2011 Study of Emergency Services Utilization in the Capital Region of NY Kevin Jobin-Davis, PhD

1. R5 Initiative— Improving Access to the Right Care in the Right Place at the Right Time for the Right Reason at the Right Cost 2011 Study of Emergency Services Utilization in the Capital Region of NY Kevin Jobin-Davis, PhD

2. HCDI Members County Health Departments Health Plans Albany County Department of Health Capital District Physicians’ Health Plan Rensselaer County Department of Health Fidelis Care New York Schenectady County Public Health Services Senior Whole Health Hospitals Federally Qualified Health Centers Ellis Hospital Hometown Health Services Albany Medical Center Whitney M. Young, Jr. Health Services Seton Health/St. Mary’s Hospital St. Peter’s Health Care Services Northeast Health/Samaritan Hospital/Albany Memorial Hospital Community Partners Catholic Charities of the Catholic Diocese of Albany Healthy Capital District Initiative | www.hcdiny.org

3. HCDI – Improving Access to Health Services • Public Health Insurance • Free application assistance for Medicaid, CHP, FHP – 4,200 people served annually • Community Health Advocates - information and assistance accessing health insurance and health services • Seal A Smile School-based Dental Services • Preventative oral health services – 3,250 served annually • Poverello Center • Primary Care for Uninsured Adults – 350 served annually Healthy Capital District Initiative | www.hcdiny.org

4. Public Health Planning • Analyze available State & Local Health Data • Collect and Analyze local data • Support County and Hospital health planning requirements – CHA and CSP • Develop local and regional initiatives to address targeted health needs Healthy Capital District Initiative | www.hcdiny.org

5. The R5 Initiative Improving Access to the Right Care in the Right Place at the Right Time for the Right reason at the Right Cost • Health System Forces • Primary care availability • Referral policies • Support services • Intake/discharge policies • Inter-organization communication • Individual • Forces • Pain • Knowledge of health resources • Work conflicts • Transportation • Social support • Suboptimal ED Use • Non-emergent • Frequent flyers • Preventable and chronic illness Target Population: Sub-optimal ER Users Healthy Capital District Initiative | www.hcdiny.org

6. R5 Goals • Identify causes of sub-optimal ED use • Identify promising practices and facilitate wider adoption in the Capital Region • Improve patient & provider engagement with primary, preventive, and managed care through collaborative interventions, resulting in better health outcomes • Collaboratively develop protocols to improve patient flow through the health system Healthy Capital District Initiative | www.hcdiny.org

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8. 2008 Capital District Emergency Department Visits 8 Healthy Capital District Initiative | www.hcdiny.org

9. Top 10 Non-Emergent Diagnoses Healthy Capital District Initiative | www.hcdiny.org

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13. Consumer Survey • HCDI developed a voluntary, anonymous consumer survey to be distributed in local EDs to determine the key factors that affect a person's decision to choose an ED for health care • 575 surveys were collected from Albany Memorial, Ellis, Samaritan, Albany Medical Center and St. Peter’s • Surveys contain a combination of open-ended and multiple choice questions on Likert scale Healthy Capital District Initiative | www.hcdiny.org

14. Results Reporting Open Ended Questions • Top Reason and Top 3 • Health Condition vs. Provider Characteristics • Why this Particular Emergency Department Closed Ended Questions • 5 point Likert Scale • Strongly Disagree to Strongly Agree Healthy Capital District Initiative | www.hcdiny.org

15. Consumer Themes for Selecting Emergency Care Healthy Capital District Initiative | www.hcdiny.org

16. More Specific Factors for Selecting Emergency Care Healthy Capital District Initiative | www.hcdiny.org

17. Factors in Selection of Particular Hospital’s Emergency Services Healthy Capital District Initiative | www.hcdiny.org

18. Consumer Defined Rationale for Choosing Emergency Services • Overall, symptoms and convenience are the driving factors for people to seek care • Pain and the quality of care are important secondary considerations • Selection of particular emergency service providers, is similarly influenced by convenience, then service quality factors, with prior visit experience also a consideration Healthy Capital District Initiative | www.hcdiny.org

