Monarch HealthCare Inc.Monarch HealthCare Inc.

Efficiency Collaborative Focus Group:Efficiency Collaborative Focus Group:

““Exploring Variation in the Frequency Exploring Variation in the Frequency of of

Emergency Department Visits Among Emergency Department Visits Among PCP Panels”PCP Panels”

  Tuesday, May 13 – PediatriciansTuesday, May 13 – Pediatricians

California Quality California Quality CollaborativeCollaborative

The California Quality Collaborative (CQC) The California Quality Collaborative (CQC) is a healthcare improvement organization is a healthcare improvement organization dedicated to advancing the quality and dedicated to advancing the quality and efficiency of patient care in California.efficiency of patient care in California.

The CQC is supported by a state-wide The CQC is supported by a state-wide leadership alliance of healthcare leadership alliance of healthcare purchasers, providers and health plans, all purchasers, providers and health plans, all working toward a shared goal of working toward a shared goal of accelerating quality improvement in accelerating quality improvement in California.California.

Efficiency Collaborative GoalsEfficiency Collaborative Goals

Increase health care affordability Increase health care affordability through the reduction of unnecessary through the reduction of unnecessary variations in care. variations in care.

Promote reduction in the underuse, Promote reduction in the underuse, misuse and overuse of medical misuse and overuse of medical services, ensuring patients get the services, ensuring patients get the care they need, when they need it, care they need, when they need it, and in the correct setting.and in the correct setting.

ParticipantsParticipants

Six (6) Medical Groups across CaliforniaSix (6) Medical Groups across CaliforniaMonarch HeatlhCare Monarch HeatlhCare

Hill Physicians (Northern CA)Hill Physicians (Northern CA)

Mills Peninsula Medical Group (Northern CA)Mills Peninsula Medical Group (Northern CA)

Physicians Medical Group, Santa CruzPhysicians Medical Group, Santa Cruz

Torrance IPA (Southern CA)Torrance IPA (Southern CA)

Physicians Associates of San Gabriel ValleyPhysicians Associates of San Gabriel Valley

Efficiency Collaborative GoalEfficiency Collaborative Goal

““Reduce Emergency Department Reduce Emergency Department Utilization for Non-emergent Utilization for Non-emergent Conditions”Conditions”Monarch consistently performs poorly on Monarch consistently performs poorly on

this measure this measure Not the quality of care we expect for our Not the quality of care we expect for our

patientspatientsProfound financial implicationsProfound financial implicationsImprovement directly affects practicing Improvement directly affects practicing

physician reimbursementphysician reimbursement

Objectives of the Focus GroupObjectives of the Focus Group

1.1. Understand variation in ED Understand variation in ED Utilization among PCP panelsUtilization among PCP panels

2.2. Determine what is working and what Determine what is working and what is notis not

3.3. Learn preferred methods of Learn preferred methods of communication and define IPA/ PCP communication and define IPA/ PCP partnershippartnership

4.4. Share what Monarch is currently Share what Monarch is currently doing to help reduce inappropriate doing to help reduce inappropriate ED utilizationED utilization

ER Utilization Variance Among MHC ER Utilization Variance Among MHC PCPsPCPs

* Larger spread between actual vs. expected utilization indicates higher ER utilization;

Ranked among PCP invitees to this focus group (individual PCP or group)

Actual vs. Expected ER Utilization for Pediatrics SpecialtyAny Panel Size, All LOBs

0

100

200

300

400

500

600

700

Ven

dor2

16

Ven

dor2

20

Ven

dor2

25

Ven

dor2

26

Ven

dor1

98

Ven

dor2

31

Ven

dor2

02

Ven

dor1

94

Ven

dor1

86

Ven

dor1

87

Ven

dor2

04

Ven

dor2

05

Ven

dor2

38

Ven

dor2

08

Ven

dor2

40

Ven

dor2

42

Ven

dor2

43

Ven

dor2

44

Ven

dor1

90

Ven

dor2

48

Ven

dor2

11

Ven

dor1

92

Ven

dor2

49

Ven

dor2

56

Ven

dor2

59

Ven

dor2

57

Ven

dor2

12

Ven

dor2

13

Ven

dor2

61

Ven

dor2

70

Pan

el A

dju

sted

Per

Th

ou

san

d U

tiliz

atio

n

Expected Visits PTMPY Actual Visits

Actual=Expected

YOUR THOUGHTS?YOUR THOUGHTS?

What causes High Utilization of the What causes High Utilization of the ED for Non-emergent conditions?ED for Non-emergent conditions?

What can “low utilizing” PCPs do to What can “low utilizing” PCPs do to keep the utilization appropriate?keep the utilization appropriate?

What are the “high utilizing” PCPs What are the “high utilizing” PCPs doing or not doing that can doing or not doing that can contribute to higher rates?contribute to higher rates?

Monarch Healthcare PCP (Vendor)2006 ER Visits PTMPY and

Percentile Ranks*

5

1

4 3 6

2

25

50

75

100

125

150

175

200

225

250

275

0 10 20 30 40 50 60 70 80 90 100

Percentile Rank (% )*

20

06

ER

Ad

mit

s P

TM

PY

Sample Practitioner ER Utilization Sample Practitioner ER Utilization ReportReport

* Higher percentile ranks indicate higher ER utilization; Ranked among vendors (PCP or PCP Office) with at least 1,000

participating member months in 2006 Calendar Year

YOUR THOUGHTS?YOUR THOUGHTS?

Is this a useful report?Is this a useful report?

What can be done to make it more What can be done to make it more useful?useful?

What Monarch is DoingWhat Monarch is Doing

Ambulatory Case ManagementAmbulatory Case ManagementDisease ManagementDisease ManagementED Frequent Flyer ListsED Frequent Flyer ListsOutreach to Patients and PCP’sOutreach to Patients and PCP’s Information to PatientsInformation to Patients

Urgent Care LocationsUrgent Care LocationsDefining “Emergent Care”Defining “Emergent Care”

THANK YOUTHANK YOU

What we will do with the information What we will do with the information from tonight:from tonight:Create a user-friendly template to Create a user-friendly template to

present variance data to Monarch’s PCPspresent variance data to Monarch’s PCPsFormulate interventions and create Formulate interventions and create

support tools to reduce inappropriate ED support tools to reduce inappropriate ED utilization - revising systems where utilization - revising systems where necessary to improve the quality of care necessary to improve the quality of care our patients receiveour patients receive