1 / 35

Coordination of Health Care Services Selected findings from 3 studies: Preventable

Massachusetts Division of Health Care Finance and Policy - 2. Why Analyze Avoidable Emergency Department Use and Preventable Hospitalizations?. Avoidable ED use and preventable hospitalizations may be an indicator of barriers to accessing appropriate primary care and need for patient-centered care coordination. Differences in ED use and preventable hospitalizations by geographic area and/or socio-economic factors inform us about needs for better care coordination that may exist for certain pop288

libitha
Télécharger la présentation

Coordination of Health Care Services Selected findings from 3 studies: Preventable

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Coordination of Health Care Services Selected findings from 3 studies: Preventable/Avoidable ED Use in Massachusetts Potentially Preventable Hospitalizations Primary Care Challenges and Opportunities DHCFP Symposium July 19, 2010

    2. Massachusetts Division of Health Care Finance and Policy - 2

    3. Massachusetts Division of Health Care Finance and Policy - 3 Overview of Findings from 3 Reports Nearly of outpatient ED visits and 13% of adult inpatient hospitalizations were considered potentially preventable/avoidable in FY08. (approx. $1.2 billion in opportunity savings) Preventable hospitalizations have declined slightly from 2004 to 2008, however ED visits are increasing over the same period. Patient demographic and socioeconomic factors and access to primary care play a role in preventable hospitalizations and avoidable ED use. Type of insurance, race/ethnicity; age; location; access to primary care (MUP); income level, education. While MA ranks high on PCP to population ratio, some residents are living in health professional shortage areas and surveys indicate some residents experience difficulty accessing primary care.

    4. Preventable/Avoidable Emergency Department Visits

    5. Massachusetts Division of Health Care Finance and Policy - 5 Nearly One-Half of Outpatient ED Visits in MA Were Considered Potentially Preventable or Avoidable, FY08 ($514M) Of the nearly 2.4 million outpatient ED visits for MA residents, 49% were considered preventable or avoidable. Emergent visits made up 39% of outpatient ED visits. More than 5% of outpatient ED visits were for mental health related issues. Preventable or avoidable ED visits are those considered to be non-emergent or ambulatory care sensitive. Note: The breakdown of visit types is based on outpatient ED visits (82% of ED visits). If we include visits that result in an inpatient admission and assume all of those to be emergent, then preventable or avoidable ED visits make up 40% of ED visits rather than 49%. Of the nearly 2.4 million outpatient ED visits for MA residents, 49% were considered preventable or avoidable. Emergent visits made up 39% of outpatient ED visits. More than 5% of outpatient ED visits were for mental health related issues. Preventable or avoidable ED visits are those considered to be non-emergent or ambulatory care sensitive. Note: The breakdown of visit types is based on outpatient ED visits (82% of ED visits). If we include visits that result in an inpatient admission and assume all of those to be emergent, then preventable or avoidable ED visits make up 40% of ED visits rather than 49%.

    6. Massachusetts Division of Health Care Finance and Policy - 6 Categorizing Preventable/Avoidable ED Visits: Definitions and Volume by Category

    7. Massachusetts Division of Health Care Finance and Policy - 7 Leading Conditions for Preventable/Avoidable ED Visits, FY08 The top 12 conditions listed make up nearly one-half of total preventable/avoidable ED visits. The majority of the conditions are considered primary care treatable and/or non-urgent. Asthma, responsible for more than 3% of preventable or avoidable visits, is considered urgent but preventable if the illness is managed properly by primary care. There has been little change in this distribution from 2004 through 2008. The top 12 conditions listed make up nearly one-half of total preventable/avoidable ED visits. The majority of the conditions are considered primary care treatable and/or non-urgent. Asthma, responsible for more than 3% of preventable or avoidable visits, is considered urgent but preventable if the illness is managed properly by primary care. There has been little change in this distribution from 2004 through 2008.

