access
to Healthcare in Austin
Step 1: Build Infrastructure – Leadership
Leadership Commitment for Successful
Collaboration is Key
• Vision to form Collaboration
• Provide funding, personnel, space and equipment
resources
• Use influence to call others to participate
• Give time, energy and commitment, and CEO’s must
be present “at the table” – don’t delegate
• Be intentional on building sustainable funding
• Have passion to meet the needs of persons who are
poor and vulnerable
Create the “business model”
• Collaborative “customers” are the safety net
providers – the member organizations. The
providers’ customers are their uninsured patients
• Collaborative doesn’t get involved in direct services
to patients
• Collaborative goal is to reduce costs to member
organizations that care for the uninsured, or to
increase revenue to member organizations (by
enrolling patients in coverage programs) so that
the member organizations can provide more and
better care to the uninsured population
Step 1: Build Infrastructure –
Information Systems
• Web-based programs that help all partners improve
enrollment to government funding and to resources
• Web-based program that builds a shared electronic
record with demographic and medical data
• Disease management repository
• Case Management Web-based programs
• Pharmacy Assistance Web-based data base
• Managed Care (HMO look-a-like) programs
Step 1: Build Infrastructure –
Information Systems
• RHNSCNY Patient Health Information Network
(PHIN) is a pilot program that provides shared
information on patients
• Questions?
• Who most benefits from this system?
• How do you engage them to help fund system?
• What is the value proposition for each partner in the
collaborative?
ICare
Step 1: Building Infrastructure –
Information Systems
The I-Care system is the overall integrating
structure for the Indigent Care Collaboration
(ICC)
Medicaider
• Common eligibility screening across the community
• Outreach to secure eligibility beyond the screening
process
MPI/CDR (Master Patient Index/Central Data Repository)
• Provides shared health data for clinical and
demographic information
• Record includes encounter codes (ICD9, CPT) and
pharmacy
Medicaider
Step 1: Building Infrastructure –
Information Systems
• Online common eligibility tool screens for Medicaid,
SSI, SCHIP and local assistance programs
• Average screening time: 3.1 minutes
• Link from Med Data Systems into Medicaider
provides pharmacy assistance eligibility
• Program forms are printed out, signed and
processed at interview
• Recently expanded to Williamson County
Medicaider Screening Results:
Travis County
• 118,687 screened through 12/13/04
86% Program eligible
• (8.4%) 9,919 Medicaid Eligible
• (1.9%) 2,261 SCHIP Eligible
• (61.2%) 72,697 MAP/Sliding Scale
Eligible
Estimated ICC Member Revenue:
Travis County Medicaider Enrollees Post Enrollment
ATC FQHCs
Seton Hospitals
St David's Hospitals
Brackenridge/CHOA
Seton Clinics
People's
Planned Parenthood
Total
$
$
$
$
$
$
$
$
61,800
77,100
56,100
546,600
6,300
2,070
1,470
751,440
N=679 Patients enrolled in Medicaid/SCHIP in 2004 for actual visits
after enrollment. Assumptions: clinic $30; FQHC $150; Hospital
$300
Medicaider Screening Results:
Williamson County
• 4173 interviews through 12/13/04
84% Program Eligible
• 16.4% (685) Medicaid Eligible
• 4.2% (174) SCHIP Eligible
• 14.3% (608) County Indigent/City
Eligible
MASTER PATIENT
INDEX/CENTRAL DATA
REPOSITORY MPI/CDR
Step 1: Build Infrastructure –
Information Systems
• Provides unduplicated count of uninsured patients
(by payor, gender, age, neighborhood)
• Tracks patients through the safety-net care system
via encounters including CPT and ICD-9 codes
• Improves care management, reduced duplication of
resources, better outcomes
• Provides reporting and analysis capability including
mapping, incidence of diagnoses, etc.
