Hospital Proviso Preliminary ReportMay 30, 2014Ana Lòpez-De Fede, PhD; Kathy Mayfield-Smith, MA, MBA; Patricia Stone Motes, PhDUSC Institute for Families in SocietyDivision of Medicaid Policy Research

Hospital and Clinic Proviso Evaluation Framework

Technical Assistance Proviso Context: Healthcare Reform

Sustaining Activities

CollaborationsInterventions Targeted At: Intermediate

Outcomes• Improved care

coordination within and across providers

• Heightened patient activation and compliance

• Improved patient outcomes

• Diffusion of best practices• Patient satisfaction • Community engagement

Long-term Outcomes

• Community improvement in quality measures

• Improvement in health status

• Reduction in costs trends

• Reduction in disparities • Ongoing collaboration

to improve healthcare

Feedback on implementation and results

Public Reporting

Consumer and

Community Engagement

Quality Improvement

Payment Reform

Proviso Stakeholders

Alliance development, setting vision and strategies

Disparity Reduction

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TIMELINE

Programmatic alignment

EVALUATION COMPONENTS

It is generally accepted in action research “that researchers should not rely on any single source of data, interview, observation, or instrument.” (Mills, 2003)

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Service Patterns

Determinants of Health

Partnership Index

Case Study

Consumer

Enrollment Patterns

5,624 uninsured successfully enrolled 4,922 uninsured enrolled with a HOP with numbers ranging from 50

to 750 targets with data available from July 2012 – Dec. 2013

GENDER• 60% Female• 40% Male

RACE• 49% White• 50% African American• 1% Other Race/Ethnicity

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As of April 2014

AGE GROUPS• 10% (18–24 yrs.)• 43% (25–44 yrs.)• 34% (45-54 yrs.)• 13% (55–64 yrs.)

o 87.3% had at least one inpatient, ED, specialty, or outpatient surgery record from July 2012 – December 2013.

o 29% had at least one inpatient hospital stay• Of those with an inpatient hospital stay, 35% had a readmission

within 30 days. • 81% of inpatient admissions were associated with an ED visit.

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Enrollment Care PatternsAs of April 2014

o 96% had at least one ED visit• Of those with an ED visit,

70% had at least 3 or more ED visits.

• Approximately, 34% of the population had 7 or more ED visits.

o 51% had 2 or more chronic conditions documented.

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Enrollment Care Patterns (continued)

As of April 2014

Outreach and Reasons for Non-Enrollment (N = 4,976) As of April 2014

Medicaid Elig or Enrolled

Medicare Elig or Enrolled

Other Ins

Not HOP Catchment Area

Refused

Not Located

Invalid Address

Invalid Telephone No.

Lack of Compliance

0 5 10 15 20 25 30 35

12

4

9

3

8

19

9

30

0.3

Percent

7

25% Insured

58% Not Reached

HOP Screenings

Level 120%

Level 221%

Level 333%

Level 426%

Level 116%

Level 216%

Level 327%

Level 441%

Healthy Outcomes Plan Increases Screenings for Uninsured: PAM

Source: USC Institute for Families in Society | Division of Policy and Research on Medicaid and Medicare

• 3,549 (42%) have been screened with the PAM

• Average score = 59.5• PAM has 4 Levels with the

following scores:• Level 1: Not engaged

47 & below • Level 2: Becoming aware

47.1 - 55.1 • Level 3: Taking action

55.2 - 67.0• Level 4: Maintaining behavior

67.1 - 100• Slight shift between levels

since March to 1% more in Levels 3 & 4

155/29/2014

SC HOP %Distribution

National % Distribution

HOP Screenings

Healthy Outcomes Plan Increases Screenings for Uninsured: GAIN-SS

Source: USC Institute for Families in Society | Division of Medicaid Policy Research

Summary of Scores:

• 4,273 (50%) have been screened with the GAIN-SS

• Average Score = 4.1• Range of scores between 0 – 23

(Maximum possible is 23)

Scoring Distribution:Low (Zero): 1,093Moderate (1 or 2): 722High (3+): 2,458

165/29/2014

Low26%

Medium17%

High57%

Low13%

Medium17%

High70%

SC HOP % Distribution

National % Distribution

HOP Screenings

Domain High Risk*Feb. 2014

High Risk*Mar. 2014

High Risk*Apr. 2014

Internalizing Disorder (Sub-screen section)**(depression, anxiety, suicidal tendencies, acute/PTSD)

1,187 (60%)

1,671 (50%)

2,038(47%)

Externalizing Disorder (Sub-screen section)** (e.g., attention deficit hyperactivity, conduct disorder, aggression)

464 (22%)

622 (19%)

767(18%)

Substance Disorder (Sub-screen section)** (substance abuse/ dependence, frequency of use, effect on daily activity and degree of dependency)

205 (10%)

294 (9%)

341(8%)

Crime and Violence Disorder (Sub-screen section)**(e.g., interpersonal violence, property crime, drug-related crime)

31 (1%) 46 (1%)

56(1%)

Total GAIN-SS Scores (includes all Sub-screen sections) 1,412 (67%)

2,009 (67%)

2,458(56%)

Average GAIN-SS Score 4.9 4.4 4.1

* High Risk = 3+** People may be counted in multiple sub-screen sections

Initial Results on 4,371 People Screened with GAIN-SS

Source: USC Institute for Families in Society | Division of Policy and Research on Medicaid and Medicare

175/29/14

HOP Screenings

2012 Latest Data

Internalizing Disorder (Sub-screen section)**(depression, anxiety, suicidal tendencies, acute/PTSD)

3,149 (35%)

Externalizing Disorder (Sub-screen section)** (e.g., attention deficit hyperactivity, conduct disorder, aggression)

2,066 (23%)

Substance Disorder (Sub-screen section)** (substance abuse/ dependence, frequency of use, effect on daily activity and degree of dependency)

4,143 (46%)

Crime and Violence Disorder (Sub-screen section)**(e.g., interpersonal violence, property crime, drug-related crime)

1,070 (12%)

Total GAIN-SS Scores (includes all Sub-screen sections) 6,311 (70%)

Average GAIN-SS Score 6.02

National Average for People Screened with GAIN-SS

Source: USC Institute for Families in Society | Division of Medicaid Policy and Research

175/29/14

Linking PAM and GAIN-SS to Individual Data

for Enrolled

Linking Collaboration Index

to Case Study Interviews

Comparing Characteristics and Services use Patterns:

Enrolled Pilot versus Uninsured Total Population

Linking Implementation Process to Interviews:

Applications Criteria; Goal Attainment

NEXT STEPSCase Study Report with

Recommendations

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Ana Lòpez-DeFede, PhDadefede@mailbox.sc.edu 803-777-9124Kathy Mayfield-Smith, MA, MBAklmayfie@mailbox.sc.edu803-777-9124

Contact

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