“reducing avoidable er vi it ”er visits” · 2018. 1. 2. · member network 105,000 commercial...
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“Reducing Avoidable ER Vi it ”ER Visits”
Dr. Michael Weiss Medical Director
Quality & Performance ImprovementMonarch HealthCare
9/28/111
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AgendaAgenda
Building on CQC Efficiency Collaborative learningslearnings
Creating the internal infrastructure
Supporting physicians through resources and actionable data
Patient education outreach effortsPatient education outreach efforts
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Monarch HealthCareMonarch HealthCarePhysician NetworkPhysician Network
1,600+ Specialists700+ Primary Care Physiciansy24 Employed Hospitalists15 Employed ambulatory physicians/PAs
Member Network105,000 Commercial31,000 Medicare31,000 Medicare24,000 Medi-Cal13,000 Healthy Families25,000 PPO ACO
Health Plan ContractsCurrently contracted with all major plans in Southern
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major plans in Southern California
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CQC Efficiency Collaborative (2008)CQC Efficiency Collaborative (2008)
A replicable model for improvement– Multi‐department collaboration
– High visibility and accountability
A l i i i d– Analyze variation in data
– Engage network physicians in the improvement processin the improvement process
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Focus Group ModelFocus Group Model
Validating the problems / identifying the solutionsIssues identified:– Access/availability of / y
urgent cares– Patient knowledge deficit– Misaligned incentives– Lack of “real time” ER
notification– Support for high-risk
patients5
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Building the Internal SupportBuilding the Internal SupportER STEERING COMMITTEEER STEERING COMMITTEE
Set goals and monitor progressReview health plan programs and updatesPrepare progress reports for health plan meetings Prepare progress reports for health plan meetings Direction work groups as needed; address barriers
Member Physician Urgent Care Education
ySupport
gStrategy
Reporting Hospital
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Reporting Hospital
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Physician StrategiesPhysician Strategies
1:1 visits to identify “root cause” of ER use– Review variation chart– Access opportunities– Resources for complex
patients– Urgent care options
Actionable data is key– Monthly ER reports– Semi-annual ER bonus
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ER Utilization ReportState Objectives & Be Purposeful
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ER Utilization ReportIdentify Performance, Targets & Trends
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ER Utilization ReportFocus on the Opportunities
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ER Utilization ReportProvide Additional Resources
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Member StrategiesMember Strategies
Post-ER follow up callsInformation on accessing appropriate care– Urgent care brochures – New member welcome
guide– monarchhealthcare.com
Wh t T D Wh Y – What To Do When Your Child Is Sick book
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Urgent Care Collaboration PilotPersonalized Patient Magnets
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ER Utilization Goes DownER Utilization Goes Down10%
0%
10%
-10%
Commercial Senior Medi-Cal Total
-20%
-30%
-50%
-40%
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ER Utilization Before vs. After(Mailer)
ER Utilization Before vs. After(No Mailer)
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Urgent Care Utilization Goes UpUrgent Care Utilization Goes Up50%
40%
50%
20%
30%
0%
10%
-10%
0%
Commercial Senior Medi-Cal Total
-30%
-20%
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Urgent Care Visits Before vs. After(Mailer)
Urgent Care Visits Before vs. After(No Mailer)
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SummarySummary
Success requires a multidisciplinary approach to taking ownership and fostering collaboration –“Our Project Team”This can be resource intensive but ROI is highActionable data is KEYIncorporating physicians in the improvement Incorporating physicians in the improvement process is the fast track to getting buy-in Patient ed cation and engagement reall orks!Patient education and engagement really works!Don’t neglect working on your approach to the physician conversation!
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Questions?Questions?
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