• Future opportunity: Incorporation of lab data and a
complete electronic medical record
Step 1: Build Infrastructure –
Information Systems
Patient count:
335,597
Encounters:
1,126,295
Pharmacy encounters:
196,027 prescriptions
MPI/CDR utilized by:
10 Hospitals
22 Clinics
2 Physician Networks
1 MHMR Authority
Step 1: Build Infrastructure –
Information Systems
• There is a critical role for IT
infrastructure in an effort to coordinate
care models and build value propositions
The Patient Journey to 100% Access –
What the Providers Don’t Know!
12/31/02
355.8 – Nerve Inflammation Leg
Brackenridge Hospital
1/5/03
729.5 – Pain in Limb
Brackenridge Hospital
1/15/03
355.2 – Femoral Nerve Lesion
City Clinic in Manor
1/16/03
728.9 – Muscle/Ligament Disease
719.70 – Difficult Walk
355.9 – Nerve Inflammation
Brackenridge Hospital
2/14/03
355.9 – Nerve Inflammation
City Clinic in Manor
4/18/03
729.5 – Pain in Limb
City Clinic in Manor
4/30/03
977.8 – Poisoning – Medicinal
305.90 – Drug Abuse – Unspecified
Brackenridge Hospital
5/13/03
975.2 – Poisoning – Skelet Muscle
E950.4 – Suicide – Drug/Med NEC
Seton Medical Center
…As of 2/2003, also an Austin/Travis County Mental Health Center Patient
. . .and who knows how many pharmacies!
Understanding Care Use: Potential To
Improve Coordination of Treatment
Date
3/3/04
3/17/04
4/15/04
4/16/04
4/27/04
4/30/04
5/17/04
5/21/04
6/15/04
6/16/04
Condition
Diabetes
Diabetes
Dental Exam
Clinic Visit
Diabetes, Renal Disease
Diabetes
Diabetes, Muscle Dis.
Diabetes
Diabetes, Chest Pain
Diabetes, Renal Dialysis
Location
ATC RZ
ATC RZ
ATC NE
Seton McCarthy
Brack (inpatient)
Seton McCarthy
Brack (outpatient)
Seton McCarthy
St David (ER)
St David (outpatient)
Patient Uses Multiple Providers for the Same Condition; without ICare access, providers could not view to prior visits at other
locations.
High Use Patient Snapshot:
Patient Use Drives Up Cost
Date
2/20/04
2/20/04
3/9/04
3/11/04
3/11/04
4/1/04
4/13/04
5/12/04
5/13/04
Diagnoses
Acute URI
Bronchitis
Backache
Lumbago, Hypertension
Skin Disturb.
Lumbago
Neuritis
Joint Pain
Lumbago
Location
Brack ER
St David ER
St David ER
St David ER
Brack ER
Seton McCarthy
ATC RZ
ATC RZ
Brack Outpatient
Step 2: Fill Service Gaps
RHNSCNY Family Health Link Programs:
* Dental Services
* Vision Assistance
* Pharmacy Assistance
* Health Insurance Referral
Step 2: Fill Service Gaps
Other Examples:
•
•
•
•
•
•
•
•
•
Medical Equipment Services
Shared Web-site with Referral Services
RN Call Center
Health Promoters
Medical Interpreters
Health Vans
Health Newsletter
Food Fair and Screenings
Transportation
Step 2: Fill Service Gaps
Questions:
1. What are greatest needs of your
patients?
2. How can providing this need help
reduce expenses or improve services
among your partners?
3. Which partners could benefit by
collaborating with one service?
Step 3: Develop Care Model
Two pilot projects in Austin, Texas:
1.
2.
Seton Care Plus (an ICC project)–
–
a care management model with a “closed “ population of 4000 uninsured
people
–
the 4000 are a subset of ICC enrollees who are all assigned to primary care
doctors at one of three Seton Community Health Centers
–
They receive ongoing case management services from clinic based case
managers
Brackenridge Emergency Room (a public hospital project being monitored by
the ICC) –
–
“open” population consisting of uninsured patients who have more than 6
ER visits per year or 3 IP admissions per year
–
may or may not be enrolled in ICC; may or may not be assigned to a primary
care physician
–
ER case managers assigned to organize and coordinate access to needed care
Step 3: Develop Care Model
Questions:
1. Do your primary care partners serve
duplicate patients?
