rural health network development grantee meeting august 2, 2010
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Rural Health Network Development Grantee Meeting August 2, 2010. Diane M. Hughes, MBA Executive Director. Mission Statement. Access Health Adams County (AHAC) develops, supports, and coordinates programs to provide appropriate access to healthcare for - PowerPoint PPT PresentationTRANSCRIPT
Rural Health Network Development Grantee MeetingAugust 2, 2010
Diane M. Hughes, MBA
Executive Director
Mission Statement
Access Health Adams County (AHAC)
develops, supports, and coordinates programs
to provide appropriate access to healthcare for
individuals whose access to services are limited
due to insurance status and other factors
including health conditions, health literacy, and
social issues.
Three Main Components
Community Service Link Physician Led Access Network Care Management
Community Service Link
(CSL)
CSL Statistics
27 Participating Agencies
1,477 unduplicated Adams County residents
Quarterly provider audit Ongoing user training
159 Users Quarterly User Group
Meetings 35 referrals came to
AHAC from Oct - May
Medicaider statistics
Medicaider screens Adams County residents
for eligibility into all state and federal programs.
992 Medicaider screenings 238 clients screened eligible for programs Avg. interview time: 2.17 minutes 80 users community-wide
Community Service Link (CSL)
What makes the linking system and Medicaider valuable?
Community Service Link (CSL)
How could this software pay for itself?
Community Service Link (CSL)
What is AHAC doing to make systemSustainable and valuable? Require Participation Agreements Quarterly User Group Meetings Training Sessions Weekly emails to update users Participation Certificates Executive user group meeting planned for the
Fall 2010
Physician Led Access Network (PLAN)
Physician Led Access Network (PLAN) Blessing Hospital Clinical Radiologists SIU Quincy Family Practice Center Quincy Medical Group Blessing Physician Services Dr. Ronald Wheeler Dr. Duane Hanzel Dr. James Hayashi Community Outreach Clinic
Sliding Fee Scale
FEE CODE B C D E
Patient pays: 10% 25% 50% 75%
Family size: 0-125% ofHHSPG
126-150% ofHHSPG
151-175% ofHHSPG
176-200% ofHHSPG
1 $13,537 $16,245 $18,953 $21,660
2 $18,212 $21,855 $25,498 $29,140
3 $22,887 $27,465 $32,043 $36,620
4 $27,562 $33,075 $38,588 $44,100
PLAN statistics
Over 700 Adams County residents 79 clients on waiting list Value of $1.6 million has been donated in healthcare
from May 2008 to April 2010 62% of patients have had a medical physical in the
past two years 23 new providers in 2010 Provider Satisfaction had a score of 93% in 2009 100% of AHAC patients have a primary care home
PLAN Value and SustainabilityHow do we continue participation?
Care Management Patient accountability Cost savings (ROI) Referral source for network members Assessing satisfaction Systematic volunteer opportunity for
physicians/providers Equitable distribution Ensuring patient eligibility
Care Management
Who receives care management?
All clients enrolled in the Physician Led Access Network
Activities of Care Management
Client advocacy Connecting clients to community resources Coordination of healthcare services in PLAN Follow-up after medical appointments Assistance with applications such as
MedAssist, Community Outreach Clinic, charity applications
Activities of Care Management, cont.
Facilitate Referrals to CareLink for nursing care management
Provide or connect clients with appropriate disease education
Managing client healthcare appointments and ensuring eligibility to physician offices
Provide healthcare appointment reminders
Evaluation of the Program
What are we tracking to demonstrate value? Medical appointment attendance rates Charity care for local hospital to maintain tax-
exempt status Reduction in the cost of care per member per
month Reduction in Emergency Room and Inpatient
Utilization Appropriate utilization of healthcare system
for treatment of ambulatory sensitive conditions
Medical AppointmentsFebruary 2010 – April 2010523 physician appointments
Show
No-show
Cancelled
3% 16%
81%
Blessing HospitalFinancial Assistance Applications
2008 $83,570.26
2009 $817,580.53
2010 $1,503,734.93
Value of Donated Care
1st Quarter $9,556.01
2nd Quarter $31,348.25
3rd Quarter $80,721.68
4th Quarter $206,005.86
5th Quarter $257,334.97
6th Quarter $260,823.03
7th Quarter $286,025.08
8th Quarter $412,462.14
Results of program
Value of Donated Healthcare per member per month (pmpm)
$0.00
$100.00$200.00
$300.00
$400.00$500.00
$600.00
1 2 3 4 5 6 7 8
Quarter
$530.89
$267.49
Emergency Room/Inpatient Utilization
Hospital service data collected on AHAC enrollees
Group 1 May 1, 2008 – Nov 30, 2008 41 unduplicated individuals
ER Utilization – Group 1
ER encounters 6-months prior
to AHAC
Dollars in Charges
ER encounters 6-month POST
AHAC
Dollars in Charges
23 $45,855 17 $19,078
26% reduction 58% savings
Inpatient Hospitalizations – Group 1
Inpatient stays 6-months prior
to AHAC
Dollars in Charges
Inpatient stays
6-month POST AHAC
Dollars in Charges
9 $141,343 6 $154,557
33% reduction 9% increase
Emergency Room/Inpatient Utilization
Group 2 Dec 1, 2008 – April 30, 2009 (exclusive of
Group 1 clients) 114 unduplicated clients
ER Utilization – Group 2
ER encounters 6-months prior
to AHAC
Dollars in Charges
ER encounters 6-month POST
AHAC
Dollars in Charges
104 $139,007 51 $73,237
51% reduction 47% savings
Inpatient Hospitalizations – Group 2
Inpatient stays 6-months prior
to AHAC
Dollars in Charges
Inpatient stays
6-month POST AHAC
Dollars in Charges
20 $600,606 14 $276,413
30% reduction 54% savings
Ambulatory Sensitive Care Conditions Treated at the Hospital
2005 problematic conditions
1. Congestive Heart Failure
2. Bacterial Pneumonia
3. Urinary Infection
4. Dehydration
5. Diabetes
6. Chronic Obstructive Pulmonary Disorder
7. Hypertension
Group 1
254 individual hospital charges representing ER, inpatient, and outpatient charges
14% or 36 charges represented one of the seven ambulatory sensitive care conditions
6 charges associated with ER encounters and inpatient hospitalizations
Remaining 83% or 30 charges associated with outpatient service utilization
Group 2
630 individual hospital charges representing ER, inpatient, and outpatient charges
9% or 56 hospital charges represented one of the seven ambulatory sensitive care conditions
Of interest, 4 of 56 were associated with ER encounters PRIOR to the AHAC enrollment
NONE were associated with ER and Inpatient hospitalization after enrollment
93% of those ambulatory sensitive diagnosis codes were associated with outpatient hospital charges
Healthcare Reform: Where does AHAC fit in?
Strong network has been developed AHAC is known to tailor to its clients needs Care coordination Disease Management
Future Funding
Community Meeting “Celebration” May 18, 2010
Public Relations Patient highlighted in news Newspaper articles Radio interviews TV interviews
Notice of intent to grant from local health system
Diverse funding
Resources
www.CHSDonline.com Georgia Health Policy Center Sustainability
Formative Assessment Tool