Emergency Department (ED) Visits MHC Overview Approx. 3300 unduplicated BH members (all fund types including NTXIXSMI, TXIX, Private Insurance, Self-Pay/Nominal Fee) Approx. 2500 RBHA-enrolled members SMI – 366 ( 269 TXIX , 97 NTXIX) GMH – 1269 SU – 301 Child – 569
TXIX SMI (Who and Where) 269 TXIX SMI Members Main (IHCC/CWC) - 178 Clinica Del Alma - 15 Wilmot - 53 Santa Catalina - 17 Dove Mountain - 6 2 or More ED visits 37 TXIX SMI Members w/2+ ED Visits (as of June ‘16) 19 w/2 ED Visits 6 w/3 ED Visits 12 w/4+ ED Visits Majority of 37 at our Main location (IHCC/CWC)
Primary Care Providers – From 2016 Data 80% 76% 80% 69% 70% 56% 60% 44% 50% 31% 40% 24% 30% 20% 20% 10% 0% Child SU GMH SMI (302/540) (198/260) (800/1160) (284/355) Internal Provider External Provider ED Utilization Definition: This measure reports on medical use of the ED and excludes principle diagnosis of mental health or chemical dependency, psychiatry, electroconvulsive therapy, alcohol or drug rehabilitation or detoxification.
Our Aim To decrease the average number of ED Visits by 25% for our TXIX SMI integrated population by February 1, 2017, resulting in decreased cost. Our Cross-Functional Team Jon Reardon, Director of Behavioral Health Selena McDonald, PHA Stefanie Lockery, Clinical Director Stephanie Speidel, RN Clinic Manager Vickie Duran, RN Case Manager Maria Borquez, RN Case Manager Recovery/Dedicated Recovery Coaches/RSS Therapists Providers and MAs
Initial State RC works with assigned RC staffs member care General Coordination of member with Supervisor Care with PCP Member inconsistent RC outreach and use of PCP for Member utilizes ED engagement intervention/prevention RC outreach, Member accesses ED reengagement and for primary care concern coordination efforts continue Baseline Data Total Cost – June 2016 $614,247.37 TOTAL COST 37 $292,717.89 $289,399.95 19 12 $32,129.53 6 2 ED VISITS 3 ED VISITS 4+ ED VISITS COMBINED 2+ *Cost not solely related to ED Visits
ED Visits per Member 20 14 JUNE 2016 10 9 7 7 5 5 4 4 4 4 MBR 12 11 10 9 8 7 6 5 4 3 2 1 Selected Interventions Start w/members with 4 or more ED visits Assign RN Case Management (if not already assigned) for individualized chronic disease management and care coordination (plus chronic disease education bi-weekly provided to team) Consider step up from RC to DRC Staff members bi-weekly (include PH & BH staff), utilizing standardized tools
Hypothesis We will experience a decline of 25% in the average number of ED visits for those with 4+ visits, for our TXIX SMI Integrated members, by August, 2016. Initial State RC works with assigned RC staffs member care General Coordination of member with Supervisor Care with PCP Member inconsistent RC outreach and use of PCP for Member utilizes ED engagement intervention/prevention RC outreach, Member accesses ED reengagement and for primary care concern coordination efforts continue
Current State Mbrs/ED usage Coordination of Care RC/DRC IDs Member staffed w/supervisor is completed, records Accessing ED requested (1-2 ED visits) Mbrs/ED usage RN Case scheduled/staffed in Consider step up from Management involved bi-weekly Care RC to DRC if not already Management for 4+ ED visits Keeping in mind ART Meeting Reviewed at following some ED visits are scheduled and all Care Management to appropriate and/or stakeholders included monitor follow- cannot be avoided (update ISP to reflect through on action new services) items, etc. 6 Months of ED Visits per Member 20 15 14 6/16-1/17 10 9 7 7 5 5 4 4 4 4 4 4 4 2 2 1 0 1 MBR 12 11 10 9 8 7 6 5 4 3 2 1
ED Visits per Member 15 12 11 11/16-1/17 7 7 6 6 6 5 5 5 5 5 5 5 5 4 4 4 4 4 4 4 4 4 4 4 4 4 4 3 3 3 2 0 1 MBR 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 18 Risk Ranking Improved 13086 8308 PRE-INTERVENTION POST INTERVENTION
Total Risk Score Decreased 123 76 PRE-INTERVENTION POST INTERVENTION ED Visit Decreased 113 94 89 84 ORIGINAL POPULATION (6 MTHS) ADDITIONAL IDENTIFIED MEMBERS (3 MTHS)
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