mhc overview - aachc
TRANSCRIPT
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)
0%
10%
20%
30%
40%
50%
60%
70%
80%
Child SU GMH SMI
56%
76%
69%
80%
44%
24%
31%
20%
Primary Care Providers – From 2016 Data
Internal Provider External Provider(302/540) (198/260) (800/1160) (284/355)
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 member
RC staffs member care with Supervisor
General Coordination of Care with PCP
Member utilizes EDRC outreach and
engagement
Member inconsistent use of PCP for
intervention/prevention
Member accesses ED for primary care concern
RC outreach, reengagement and coordination efforts
continue
Baseline Data
2 ED VISITS 3 ED VISITS 4+ ED VISITS COMBINED 2+
Total Cost – June 2016
6
1219
37
$614,247.37
TOTAL COST
$292,717.89
$32,129.53
$289,399.95
*Cost not solely related to ED Visits
ED Visits per Member
20
14
109
7 7
5 54 4 4 4
MBR 12 11 10 9 8 7 6 5 4 3 2 1
JUNE 2016
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
HypothesisWe 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 StateRC works with assigned
memberRC staffs member care
with SupervisorGeneral Coordination of
Care with PCP
Member utilizes EDRC outreach and
engagement
Member inconsistent use of PCP for
intervention/prevention
Member accesses ED for primary care concern
RC outreach, reengagement and coordination efforts
continue
Current StateRC/DRC IDs Member
Accessing ED
Mbrs/ED usage staffed w/supervisor
(1-2 ED visits)
Coordination of Care is completed, records
requested
Mbrs/ED usage scheduled/staffed in
bi-weekly Care Management for 4+
ED visits
RN Case Management involved
if not already
Consider step up from RC to DRC
ART Meeting scheduled and all
stakeholders included (update ISP to reflect
new services)
Reviewed at following Care Management to
monitor follow-through on action
items, etc.
Keeping in mind
some ED visits are
appropriate and/or
cannot be avoided
6 Months of ED Visits per
Member
20
14
109
7 7
5 54 4 4 44
15
4 4
1 0 1 2 2
MBR 12 11 10 9 8 7 6 5 4 3 2 1
6/16-1/17
ED Visits per Member
12
7
6 6 6
5 5 5 5 5
4 4 4 4 4 4 4 4
15
7
5
4
11
4 4
2
3 3
4
0
5
3
4
5
1
4
MBR 18
17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1
11/16-1/17
Risk Ranking Improved
8308
13086
PRE-INTERVENTION POST INTERVENTION
Total Risk Score Decreased
123
76
PRE-INTERVENTION POST INTERVENTION
ED Visit Decreased113
9489
84
ORIGINAL POPULATION (6 MTHS) ADDITIONAL IDENTIFIED MEMBERS (3 MTHS)