Presented to Florida Hospital Association Webinar February 18, 2010 By Wally Plosky, Program Director HERAP Duval Count

1. Presented to Florida Hospital Association Webinar February 18, 2010 By Wally Plosky, Program Director HERAP Duval County Health Department

2. HERAP Focus • Uninsured and low income populations. • Patients without a family physician. • Patients requiring case and disease management assistance (for diabetes, cardiovascular, pulmonary and other chronic conditions). • Patients who have trouble filling prescriptions. • Zip codes with high hospital use for Ambulatory Care Sensitive conditions.

3. HERAP Components • Coordination of hospital ER and inpatient referrals. • Primary care medical homes. • Multi-disciplinary disease management services. • Free walk-in medical condition management centers (MCMCs). • Neighborhood community living rooms (CLRs). • Medication assistance program (MAP). • Expanded clinic hours – evenings and Saturdays. • Stanford Medical School’sChronic Disease Self Management Program (CDSMP) - Living Healthy. • Regional health information exchange (JHIN).

4. HERAP Staffing • RN disease managers • Financial eligibility specialists • Clinical pharmacologists/pharmacists • Registered dietitians/certified diabetic educators • Health educators • Mental health counselors • Patient navigators

5. 2009 HERAP Accomplishments • Received 2,697 client referrals from hospitals and community partners. • Connected 70% of hospital-referred patients with medical homes in the community. • Reduced emergency room utilization of HERAP-enrolled clients by 55.4%. • Reduced hospitalization of HERAP-enrolled clients by 89.8%. • Coordinated with hospitals to recoup over $1M in billable Medicaid dollars. • Helped hospitals in accessing over $75,000 in billable Medicaid under the Medically Needy Share of Cost program.

6. 2009 HERAP Accomplishments (cont’d) • Submitted 264 medication assistance applications totaling $83,841. • Provided chronic disease management services for an average of 200 patients monthly • Conducted three 6-week Stanford Medical School Chronic Disease Self Management Programs (CDSMP), graduating 30 participants • Held 28 CLR outreach events, attended by 1007 participants, resulting in 227 HERAP enrollments • Implemented innovative technology to streamline financial eligibility for hospital-referred clients needing access to medical homes within 72 hours • Provided office space and IT support for the Duval County WE CARE program and a volunteer Project Dentists Care

7. Key HERAP Partners • Baptist Health (BMC – Baptist South) • Memorial Hospital (HCA) • St. Vincent’s Medical Center (includes St. Luke’s) • Jacksonville Health Information Network (JHIN) • DCHD Institute for Public Health Informatics and Research (IPHIR) • Agape Community Health Center Network (Co-Applicant public entity FQHC with DCHD) • WE CARE, Inc.

8. HERAP Referral Sources Hospitals/ ERs Agape CHC Network Community partners Volunteers in Medicine We Care HERAP Community physicians Community outreach DCHD programs Self referral I M Sulzbacher

9. HERAP Referrals by ZIP Codes >40 30-39 24-29 10-23 <10

10. Duval County HERAP Cost Effectiveness Review • Objectives • Evaluate the impact of HERAP’s comprehensive multi-disciplinary disease management and medical home program on: • Emergency room utilization • In-patient hospital admissions/stays • Evaluate the effectiveness of a health information exchange in monitoring HERAP effectiveness (Jacksonville Health Information Network – JHIN) • Measure the effectiveness of a multi-hospital partnership model with individual hospital-specific program elements

11. Duval County HERAP Impact Analysis • Methods/Procedures • Data set stratification • 521 uninsured patients formally enrolled in HERAP’s disease management program with at least one emergency room visit or one in-patient admission • January 1, 2009 – September 30, 2009 • “Before and after” utilization rate comparison • Time bounded: 180 days immediately prior to and following HERAP admission

12. Duval County Hospital Emergency Room Alternatives Program (HERAP) Impact Analysis • Emergency room visits • Reduction: 55.5% • Projected six month savings: • $176,490 • Hospital in-patient admissions • Reduction: 89.8% • Projected six month savings: • $4,324,260

13. Resources Our Partner Hospitals Want for Their Discharged Patients • Assistance with non-compliant clients. • Primary care medical home. • Prescription access. • Chronic disease care and case management. • Knowledge of available community resources and how to connect clients to those resources. • Dental access. • Behavioral health and substance abuse services.

14. HERAP Contact Information Hospital Emergency Room Alternatives Program Duval County Health Department MC-92 900 University Blvd. N., Suite 202 Jacksonville, FL 32211 Tel: (904) 253-1444 Fax: (904) 745-3005 http://www.dchd.net/herap.htm Wallace B. Plosky, MBA, Program Administrator Wally_plosky@doh.state.fl.us Brenda Bernardez, MSN, Project Director Brenda_bernardez@doh.state.fl.us