November 15, 2010 1:00 p.m. Room 131 Capitol Annex Health Care Access Now

1. November 15, 2010 1:00 p.m. Room 131 Capitol Annex Health Care Access Now Judith Warren, MPH - Executive Director

2. Ohio 501(c)(3) corporation established in 2009 with support from the Health Foundation of Greater Cincinnati • HCAN serves as a “system integrator” by developing and managing partnerships and programs to improve access to care and improve health outcomes. • HCAN works with medical and social service providers to reduce inappropriate ED use and improve access to prescriptions. • HCAN works with entities at the local, state, and national level that are aligned with the HCAN vision of sustainable primary care access delivery systems for the uninsured & underserved. 2

3. If given true options and timely connections, people will stop using hospital EDs for primary care. We do not need to inject more money in the system; we need to spend the existing money in a smarter way. • We can empower/support people in taking control of their healthcare needs • Health care payors are paying for care delivered at the wrong place and time. 3

4. Estimated Population 2009 – 4,314,113 • ED Utilization per 1,000 = 519 * • Estimated ED Visits = 2,239,000 • Estimated Avoidable Visits** @ 20% = 448,000 • Estimated Avoidable ED Charges= $464M *** • Estimated Avoidable Patients @ 2.3 Visits/Patient = 195,000 patients with avoidable visits. • Number of primary care providers required to service all avoidable visits in Kentucky = 162 * Statehealthfacts.org (2003) ** Avoidable Visits defined by AHRQ - Ambulatory Care Sensitive Conditions codes ***Average ED Expense = $1,038 per 2007 Medical Panel Expenditure Survey (MEPS) 4

5. Care Coordination is a way to reduce the costs of care and ensure that the patient receives the right treatment at the right time and the right setting through the use of “Patient Navigators” aka Community Health Outreach Specialists • The evidenced-based care coordination approach is known as a “pathway” which enables patients to be guided to appropriate medical and supportive care services via a “real time” contact in the hospital ED. • The pathway outcome is to connect patients with a consistent Medical Home relationship that can impact unnecessary ED visits, hospital readmissions & Rx refill requests. 5

6. Opportunity Provide a cost-effective solution for reducing avoidable ED visits by navigating patients to primary care settings and establishing a medical home: • 3 Pilot Program Partnerships (hospitals & FQHC community primary care practice sites) • Mercy Health Partners • University Hospital (UC Health) • St. Elizabeth & St. Luke Hospitals • HealthPoint Family Care 6

7. Four Hospitals • St. Elizabeth’s Fort Thomas (38,300 ED Visits) • St. Elizabeth’s Florence (43,800 ED Visits) • St. Elizabeth’s Covington (28,200 ED Visits) • St. Elizabeth’s Edgewood (77,100 ED Visits) • Total ED visits (2009) = 187,400 • Avoidable visits (2009) = 16% 7

8. 706 Patients met criteria* and were counseled • Hospital and primary care staff and clinicians gained a better understanding of organizational operations and patient populations – improved patient referral relationships and reduced access barriers to care • 80% of patients referred kept their appointment with HealthPoint Family Care • Majority of clients needed social service/family support information – newly uninsured • Pilot reduced hospital charges = $425,000 • Increased CHC Expense = $34,000 • Program Direct Cost = $171,000 • Medicaid recipients = 22% of all St. E’s ED visits • Medicaid accounts for 30% if all St. E’s avoidable visits *Patient cohort who had no regular source of care, 4+ ED Visits , or chronic disease diagnosis 8

9. Quotes from St. Elizabeth ED Staff Survey (2009): Q: How does the Medical Navigator benefit the patient? A: “The Navigator can help get primary care appointments for patients who would not do this on their own.” Q: Why do you think this pilot program should remain permanent? A: “Anything to help decrease the amount of unnecessary ER visits will ultimately decrease healthcare costs.” 9

10. There is value to service providers and payors institutionalizing lower cost & effective partnerships between hospitals, health plans and primary care practice sites that serve Medicaid and the uninsured. • The ED Care Coordination model can be further customized for patients with chronic disease and behavioral health disorders (typically higher ED utilization and poorer health outcomes) 10

11. Currently, a reduction in ED utilization provides disincentives to contracted ED Physicians and Hospital Management; • Hospitals must redesign ED Services to capture any direct cost savings from reduced volume; • Care Coordination needs to be in “real-time” and on-site in order to intercept patients at the most receptive opportunity; ideally 24/7 or at peak ED utilization times 11

12. St. Elizabeth/HealthPoint Family Care ED Care Coordination pilot recently discontinued due to: • No established funding support for service • Services were not scaled to make a large enough impact on significant reduction in target ED utilization. • University Hospital staff and HCAN working to secure ongoing funding (2011) for one FTE and management services • To date, 75% of patients (900+) received a medical or dental care appointment • 70% of patients making appointments kept the appointment. • Avoidable visits have dropped from 14.5% of total visits in the 1st quarter of 2008 to 8.7% in the 4th quarter of 2009. 12

13. Ohio Department of Job and Family Services’ IMPROVE Initiative • Ohio Medicaid Managed Care Plans paying for primary care coordination targeting improvement in birth outcomes/reduction in low-birth weight babies. • Washington and Texas hospitals supporting community-based care management services for chronic disease and CHIP families ; services recognize outcome-based payment vs. volume-based payment = reduces overall cost of care, inappropriate utilization, patient/provider satisfaction CMS payment policy regarding readmits; cost shifting to the insured population continues 13

14. Health Care Access Now will continue to pursue the development of intentional and sustainable care coordination programs • Health Care Access Now will continue to serve as neutral convener & partner to coordinate inter-agency projects that improve access to care, promote consumer engagement and personal responsibility, and ensure multi-lateral engagement of relevant stakeholders 14

15. The Task Force consider developing a statewide or regional Medicaid pilot that will provide the forum for spreading methods and approaches that eliminate avoidable ED visits and stimulate rapid cycle improvement and measurement. The goal would be to engage providers from all relevant sectors, consumers and other key stakeholders to set specific service targets with specific timelines. 15

16. Judith Warren, MPH Executive Director Health Care Access Now 8790 Governor’s Hill Drive, Suite 202 Cincinnati, OH 45246 jwarren@healthcareaccessnow.org 513-707-5696 16