The ED in Population Health Utilization and Communication Hans - PowerPoint PPT Presentation

The ED in Population Health Utilization and Communication Hans Notenboom, MD Medical Director, S acred Heart Emergency Departments

 I have no relevant financial disclosures

Roadmap  Hist ory  Recommendat ions  Current t ools  Examples

History  New England Healt hcare Inst it ut e (NEHI) produces “ Wast e and Inefficiency in t he Healt hcare S yst em”  Examines areas of waste  S uggestions for improvement  Launched initiative to improve waste

The Triple Aim  Inst it ut e for Healt hcare Improvement (IHI)  Improving t he pat ient experience of care (qualit y and sat isfact ion)  Improving t he healt h of populat ions  Reducing t he per capit a cost of healt h care  Much of t his direct ly relat es t o t he NEHI st udy

NEHI S tudy  30% of cost , or $700 billion in wast ed care  Care that could be eliminated without reduction in quality  S ix maj or sources  Unexplained variation in clinical care  Patient medication adherence  Misuse of drugs and treatments  Emergency Department overuse ($38 Billion)  Underuse of appropriate medications  Overuse of antibiotics

ED Use Rising  Many papers support t his, as well as our collect ive experience  Past 15 years has almost doubled at our facility  2000 – 50,000 visits per year  2015 – 90,000 visits per year  Why?  Is that good or bad?  What are the impacts?

Who and Why?  “ S uperusers” are 1% of ED patients but can account for 30% of costs  Insured actually responsible for much of the overuse  Limited access to primary care – huge issue locally  Convenience – after hours and weekends  Immediate reassurance of medical conditions  Primary care refers to ED  Hospitals have financial and legal obligations to treat all patients

Best Option for Care?  Fragment ed care in ED  Lacks benefit of continuity of care  Over ½ of Americans have a chronic condition  Disease prevention  Follow through of treatment plans  Lack of care coordination  Difficult for patients to understand discharge and aftercare

NEHI Recommendations  Est ablish collaborat ive relat ionships bet ween EDs, primary care, and communit y services  Underst and t he pat ient populat ion  Reform payment for primary care services  Invest in Healt hcare Informat ion Technology (HIT)  Increase t he primary care workforce  Redesigning primary care services

Current Tools  Emergency Depart ment Informat ion Exchange (EDIE)  Prescript ion Drug Monit oring Program

What is EDIE?  EDIE is a web-based application developed to help Emergency Departments (EDs) identify high-utilization and complex needs patients who frequently visit EDs for their care, and who would be better served in a different care setting.

EDIE is…  Collaborat ive framework for case management  Proact ive not ificat ion  In the moment  Coordinate on site  Bird in the hand  Way t o share bet ween different organizat ions or groups (i.e. ED doct ors, social services, primary care), regardless of IT plat form

EDIE isn’ t…  Punit ive or way t o cat ch people  Full EMR  Full healt h informat ion exchange (HIE)

EDIE S uccess: Washington  As part of t he “ ER is for Emergencies” init iat ive t o reduce unnecessary ED visit s by Medicaid pat ient s, EDIE was implement ed in 91 hospit als in Washingt on S t at e .  11% S t at e-wide Visit Reduct ion in Medicaid patients with 5 or more annual ED visits  58% Visit Reduct ion in patients with Care Guidelines  $33 Million in S avings for Washington S tate

EDIE in Oregon is growing  S ummer of 2014, more t han 62% of hospit als act ive and sharing informat ion  All hospit als in Oregon signed at t est at ions wit h plans t o be live by t he end of 2014.

S ome Oregon details  Oregon t racking t he ED visit s, high ut ilizers and 60 day pat ient s  High utilizer is any patient that visits any ED 5 or more times in a 12 month period  60 day patients include anyone that visits 3 or more different EDs in a 60 day period  Informat ion is sent t o Oregon leaders and hospit al leaders mont hly  Breaks down by age, diagnosis and more

Most Recent S napshot

Regional Breakdowns

Example of Diagnosis Breakdown

Age Breakdown

Results starting to show in Oregon

S ome local specifics  S pecific crit eria can be set for each inst it ut ion (# of visit s, et c.)  Result s available wit hin 3-5 minut es of regist rat ion  Pushed t o ED as well as care management (can be t ailored)  Our crit eria:  4 or more visits to the ED within 60 days  3 or more visits to any EDIE facility in 60 days

Care Planners – What Do They Do?  Find/ verify PCPs and other providers, counselors, etc.  Notifications letters to PCP , providers  Enter plans of care and expectations  Link pain/ medication contracts from outside sources  Education for proper use of ED / urgent care / PCP  Referrals for S DS , Medicaid, APS and community health workers  Coordinate in home health, transportation, hospice, equipment (O2)  Reminders for high risks (meds / conditions / behaviors / etc)  Assistance for coordination for people with no resources or ability (e.g. homeless with no phone)

Local S uccess  59 yo woman  Hist ory of ICH, mult iple pain relat ed complaint s, seizures, and more  19 visit s in 2014  EDIE flagged and care management addressed  Coordinat ed wit h V A, connect ed wit h care mgmt, and PCP  No visit s since December

Local S uccess  57 yo male  Poorly cont rolled DM, medicat ion non-compliance, pain, and ment al healt h issues wit h depression and S I  24 visit s in 2014 wit h mult iple admissions  Homeless and living in a t ent  Care planned and received medical respit e care and coordinat ion  1 visit since November 14

Local S uccess  Quicker ident ificat ion  45 yo male wit h ETOH abuse and mult iple hospit alizat ions  7 ED visit s in 2 mont hs wit h a few inpat ient st ays  Care planning set up wit h fost er home, wit h parent al coordinat ion.  No visit s in past 3 mont hs since care coordinat ion

Future Opportunities  Closer coordination with urgent cares and PCPs to get the right patients, the right treatment, at the right times  S hared protocols through information exchange (e.g. EDIE) to impact outcomes and utilization  Reduce variability and stop the ‘ shopping for treatment’  Telemedicine  Augmented ‘ ask-a-nurse’  Reassurance and triage coordination  Further advancements of technology  Broader Health Information Exchange (HIE)

Questions? ?