PROVIDENCE CENTRALIA HOSPITAL EMERGENCY DEPARTMENT COMMUNITY ACCESS PROJECT

1. PROVIDENCE CENTRALIA HOSPITALEMERGENCY DEPARTMENT COMMUNITY ACCESS PROJECT Cindy Mayo, Chief Executive

2. ED Community Access Project • Lack of primary care access in Lewis County • Unemployment rate exceeds 14% • Community (based on hospital mission) sees “Providence” as provider of care to community (via Emergency Department) • Data reviewed in 2008 demonstrated 14,297 patients in ED with triage levels 4 or 5 status, of which 25% were charity and 24% Medicaid (this included visits for medical as well as dental issues) • Cultural/generational issues related to ED utilization for primary care

3. Collaborative Solution Involved • Valley View – Federally Qualified Health Clinic • Private practice physicians and dentists • Washington State Department of Social and Health Services • Behavioral Health Resource Services Network • CHOICE Regional Health Network • Hospital based leaders • Community Ministry Board (past-chair) • Lewis County Emergency Department Physicians • Public Health Department - MD

4. Target Patient Populationand Goals • Reduce Level 4 and 5 triage emergency visits by 10% from 2008 baseline data • Reduce ED visits for dental issues by 10% • Reduce ED patients with repeat/multiple visits for dental issues by 10% • These patients have chronic diseases, behavioral health issues, drug seeking behaviors, dental issues and inability to establish primary care home

5. Solutions • Valley View Walk In Clinic – on hospital campus; 7 days a week 12:00pm – 10:00pm • Advertised in local paper and in local school system • Emergency Department post discharge follow-up to Valley View Health Center – Valley View Walk In Clinic – Valley View Dental Center • Dental referral began June 2009 (quasi-case management process) • Walk In Clinic opened December 2009 • Walk In Clinic space donated to Valley View by Providence Centralia Hospital

6. Results • 2010 – Walk In Clinic volume 8,923 (5,794 patients), 32% uninsured, 34% Medicaid • Drop in hospital triage level 5 of 34%, triage level 4 of 15% (2010 as compared to 2008 baseline) • Post ED discharge/referrals to Valley View (with appointment); N=1,612 – 76% kept appointments

7. Results (cont’d) • Post ED referral for dental care; N=113 (with appointments) 80% kept follow-up appointment • Reduction of ED visits for dental patients by 7% (18 month trend) • Patients with repeat (multiple) dental visits reduced by 21% (18 month trend)

8. ED Consistent Care Program(EDCCP) • Consistent Care is a proactive intervention program designed to guide treatment decisions for individuals with unresolved and complex health care needs • Innovative and collaborative structure to improve health of vulnerable people by effectively managing co–occurring chronic conditions and behavioral health issues.

9. ED Consistent Care ProgramEDCCP (cont’d) • Collaborative includes PSPH and PCH Emergency Centers, ED physicians, CHOICE Regional Health Network, Department of Social and Health Services Review and Coordination Program, primary care physicians, community health clinics, chemical dependency center/Behavioral Health staff (if available)

10. Patient Population • High users – 2 visits/month or 4 visits in 6 months • Complex cases – chronic pain (head, neck, back, abdomen, teeth) • Mental, behavioral and social issues • Chronic disease management (hypertension, diabetes) • Consume resources ( example staffing and diagnostic exams) due to threatening behavior • Visits unnecessary, preventable, best treated in outpatient (non emergency) setting • High frequency of drug seeking behavior

11. Interventions • Alerting patients to their heavy (inappropriate) use of the ED • Establishing and sharing patient plan of care among clinicians • Personal case management by community health workers • Collaborative approach to patient specific treatment decisions based on shared plan of care among the patient and all clinicians

12. Interventions (cont’d) • Data sharing among hospitals, providers, and payers to form a complete picture of patient life, behaviors and care needs • Team usually consists of ED Medical Director, RN Nurse Coordinator, Behavioral Health/Chemical Dependency Specialist (if available), CHOICE provides Administrative Coordinator, Community Health Worker, Social Services/Intake Referral Coordinator (administrative support)

13. Results • PSPH – Most mature program with demonstrated results – in targeted population reduced ED visits by 50%, and saved on average $9,000 in charges per enrolled patient year, with an estimated $5,662,000 in combined saved charges (since program inception).

14. Results (cont’d) • CHOICE calculates combined arrival costs (hospitals, CHOICE and Primary Care) to operate six programs to be $400,000 depending on case mix and complexity. If 750 high users enrolled in EDCCP this could result in 4,200 fewer unnecessary ED visits and reduced charges of $7.3M in our region per year • Current Participating Facilities: Providence St. Peter Hospital, Providence Centralia Hospital, Mason General Hospital, Mark Reed Hospital, Grays Harbor

15. Thanks to Jackie Brown,Sr Director Emergency Services PSPH & Kristen West, Executive Director CHOICE