Practice Improvement Network Working together to perfect your medical home

1. PIN Practice Improvement Network Working together to perfect yourmedical home Reducing Emergency Department Overcrowding by Reducing Barriers to a Medical HomePresented at the Illinois Academy of Family Physicians 2012 Annual Meeting by Elif Oker M.D., F.A.C.E.P. Medical Director, BCBSIL

2. PIN Practice Improvement Network Working together to perfect your medical home Purpose of this Presentation This session will provide insight into strategies for reducing the use of hospital emergency departments for non-urgent care by building a framework that removes barriers to care.

3. PIN Practice Improvement Network Working together to perfect your medical home • Agenda • Emergency Department Overcrowding • Defining the Patient Centered Medical Home • Core Elements of the Patient Centered Medical Home to Reduce Emergency Department Overcrowding • Case Study • Q&A

4. PIN Practice Improvement Network Working together to perfect your medical home • Emergency Department Overcrowding • Urgent Matters, a national initiative funded by the Robert Wood Johnson provides staggering data on ED utilization: • U.S. ED utilization increased by 18 % between1992 and 2004, while hospital EDs decreased by 12 percent. • A 2002 national survey revealed that 62% of all U.S. hospitals reported their status as being "at" or "over" operating capacity. • Crowding reflects inefficiencies in community-based health care, the emergency department and the hospital. Source: Urgent Matters, Robert Wood Johnson Foundation www.urgentmatters.org

5. PIN Practice Improvement Network Working together to perfect your medical home • Solutions for Emergency Department Overcrowding? • Urgent Matters reveals that: • Overcrowding reflects waste and lack of coordination among hospitals, emergency departments and community health centers. • The solution to overcrowding is based in coordination of preventive and follow-up care in the community. • The answer: a Patient Centered Medical Home. Source: Urgent Matters, Robert Wood Johnson Foundation www.urgentmatters.org

6. PIN Practice Improvement Network Working together to perfect your medical home The Patient Centered Medical Home • Core components of the Patient Centered Medical Home • Focus on individuals and families • Redesign of primary care services and structures • Population health management • Control unnecessary costs and waste • System integration and education The Patient Centered Medical Home as defined by the American Academy of Family Physicians

7. PIN Practice Improvement Network Working together to perfect your medical home The Patient Centered Medical Home • Core components of the Patient Centered Medical Home • Focus on individuals and families • Redesign of primary care services and structures • Population health management • Control unnecessary costs and waste • System integration and education How can we leverage the medical home model to create team-based and case management models to support the delivery of care?

8. PIN Practice Improvement Network Working together to perfect your medical home • The Patient Centered Medical Home Encourages a Team-Based Approach • Physicians, Specialty Physicians, Nurses, Nurse Practitioners, Physicians Assistants, Office Staff, Community Partners comprised the caregiving team. • The team-based approach is a coordinated care approach supported by clear communication and processes among every member of the practice. • By taking a team-based approach, role of each member of the practice is clearly defined and maximized to contribute to each patient’s good health. • The team-based approach supports case management which ultimately provides continuity to a patient’s care and overall wellbeing while reducing cost and eliminating waste.

9. PIN Practice Improvement Network Working together to perfect your medical home • A Case Management Primer • The term “case management” historically refers to a planned approach to manage service or treatment to an individual which facilitates a more effective intervention to meet patient needs and contains costs. • The Patient Centered Medical Home definition of “case management” extends well beyond the Primary Care Case Management as defined by Medicaid. • Patient Centered Medical Home case managers serve as a patient advocates , educators and even coaches, helping to coordinate their care, encouraging patients to maintain their path to wellness, reminding them to schedule appointments, connecting them with community health resources and even helping patients manage their healthcare costs.

10. PIN Practice Improvement Network Working together to perfect your medical home • Patient Centered Medical Homes Reduce Emergency Room Overcrowding: The Data • The National Association of Public Hospitals and Health Systems conducted a study of medical homes at safety net hospitals and health systems (46 programs at 37 member facilities). • 20% of the organizations interviewed had developed medical homes specifically to reduce overcrowding of Emergency Departments. • Almost 40% of hospitals in the study identified a reduction in Emergency Department utilization related to the • redirection of patients seeking primary care services to a • medical home in the community. Source: National Association of Public Hospitals and Health Systems www.naph.org

11. PIN Practice Improvement Network Working together to perfect your medical home Key Takeaways • National and local data continues to demonstrate that the Patient Centered Medical Home can reduce Emergency Department overcrowding • The medical home model facilitates the redistribution of care delivery resources and supports sustainable quality improvement throughout the continuum of care. • The core elements of the medical home framework include education of the patient population about care options and appropriate use of care and use of case managers and tools to refer patients to the right source of care within the medical home model. Source: National Association of Public Hospitals and Health Systems www.naph.org

12. PIN Practice Improvement Network Working together to perfect your medical home Thank You Elif Oker M.D., F.A.C.E.P. Medical Director, BCBSIL Elif_Oker@bcbsil.com Source: National Association of Public Hospitals and Health Systems www.naph.org