Project HOME Netw ork Helpful Opportunities for Medical Care Enhancement Grant Workshop John Isfort, Director Project HOME Network Office of Rural Health Marcum & Wallace Policy Memorial Hospital 60 Mercy Ct Winchester, KY Irvine, KY 40336
Project HOME Netw ork Helpful Opportunities for Medical Care Enhancement • ORHP Network Planning Grant 2009 • ORHP Rural Healthcare Outreach Grant 2012 • $450,000 (3 Years/ 2012-2015) • Based on Collaboration with CAH & FQHC’s • Focused on Uninsured Overutilization of ED for Primary Care • Transportation • Specialty Care • Lung Cancer Screening
Project HOME Netw ork Helpful Opportunities for Medical Care Enhancement Lexington Campbell Boone Estill & Lee Counties Kenton Gallatin Project HOME Network Bracken Carroll Pendleton Grant Mason Trimble Owen Robertson Greenup Lewis Harrison Henry Oldham Fleming Nicholas Carter Boyd Scott Franklin Jefferson Rowan Shelby Bourbon Bath Elliott Lawrence Fayette Spencer Bullitt Anderson Meade Clark Menifee Morgan Mercer Powell Johnson Nelson Martin Breckinridge Henderson Madison Wolfe Daviess Washington Magoffin Estill Hardin Garrard Lee Union Floyd Webster Larue Mclean Marion Breathitt Grayson Lincoln Ohio Jackson Pike Owsley Rockcastle Crittenden Knott Hopkins Hart Casey Perry Edmonson Green Butler Muhlenberg Clay Laurel Caldwell Adair Pulaski Leslie Letcher Ballard McCracken Metcalfe Lyon Russell Warren Barren Carlisle Marshall Christian Knox Logan Harlan Todd Cumberland Trigg Wayne Allen Simpson Graves Whitley Bell Hickman Clinton Mccreary Monroe Calloway Fulton
Project HOME Netw ork Helpful Opportunities for Medical Care Enhancement 14 Agencies in Network • Marcum & Wallace Hospital • Westcare • White House Clinics • Estill Development Alliance • Juniper Healthcare, Inc • Lee Health Department • Foothills Mobile Clinic • Estill Health Department • Mercy Health Clinics • KRCC • Team Health (MESA) • Bluegrass.org • Kentucky Homeplace • Hospice Care Plus
Project HOME Netw ork Helpful Opportunities for Medical Care Enhancement Programs/Focus Areas ED Navigation CT Screening ACA Insurance Specialty Care/ Program Program Program Transportation Target 184 Target Target Target Seen 40 100 00 96 SDM Contacted Specialty Care Navigated 22 246 04 51 Screened Signed Up Transportation Declined 22 246 06 43 Percent Percent Discharged Screened Signed up 2 55% 246% 53% Navigated
Project HOME Netw ork Helpful Opportunities for Medical Care Enhancement Emergency Department Health Care Navigation
Project HOME Netw ork Helpful Opportunities for Medical Care Enhancement • Health Care Navigator (HCN) for the ED • Lay Worker • Trained by Kentucky Homeplace • Database Provided by Kentucky Homeplace • Liaison to Network Clinical Partners • Works with Medicaid MCO’s • 40 hour week (Peak Hours) • Onsite in ED Jim Thacker
Project HOME Netw ork Helpful Opportunities for Medical Care Enhancement Criteria for Navigation • Uninsured • 6 or more ED visits in previous 12 months • No Primary Care Provider • Resident of Project HOME Network Counties
Project HOME Netw ork Project HOME Netw ork Helpful Opportunities for Medical Care Enhancement Cost Comparison for Navigated Patients (2013) • 96 Patients • 821 ED Visits • $2,660 Average ED cost per patient ($311 per visit) • $255,361 Total cost for ED visit • $134.50 Average cost of Clinic Visit • $110,424 Total Cost of ED visits if in Clinic • 187 ED visits after Navigation • 77% decrease in ED Visits after HCN contact
Project HOME Netw ork Helpful Opportunities for Medical Care Enhancement ACA Enrollment
Project HOME Netw ork Project HOME Netw ork Helpful Opportunities for Medical Care Enhancement ACA ACA Supplemental 300 Funding 246 250 • $25,000 200 • Open Enrollment Target 150 100 Enrolled 100 • Health Care Navigator 50 • Target 100 0 • Enrolled 246 Target Enrolled
Project HOME Netw ork Affordable Care Act Kynect Enrollment Results ACA 300 ACA Total 246 1% 3% Estill (205) 246 1% 250 1% 0% 0% Lee (10) 4% 7% 200 Powell (17) Target Owsley (1) 150 83% 100 Enrolled Jackson (2) 100 Wolfe (1) 50 Madison (8) 0 Fayette (1) Target Enrolled Clark (1)
Project HOME Netw ork Estill County Uninsured/Enrolled 8% Uninsured Estill County (2351) Number Enrolled by HCN 92% (205)
Project HOME Netw ork ACA Supplemental Grant Information 300 During the ACA Enrollment Period 52 Grantees enrolled 9,287 individuals. The average 250 enrollment for each grantee w as 179 individuals. The HCN 246 and Financial Counselor enrolled 246 individuals. This 200 w as a 27% increase above the average enrollment 179 150 Enrolled by HCN 100 Average enrolled by other grantees 50 0
Project HOME Netw ork ED Payor Mix Results 6000 5000 4000 2012 3000 2013 2014 Annualized 2000 1000 0 Medicare Medicaid Commercial Self Pay
Project HOME Netw ork Helpful Opportunities for Medical Care Enhancement Community Lung Cancer CT Screening Program
Project HOME Netw ork Project HOME Netw ork Helpful Opportunities for Medical Care Enhancement Lung Cancer CT Scan Screening Program • Partnership with University of Kentucky Markey Cancer Center • 40 Patients to be Screened (Uninsured) • Community Program (Screened Locally) • Treatment and Follow-up Provided by UK • Multi Disciplinary Team
Project HOME Netw ork Helpful Opportunities for Medical Care Enhancement Lung Cancer CT Scan Patients Lung Cancer Screening Results Screening Program N = 22 • 22 - Patients screened • 2 - Positive 2, 9% Positive (2) • 8 - with 3-6 month follow- 8, 36% Negative (12) up 12, 55% • 12 - Negative Suspicious (8)
Project HOME Netw ork Helpful Opportunities for Medical Care Enhancement Summary of Accomplishments • Navigated 364 patients in all programs (18 months) • 77% reduction in ED visits after contact with HCN • ACA enrollment penetrated 8% of local uninsured market • CT Lung Screening detected 2 early cancers • ED Navigator providing significant ROI
Project HOME Netw ork Helpful Opportunities for Medical Care Enhancement Thank You Questions
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