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Jan Eldred Karen W. Linkins Lisa Mangiante December 10, 2008

Jan Eldred Karen W. Linkins Lisa Mangiante December 10, 2008. Overview of the Initiative. Five year project funded by The California Endowment and the California HealthCare Foundation, based at Corporation for Supportive Housing California Program

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Jan Eldred Karen W. Linkins Lisa Mangiante December 10, 2008

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  1. Jan Eldred Karen W. LinkinsLisa Mangiante December 10, 2008

  2. Overview of the Initiative • Five year project funded by The California Endowment and the California HealthCare Foundation, based at Corporation for Supportive Housing California Program • The issue – emergency rooms are inundated with large numbers of patients, many of whom have complex, unmet needs not effectively dealt with in acute care settings • Create a more responsive system of care that proactively • Addresses patients’ need and produces better health outcomes • Frees up emergency department resources for acute medical crises

  3. Who Are Frequent Users? • 65% chronic illness (diabetes, cardiovascular disease, chronic pain, cirrhosis & other liver disease, asthma & other respiratory disease, seizures, Hepatitis C, and HIV) • 53% substance use issues (alcohol, methamphetamines, crack/cocaine, heroin, prescription drugs) • 45% homeless, living on the streets • 32% mental illness (Axis I and II) • 36% have 3+ of these presenting conditions

  4. The Challenge • Disproportionate use by small number of patients • Most use is avoidable • 8.9 ED visits each annually, with average annual charges of $13,000 per patient • 1.3 hospital admissions annually • 5.8 inpatient days each, with average annual charges of $45,000 per patient • Episodic, hospital-based care doesn’t effectively meet the multiple, complex needs

  5. The Models • 6 counties, 6 programs (partnerships of hospitals, health/human service, housing, behavioral health, criminal justice) • 5 intensive case management, 1 brief peer intervention • 3 hospital-based, 3 community-based • Various team compositions ranging from peer counselors and paraprofessionals to multidisciplinary teams – one with social workers and nurses and the ability to bill for direct services

  6. Frequent User Case Management Key elements • Connect patients to both medical and non-medical services (e.g., primary care, mental health, drug and alcohol treatment, housing, transportation) • Intensive individual support, especially initially • Coordination of care • Effective linkages between case managers and ED

  7. Policy Impact • Increased awareness of frequent users and commitment to address high cost, ineffective utilization patterns • Other initiatives in place that affect some frequent users • CoverageInitiative—expands healthcare to some uninsured (10 counties) • Mental Health Services Act— provides funding to county mental health departments for services to people w/ serious and persistent mental illness • Coordinated Care Management Program— pilot to reimburse for services to low income people with medical illness and serious and persistent mental illness in some counties • SB 1738 (2008) Passed both houses with bi-partisan support but vetoed by Governor (prefers “statewide solution”) • Victories: universal agreement on the approach, belief in the data, and Administration and stakeholder commitment to work together next year

  8. Local Accomplishments • Most Initiative programs self-sustaining • Broader adoption of case management & multidisciplinary care • Increased collaboration to improve service delivery: • frequent user programs and supportive housing • FQHCs and hospitals • health and mental health agencies, health agencies and jails • Increased focus on benefits advocacy • Collaborative planning of community initiatives for overlapping populations: • Medical respite for homeless patients • Coverage Initiative for uninsured Californians • 10 year plans to end homelessness

  9. Outcomes: Connections to Housing, Health, and Income Benefits • Clients homeless at enrollment: • 34% connected to permanent housing • Clients connected to health benefits: • 68% Medicaid applications approved • Clients connected to SSI: • 53% SSI applications approved

  10. Outcomes: Hospital Utilization & Charges

  11. More information For more information about the Initiative or to download the Frequent Users of Health Services Initiative: Final Evaluation Report, visit: www.frequenthealthusers.org

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