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Reducing Preventable ER Visits April 19, 2011

Reducing Preventable ER Visits April 19, 2011. John W. Robinson, MD, SM VP Medical Affairs & Chief Medical Officer Molina Healthcare of Washington, Inc. Creating Community Partnerships and Data Planning between Hospitals and Health Plans.

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Reducing Preventable ER Visits April 19, 2011

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  1. Reducing Preventable ER VisitsApril 19, 2011 John W. Robinson, MD, SM VP Medical Affairs & Chief Medical Officer Molina Healthcare of Washington, Inc.

  2. Creating Community Partnerships and Data Planning between Hospitals and Health Plans

  3. Molina Healthcare of WA (MHW), a managed care health plan, provides a wide range of quality health care services to families and individuals who qualify for government-sponsored programs, including Healthy Options, the Children's Health Insurance Program (CHIP), Basic Health+, Basic Health, WMIP and Medicare. Over 350,000 members are covered in Washington. MHW also operates two primary care clinics in Snohomish County.

  4. The Problem • Molina members go to the ER over 15,000 times each month. • Based on the NY Algorithm calculations, 55% of these ER visits are preventable.

  5. Medical Management Initiatives ReduceER Utilization Full Range of initiatives Low High # of Members ED Use Low High

  6. Medical Management Initiatives The Top of the Pyramid

  7. eCensus Background • Molina Healthcare of Washington wants to partner with hospitals serving Molina Healthcare members to receive daily census and ER information in a secure electronic format (“eCensus” data). • eCensus data is used to: • Improve turn-around time and accuracy of admission notification • Ease the administrative burden on facility staff by eliminating time spent printing and faxing daily census • Quickly identify Molina Healthcare members with potentially avoidable emergency department visits who might benefit from Molina Healthcare education and outreach efforts • Started in CY2010

  8. Current Hospitals Live on eCensus • HOLY FAMILY HOSPITAL • KADLEC MEDICAL CENTER • KENNEWICK GENERAL HOSPITAL • MOUNT CARMEL HOSPITAL • PROV EVERETT MED CTR • PROVIDENCE CENTRALIA HOSPITAL • PROVIDENCE ST PETER HOSPITAL • SACRED HEART MEDICAL CENTER • SEATTLE CHILDRENS HOSPITAL • ST JOSEPH HOSPITAL OF CHEWELAH • VALLEY MEDICAL CENTER HOSPITAL

  9. eCensus Flow Chart

  10. Pilot: eCensus data from 10 Hospitals • Data fields transmitted to Molina daily: • Patient name • DOB • Policy number • Admission date • Discharge date (for I/P) • Status (active, discharged or blank) • Patient type (EMR, I/P, or OBO) • Admission Diagnosis • Unit • Patient phone • Adm Source (floor in hospital) • Adm physician

  11. RESULTS • Sample Data: January 2011 • # of ER visits in eCensus data: 1673 • # of f/u phone calls completed to those members: 716 • # of members with scheduled f/u: 360 • # of members assigned to CM/DM: 85 • # of members contacted who refused assessment: 4

  12. Questions and Comments

  13. Presenter Contact Information • John W. Robinson, MD, SM • VP of Medical Affairs & Chief Medical Officer • Molina Healthcare of WA • Ph: 425-424-7124 • John.robinson@molinahealthcare.com

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