19. Most Commonly Shared Reasons for Seeking Emergency Services Healthy Capital District Initiative | www.hcdiny.org

20. Phone Triage and Access Issues Healthy Capital District Initiative | www.hcdiny.org

21. Consideration of Urgent Care, Primary Care, and Emergent Care Healthy Capital District Initiative | www.hcdiny.org

22. The Convenience of Accessing Emergency Care 22 Healthy Capital District Initiative | www.hcdiny.org

23. The Inconvenience of Accessing Primary Care 23 Healthy Capital District Initiative | www.hcdiny.org

24. Summary of Patient Reasons for Selecting Emergency Health Services • The sense of urgency (84%) and pain (76%) associated with the trauma is the primary motivation for seeking emergency services • The convenience of comprehensive, timely services regardless of insurance are the major draws for patients • Patients don’t distinguish clearly emergent from primary care treatable conditions (42% of ED visits) • The vast majority (80%) do not consider the ED a better source of care than primary care • Not establishing a primary care provider was a factor for 1 in 3 respondents Healthy Capital District Initiative | www.hcdiny.org

25. Methods of Gap Analysis • Discussion/Meetings • 35 different providers (e.g., primary care physicians, emergency department (ED) nurses, patient navigators, case managers, urgent care clinic nurses, medical directors, discharge planners, long-term care providers, and others • Surveys • 13 primary care doctors • 3 hospitals • 4 nursing facilities • 3 urgent care centers Healthy Capital District Initiative | www.hcdiny.org

26. Major Gaps • Care management • Patient handoff • Capacity • Protection from liability • Alternatives to the ED Healthy Capital District Initiative | www.hcdiny.org

27. Primary Care Providers (PCP) • Capacity and support for timely preventive care is lacking • Same day appointments at primary care offices limited • Payment systems do not support robust primary care • No reimbursement for extra time managing care • There are extra challenges for the publicly insured • Some PCPs don’t accept MA; wait before seeing PCP • PCP shortages are acute for certain health conditions • Dental, mental health, and substance abuse were cited often 27 Healthy Capital District Initiative | www.hcdiny.org

28. Hospitals • EDs are not geared to manage care • Focus is emergent care, not chronic care • There are barriers to effective follow-up • Little time to educate patient; limited record exchange 28 Healthy Capital District Initiative | www.hcdiny.org

29. Hospital / PCP Care Coordination Findings • EDs communicate with affiliated physicians • EDs communicate with PCP re: admissions • FQHCs typically must actively seek info • Other instances, follow-up left to patient 29 Healthy Capital District Initiative | www.hcdiny.org

30. Long Term Care / EMS • Senior housing can’t manage residents’ health or provide services • Many home and community-based providers fear liability if they don’t send patients to the ED • If called, EMS must take patients to the ED 30 Healthy Capital District Initiative | www.hcdiny.org

31. Urgent Care Centers (UCCs) and Federally Qualified Health Centers (FQHCs) • There is not widespread awareness about UCCs or FQHCs as an alternative to the ED • UCCs not located in urban areas • Certain diagnostics only available at ED • Service hours are limited 31 Healthy Capital District Initiative | www.hcdiny.org

32. What to Do? • Improve Access to Primary and Preventive Care • Help Consumers Distinguish Primary Care Treatable Conditions from Emergent • Bolster Communication between Emergency Departments and PCPs Healthy Capital District Initiative | www.hcdiny.org

33. ACCESS TO PRIMARY AND PREVENTIVE CARE • Facilitated Enrollment education on importance of primary care/well visit and assistance with securing PCP • Development of evening primary care services in urban centers

34. CONSUMER SELECTION OF HEALTH SERVICES • Develop messaging and materials on benefits of primary care to support referrals of ED patients without a PCP • Targeted outreach in areas with high self-pay population • Develop marketing campaign on the benefits of Primary Care

35. COMMUNICATION BETWEEN EMERGENCY DEPARTMENTS AND OTHER PROVIDERS • Launch pilot exchange of ED visit information with primary care group • Enhance referral processes of ED patients without a PCP to primary care

36. Healthy Capital District Initiative 315 Sheridan Ave. Albany, NY 12206 www.hcdiny.org/r5.htm Kevin Jobin-Davis (518) 462-1459 kjobin-davis@hcdiny.org Contact 36 Healthy Capital District Initiative | www.hcdiny.org