Alaska ER Project
Speakers • Anne Zink, MD, FACEP Board certified emergency physician at Mat-Su Regional • Alaska Chapter ACEP President • • Becky Hultberg ASHNHA President/CEO • • Connie Beemer, PMP ASHNHA Program Officer •
Why the AK ER Project? Increasing health care costs •
Why the AK ER Project? Decreasing state budget • Graphs from ISER presentation: http://www.iser.uaa.alaska.edu/Publications/presentations/2016_02_02-AnIntroductionAKFiscaFactsChoices.pdf
Why the AK ER Project? • Need for a better design • Medicaid Redesign Meetings held at the end of 2015 • Recommendations based on groups input and actuarial reporting 5
Learning from Others: Washington State Model Goal was to save $30 Million dollars - $34 saved the first year! 9.9 percent reduction in overall ED Medicaid visits 10.7 percent reduction among frequent utilizers. 14.2 percent low-acuity visits dropped 24 percent, reduced narcotic prescriptions from the ED Better patient care!
Washington Seven Best Practices 1. Adopt an electronic emergency department information system 2. Implement patient education 3. Institute an extensive case management program 4. Identify frequent users of ED 5. Develop patient care plans for frequent users of ED 6. Implement narcotic guidelines to discourage narcotic-seeking behavior and monitor patients who are prescribed controlled substances 7. Track progress of the plan to make sure steps are working
What about Alaska? - 2012 data
What about Alaska? - 2012 data 2012 HIDI discharge data (Mat-Su not included)
What about Alaska? - 2012 data 2012 HIDI discharge data (Mat-Su not included)
A closer look The average yearly charge total for patients < 5 visits was $14,235/year • 6-9 visits $20,790/year • >10 visits $45,385/year •
Background and process resulting in SB 74 Hospital Based ER Project Partnership between State, ACEP, and ASHNHA • About SB 74 • Could have positive impact for all patients, not just • Medicaid
Alaska’s ER Project (1)an interdisciplinary process for defining, identifying, and minimizing the number of frequent users of emergency department services ; (2) to the extent consistent with federal law, a system for real-time electronic exchange of patient information, including recent emergency department visits, hospital care plans for frequent users of emergency departments, and data from the controlled substance prescription database; (3) a procedure for educating patients about the use of emergency departments and appropriate alternative services and facilities for nonurgent care; (4) a process for assisting users of emergency departments in making appointments with primary care or behavioral health providers within 96 hours after an emergency department visit; (5) a collaborative process between the department and the statewide professional hospital association to establish uniform statewide guidelines for prescribing narcotics in an emergency department ; and (6) designation of health care personnel to review successes and challenges regarding appropriate emergency department use.
Implement electronic ED information system Goal: Exchange patient information among Emergency Departments • Information pushed to providers with pertinent information and used to provide efficient and safe care • Emergency departments will receive flags identifying high utilizers • The information system will reduce unnecessary medical tests • It will provide access to care/treatment plans • The system does not create any new legal right to information. If an information request is for the purposes of providing immediate treatment, HIPAA permits disclosure of information to another provider. • System demonstrations begin June 20
An example of the electronic record possibility
Identify frequent users Goal: Ensure hospitals know when they are treating a frequent patient and treat accordingly • This project will… – Define – Identify – Minimize the number of frequent users of emergency department services
Patient Education Goal: Help patients understand and use appropriate sources of care • Active distribution of educational materials • Partnership with primary care providers • ACEP/ASHNHA/AK DHSS collaborative approach to education • Discharge instructions
Primary Care & Behavioral Health Coordination Goal: Create a process for assisting users of EDs in making appointments with primary care or behavioral health providers within 96 hours • Contact the primary care provider when frequent patient visits the ED • Make efforts to schedule an appointment with the primary care provider within 96 hours when appropriate • If no appointment required, notify primary care provider that a visit occurred • Relay barriers to care coordinators • Use care plans
ED Narcotic Guidelines Goal: Reduce drug-seeking and drug-dispensing to frequent ER users • Implement statewide guidelines for prescribing and monitoring of narcotics • Direct patients to better resources • Track data and follow up with providers who excessively prescribe • Integrate ED information system and Prescription Drug Monitoring Program (PDMP)
Review Successes and Challenges Goal: Review reports, ensure interventions are working, make improvements • Get patient feedback • Monitor and report on ER utilization trend • Designate ER leader and quality manager to receive, review, and act on utilization management reports • Involve executive-level leadership • Report successes and challenges to Legislature and other stakeholders
Shared Savings Goal: Move from fee-for-service towards value As providers look at moving from a volume-based system to one based on value, the ability to engage in shared savings and other forms of risk is important for us to understand moving forward.
https://www.healthcatalyst.com/
Ultimate Goal • Improve patient care via timely, coordinated care in the emergency department • Reduce over all health care cost by minimizing redundancy and improving care
Participating Organizations American College of Emergency Physicians Alaska Regional Hospital • • – Alaska Chapter Bartlett Regional Hospital • Alaska State Hospital and Nursing Home Central Peninsula Hospital • • Association Fairbanks Memorial Hospital • State of Alaska – DHSS Mat-Su Regional Medical Ctr • • Alaska eHealth Network North Star Behavioral Health • • Alaska Primary Care Association NorthStar Behavioral Health • • 673d Medical Group, JBER Providence Alaska Medical Ctr • • Alaska Native Medical Ctr Providence Kodiak Island Medical Ctr • • South Peninsula Hospital • More to come as we broaden stakeholder engagement!
Next Steps Many groups doing great work • Break down silos • Here to support the work many of you are already doing • Please get involved • Broke things into 3 parts: • - Education - IT - Care Coordination Next meeting: June 20 vendor demonstrations at ANC Neighborhood Health Center • 4951 Business Park Boulevard Room 301 from 8 am – noon. Care Coordination and Narcotics Guidelines meetings beginning in August • September 7 tentative project meeting •
Questions? AK ER Project Contacts: Anne Zink, MD annezink@gmail.com Connie Beemer, ASHNHA Program Officer connie@ashnha.com 907-646-1444
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