1 / 13

Reducing Preventable ER Visits April 19, 2011

Reducing Preventable ER Visits April 19, 2011. John W. Robinson, MD, SM VP Medical Affairs & Chief Medical Officer Molina Healthcare of Washington, Inc. Creating Community Partnerships and Data Planning between Hospitals and Health Plans.

jeanette-brown
Download Presentation

Reducing Preventable ER Visits April 19, 2011

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Reducing Preventable ER VisitsApril 19, 2011 John W. Robinson, MD, SM VP Medical Affairs & Chief Medical Officer Molina Healthcare of Washington, Inc.

  2. Creating Community Partnerships and Data Planning between Hospitals and Health Plans

  3. Molina Healthcare of WA (MHW), a managed care health plan, provides a wide range of quality health care services to families and individuals who qualify for government-sponsored programs, including Healthy Options, the Children's Health Insurance Program (CHIP), Basic Health+, Basic Health, WMIP and Medicare. Over 350,000 members are covered in Washington. MHW also operates two primary care clinics in Snohomish County.

  4. The Problem • Molina members go to the ER over 15,000 times each month. • Based on the NY Algorithm calculations, 55% of these ER visits are preventable.

  5. Medical Management Initiatives ReduceER Utilization Full Range of initiatives Low High # of Members ED Use Low High

  6. Medical Management Initiatives The Top of the Pyramid

  7. eCensus Background • Molina Healthcare of Washington wants to partner with hospitals serving Molina Healthcare members to receive daily census and ER information in a secure electronic format (“eCensus” data). • eCensus data is used to: • Improve turn-around time and accuracy of admission notification • Ease the administrative burden on facility staff by eliminating time spent printing and faxing daily census • Quickly identify Molina Healthcare members with potentially avoidable emergency department visits who might benefit from Molina Healthcare education and outreach efforts • Started in CY2010

  8. Current Hospitals Live on eCensus • HOLY FAMILY HOSPITAL • KADLEC MEDICAL CENTER • KENNEWICK GENERAL HOSPITAL • MOUNT CARMEL HOSPITAL • PROV EVERETT MED CTR • PROVIDENCE CENTRALIA HOSPITAL • PROVIDENCE ST PETER HOSPITAL • SACRED HEART MEDICAL CENTER • SEATTLE CHILDRENS HOSPITAL • ST JOSEPH HOSPITAL OF CHEWELAH • VALLEY MEDICAL CENTER HOSPITAL

  9. eCensus Flow Chart

  10. Pilot: eCensus data from 10 Hospitals • Data fields transmitted to Molina daily: • Patient name • DOB • Policy number • Admission date • Discharge date (for I/P) • Status (active, discharged or blank) • Patient type (EMR, I/P, or OBO) • Admission Diagnosis • Unit • Patient phone • Adm Source (floor in hospital) • Adm physician

  11. RESULTS • Sample Data: January 2011 • # of ER visits in eCensus data: 1673 • # of f/u phone calls completed to those members: 716 • # of members with scheduled f/u: 360 • # of members assigned to CM/DM: 85 • # of members contacted who refused assessment: 4

  12. Questions and Comments

  13. Presenter Contact Information • John W. Robinson, MD, SM • VP of Medical Affairs & Chief Medical Officer • Molina Healthcare of WA • Ph: 425-424-7124 • John.robinson@molinahealthcare.com

More Related