2. Are emergency rooms overcrowded with
primary care visits?
3. Will packaging a benefits plan with
collaborators improve inappropriate
utilization?
4. Is there a value proposition?
Step 4: Engage Private Physicians
•
•
•
•
•
Project Access model, Asheville, NC
Medical Society recruits physicians to volunteer for a
“fair and finite” number of uninsured people
– Primary care physician = 10 patients per year
– Specialty care physician = 20 patients per year
Project Access physicians can view hospital, clinic and
pharmacy encounters of uninsured patients entered into
MPI/CDR
Care is supported by case managers and pharmacy
assistance programs
Project Access expands the number of medical homes
available for uninsured patients
Step 4: Engage Private Physicians
Questions:
• Are there private physicians in your
community willing to volunteer?
• Are there specialists in your community or
near by?
• What are physician gaps?
• Are physicians at the table of the
collaboration? What do they need?
Step 5: Achieve Sustainable Funding
to Pay for Care for the Uninsured
Two Key Strategies:
1. Look for public funding opportunity –
Hospital District (tax support or public
funding)
2. Identify value propositions that partners
want to support (1+1=3 formula)
Step 5: Achieve Sustainable Funding
to Pay for Care for the Uninsured
Goal:
• Reduce costs to, and burden on, ICC member providers
caring for medically indigent, through collaborative
ventures
Develop Value Propositions:
• Reduce visits to emergency departments
• Reduce ambulatory-sensitive admissions
• Effectively channel patients to funded sources
• Improve physician satisfaction by supporting care
• Provide backbone for continuity of care
• Provide longitudinal picture of indigent care
Seton Care Plus Outcomes – “Closed System”
600
400
200
0
Rx Cost PMPM
ER Visits/1000
538
371
20
15
10
5
0
280
Base Yr. 1 Yr. 2
20
%
5.88
Base Yr. 1 Yr. 2
Referrals PMPM (x100)
8
6
4
2
0
Base
Yr. 1
17.9 10.5
Yr. 2
Outcomes - 2004
Closed System Seton Care Plus & MAP
Bed Days/1000
ER vst/1000
1400
600.0
1264.8
1200
500.0
1000
400.0
555.4
800
ER vst/1000
600
400
316.9
300.0
Bed Days/1000
200.0
97.6
200
100.0
0
0.0
Seton Care Plus
MAP
Seton Care Plus
MAP
ALOS
Adm./1000
6.0
120
5.2
107
5.0
100
4.0
80
60
40
Adm./1000
28.3
3.6
3.0
ALOS
2.0
20
1.0
0
Seton Care Plus
MAP
0.0
Seton Care Plus
MAP
Care Model Outcomes
ANNUAL COST PER COVERED LIFE
(EXCLUDING INFRASTRUCTURE)
$2,500
$1,954
$2,000
$1,768
$1,500
$1,000
$797
$500
$0
ICC CARE MANAGEMENT
MEDICAID MANAGED CARE
LOCAL MANAGED CARE
Results: Brackenridge ER “Open” Model
Projected costs of avoided ER visits and
hospitalizations for uninsured patients:
Network in FY04:
$1.4 Million
Network in FY05:
$1.75 Million
These represent hospital expenses that would
have been written off or charity care
Step 5: Achieve Sustainable Funding
to Pay for Care for the Uninsured
Questions?
1. What kinds of things are all the partners
doing individually that they could do
together?
2. What could be solved better if it was
centralized and shared?
3. What could be affordable if it was shared?
4. Who benefits from the savings of better
access to care for uninsured?
In the End Everyone Wins
• Working together is critical – it is no
longer possible to do it alone
• Everyone has to be at the table
• Once you build a culture of
collaboration anything is possible
• Everyone has to get value from
participation – win/win
• It takes longer