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Hospital Proviso Preliminary Report

Hospital Proviso Preliminary Report. May 30, 2014. Ana Lòpez - De Fede, PhD; Kathy Mayfield-Smith, MA, MBA; Patricia Stone Motes, PhD USC Institute for Families in Society Division of Medicaid Policy Research. Hospital and Clinic Proviso Evaluation Framework.

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Hospital Proviso Preliminary Report

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  1. Hospital Proviso Preliminary Report May 30, 2014 Ana Lòpez-De Fede, PhD; Kathy Mayfield-Smith, MA, MBA; Patricia Stone Motes, PhD USC Institute for Families in Society Division of Medicaid Policy Research

  2. Hospital and Clinic Proviso Evaluation Framework Proviso Context: Healthcare Reform Technical Assistance Alliance development, setting vision and strategies Proviso Stakeholders Sustaining Activities Collaborations Interventions Targeted At: • Long-term • Outcomes • Community improvement in quality measures • Improvement in health status • Reduction in costs trends • Reduction in disparities • Ongoing collaboration to improve healthcare • Intermediate Outcomes • Improved care coordination within and across providers • Heightened patient activation and compliance • Improved patient outcomes • Diffusion of best practices • Patient satisfaction • Community engagement Public Reporting Consumer and Community Engagement Quality Improvement Programmatic alignment Payment Reform Disparity Reduction Feedback on implementation and results TIMELINE 2

  3. It is generally accepted in action research “that researchers should not rely on any single source of data, interview, observation, or instrument.” (Mills, 2003) Evaluation Components 3

  4. Enrollment Patterns As of April 2014 • 5,624 uninsured successfully enrolled • 4,922 uninsured enrolled with a HOP with numbers ranging from 50 to 750 targets with data available from July 2012 – Dec. 2013 Gender • 60% Female • 40% Male Race • 49% White • 50% African American • 1% Other Race/Ethnicity Age Groups • 10% (18–24 yrs.) • 43% (25–44 yrs.) • 34% (45-54 yrs.) • 13% (55–64 yrs.)

  5. Enrollment Care Patterns As of April 2014 • 87.3% had at least one inpatient, ED, specialty, or outpatient surgery record from July 2012 – December 2013. • 29%had at least one inpatient hospital stay • Of those with an inpatient hospital stay, 35% had a readmission within 30 days. • 81% of inpatient admissions were associated with an ED visit.

  6. Enrollment Care Patterns (continued) As of April 2014 • 96% had at least one ED visit • Of those with an ED visit, 70% had at least 3 or more ED visits. • Approximately, 34% of the population had 7 or more ED visits. • 51% had 2 or more chronic conditions documented.

  7. Outreach and Reasons for Non-Enrollment (N = 4,976) As of April 2014 58% Not Reached 25% Insured

  8. HOP Screenings Healthy Outcomes Plan Increases Screenings for Uninsured: PAM National % Distribution • 3,549 (42%) have been screened with the PAM • Average score = 59.5 • PAM has 4 Levels with the following scores: • Level 1: Not engaged 47 & below • Level 2: Becoming aware47.1 - 55.1 • Level 3: Taking action55.2 - 67.0 • Level 4: Maintaining behavior67.1 - 100 • Slight shift between levels since March to 1% more in Levels 3 & 4 SC HOP % Distribution Source: USC Institute for Families in Society | Division of Policy and Research on Medicaid and Medicare 5/29/2014 15

  9. HOP Screenings Healthy Outcomes Plan Increases Screenings for Uninsured: GAIN-SS National % Distribution • Summary of Scores: • 4,273 (50%) have been screened with the GAIN-SS • Average Score = 4.1 • Range of scores between 0 – 23 (Maximum possible is 23) • Scoring Distribution: • Low (Zero): 1,093 • Moderate (1 or 2): 722 • High (3+): 2,458 Source: USC Institute for Families in Society | Division of Medicaid Policy Research 5/29/2014 16

  10. HOP Screenings Initial Results on 4,371 People Screened with GAIN-SS * High Risk = 3+ ** People may be counted in multiple sub-screen sections Source: USC Institute for Families in Society | Division of Policy and Research on Medicaid and Medicare 5/29/14 17

  11. HOP Screenings National Average for People Screened with GAIN-SS Source: USC Institute for Families in Society | Division of Medicaid Policy and Research 5/29/14 17

  12. Linking Collaboration Index to Case Study Interviews Linking PAM and GAIN-SS to Individual Data for Enrolled Case Study Report with Recommendations Next Steps Comparing Characteristics and Services use Patterns: Enrolled Pilot versus Uninsured Total Population Linking Implementation Process to Interviews: Applications Criteria; Goal Attainment

  13. Contact Ana Lòpez-DeFede, PhD adefede@mailbox.sc.edu 803-777-9124 Kathy Mayfield-Smith, MA, MBA klmayfie@mailbox.sc.edu 803-777-9124

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