Return On Community Investment HCAP Disease Management

1. Return On Community Investment HCAP Disease Management Michael De Lucca, Deputy Director Broward Regional Health Planning Council, Inc.

2. Part I. Describe the enterprise you intended to make sustainable: • Critical activities: these are the defining operations that produce the services and outcomes. (In economic terms, it's the "production function.") • Outcomes: these are the important tangible products and observable results of the enterprise. • Defining measurements: these are the measured factors that are most important to the discussion of value. • Scale: indicate the operating level (such as number of patients, number of staff, budget, ...) and the magnitude of the outcomes. Broward Regional Health Planning Council

3. HCAP Disease Management Asthma, Diabetes and HIV/AIDS Disease Management program at the two tax-assisted hospital districts and the Federally Qualified Health Center serving Broward County (population 1.7 million). The prevalence of these diseases in Broward County are: Asthma: 6% Diabetes: 8% HIV/AIDS: 17.3% Broward Regional Health Planning Council

4. Critical Activities: • Information and Referral • Pre-eligibility Screening • Enrollment into Insurance Programs • Case Management • Self-Management Education • Medical Home Broward Regional Health Planning Council

5. Outcomes: • Improved Health Status • Improved Patient Quality of Life • Overall Cost Savings Broward Regional Health Planning Council

6. Defining measurements: • Decreased hospitalizations (hospital days) and associated costs. • Decreased emergency department visits and associated costs. • Decreased overall costs through patient enrollment in insurance programs. • Increased Quality of Life as measured by nationally recognized scales. • Improved clinical lab values (HbA1c, CD4& Viral Load) • Increased patient satisfaction. • Increased provider satisfaction. Broward Regional Health Planning Council

7. Scale: • Patients Served: 1,600 + • Staff: 4 Disease Managers • Budget: $452,025 • Cost Savings: Reduction in inappropriate ER use Reduction in Hospitalizations Enrollment in Insurance Programs Reduction in missed work days Broward Regional Health Planning Council

8. Concluding Message: Once you have defined what you want to accomplish (outcomes), what you are going to do (program components), and how you are going to measure the accomplishments, the next step is to ensure that you have a system in place for collecting data………. Broward Regional Health Planning Council

9. Part II. Describe the deals made: • Who the partners are. • The value the partners see in the outcomes produced by the enterprise. • The kind and amount of value you delivered to them and what you received in return. • How you are accountable --- the way you demonstrate that the value promised is delivered (measurements, reporting, events, media coverage, ...) Broward Regional Health Planning Council

10. Who the partners are: • Senior Vice Presidents of both Hospital Districts • CEO Regional Health Planning Council • CEO Federally Qualified Health Center • Administrator of Local Health Department • CEO Coordinating Council of Broward • Medicaid District Administer • Disease State Management Program Supervisors • CEO First Call For Help • Hospital Districts MIS Managers • CAP Program Director • CAP Evaluator Broward Regional Health Planning Council

11. Value partners see in the outcomes: • Cost savings to the hospital districts: it is more efficient and effective to provide disease management to keep patients healthy then to pay for them to be hospitalized. • Helping clients find a “medical home” eliminates the need to inappropriately use the emergency room for routine care. Broward Regional Health Planning Council

12. Value partners see in the outcomes: • The Federally Qualified Health Center made a deal with the hospital districts: the FQHC would be able to have their chronic disease clients disease managed at the hospital districts while still having their medical home at the FQHC. Broward Regional Health Planning Council

13. Value: • A healthier community with an increased quality of life. • Decreased use of tax payer dollars to pay for ER visits/ hospitalizations. Broward Regional Health Planning Council

14. Accountability: • Annual program evaluations to the community and posted on website: www.brhpc.org • Reductions in ER usage and hospital admissions, as well as associated cost savings, were calculated using an Access program outcomes database linked to the hospital billing database. • Improved clinical outcomes were reported by analyzing baseline lab values upon program entry to values at six month intervals. • Quality of Life improvement was reported by comparing baseline scores on nationally recognized QOL instruments varying by disease and comparing to six month intervals. Broward Regional Health Planning Council

15. Part II Conclusion: In order to successfully collaborate, you must first understand the history and goals of participating organizations. Prior successes in collaborative ventures are helpful and provide the framework for trust and positive relationships. Broward Regional Health Planning Council

16. Part III. Community Context: • Describe the community context for the deal and how you used it or changed it to support the deal. • Often, for a deal to happen, many community voices will have to be pushing for it. There is a readiness factor. The context is the political, social, and economic conditions with the readiness for action that they create among specific players. Broward Regional Health Planning Council

17. Readiness Factor: • In order to obtain the HCAP funding, we needed to demonstrate a community collaborative. The collaborative had to include the county, local health department, local Medicaid office, hospital districts, and the Federally Qualified Health Center. • These agencies have worked together in Broward for the past 20 years. Administrators from these agencies were asked to the table to discuss supporting the project and the corresponding benefits to the community. Broward Regional Health Planning Council

18. Readiness Situations: • These agencies participated in setting the Broward Benchmarks and agreed to work together to ensure that the goals would be reached. • The community agencies had decided to support any funding that would come to the county regardless of which agency benefited from the dollars. • For this grant, the hospital districts received the funding to hire disease managers. Broward Regional Health Planning Council

19. Readiness Situations: • The hospital districts benefit from providing outpatient disease management to the uninsured and underinsured because they are responsible for the costs associated with hospitalizations and ER usage for this population. • The hospital districts also benefited from participating in this program because it included a system to measure program outcomes which provides effectiveness data and leads to sustainability. Broward Regional Health Planning Council

20. Conclusion • In order to get buy in from agencies into a collaborative, it is important to have all parties agree to a long term commitment of supporting the community as a whole. In other words, the collaborators need to know that when they need the support of the members they will be willing to give it regardless of the direct benefit to their agency. Broward Regional Health Planning Council