    8. Massachusetts Division of Health Care Finance and Policy - 8 One-Third of Both Emergent and Preventable/Avoidable Visits Occur During Regular Physician Office Hours Distribution of ED visits by time of day and day of week, FY08 More than one-third of both emergent and preventable/avoidable ED visits occur during hours when physician offices are open. This distribution of visits by time/day is relatively the same for each category of preventable or avoidable visits, including those that are emergent but could be treated in the primary care setting (physicians office). This suggests that lack of access to care due to closed physician offices is not a primary driver of primary care treatable ED visits. Many are open weekends and off hours. Cost is about 3 times in ED. This distribution has changed little from 2004 through 2008. More than one-third of both emergent and preventable/avoidable ED visits occur during hours when physician offices are open. This distribution of visits by time/day is relatively the same for each category of preventable or avoidable visits, including those that are emergent but could be treated in the primary care setting (physicians office). This suggests that lack of access to care due to closed physician offices is not a primary driver of primary care treatable ED visits. Many are open weekends and off hours. Cost is about 3 times in ED. This distribution has changed little from 2004 through 2008.

    9. Massachusetts Division of Health Care Finance and Policy - 9 Four Percent of Patients Are Frequent ED Users, Accounting for 20% of Outpatient ED Visits in FY08 Frequent Users and Visits by Frequent Users by Category of Visit, FY08 Overall, 4% of patients have 5 or more ED visits in a 12-month period, accounting for 20% of the total outpatient ED visits in a given year. 7% of patients having alcohol related ED visits were considered frequent users. Frequent alcohol-related ED users had an average of 10 visits in the 12 month period and accounted for more than 1/3 of ED visits for alcohol-related conditions in FY2008. Overall, 4% of patients have 5 or more ED visits in a 12-month period, accounting for 20% of the total outpatient ED visits in a given year. 7% of patients having alcohol related ED visits were considered frequent users. Frequent alcohol-related ED users had an average of 10 visits in the 12 month period and accounted for more than 1/3 of ED visits for alcohol-related conditions in FY2008.

    10. Massachusetts Division of Health Care Finance and Policy - 10 Emergent ED Visits Were Relatively Stable 2004 to 2008, while Preventable/Avoidable ED Visits Increased 13% Indexed Trend of Outpatient ED Visits in MA, FY04-FY08 Total outpatient ED visits increased 9 percent from 2004 to 2008. Emergent ED visits were relatively stable over the period, whereas preventable/avoidable visits grew by 13%. Mental health and substance abuse ED visits (which make up 5% of outpatient ED visits) increased by 20% over the period.Total outpatient ED visits increased 9 percent from 2004 to 2008. Emergent ED visits were relatively stable over the period, whereas preventable/avoidable visits grew by 13%. Mental health and substance abuse ED visits (which make up 5% of outpatient ED visits) increased by 20% over the period.

    11. Massachusetts Division of Health Care Finance and Policy - 11 Non-Emergent and Primary Care Treatable Visits Increased Fastest within Preventable/Avoidable ED Visits Indexed Trend of Preventable/Avoidable Categories of Outpatient ED Visits in MA, FY04-FY08 Both non-emergent (e.g. sore throats, etc.) and emergent but primary care treatable (PCT) visits (e.g. infant fevers) increased fastest between 2005 and 2007. Emergent but preventable conditions (e.g. asthma) increased between 2005 and 2006, but then remained relatively flat. Both non-emergent (e.g. sore throats, etc.) and emergent but primary care treatable (PCT) visits (e.g. infant fevers) increased fastest between 2005 and 2007. Emergent but preventable conditions (e.g. asthma) increased between 2005 and 2006, but then remained relatively flat.

    12. Massachusetts Division of Health Care Finance and Policy - 12 CommCare and Medicaid Patients Had Highest Proportion of ED Visits Considered Preventable/Avoidable Preventable/avoidable visits as a proportion of the total ED visits for that payer, FY08 55% of ED visits by patients covered by Medicaid and CommCare were considered preventable or avoidable compared with 48% for Medicare and private payers and 52% for the uninsured. These proportions have changed little over time. Not surprisingly the other payers which includes auto insurance and workers compensation has a very low rate of preventable or avoidable ED visits because many of their visits result from traumatic injury. Difference if Medicaid were at the average percentage it is nearly 20,000 visits.55% of ED visits by patients covered by Medicaid and CommCare were considered preventable or avoidable compared with 48% for Medicare and private payers and 52% for the uninsured. These proportions have changed little over time. Not surprisingly the other payers which includes auto insurance and workers compensation has a very low rate of preventable or avoidable ED visits because many of their visits result from traumatic injury. Difference if Medicaid were at the average percentage it is nearly 20,000 visits.

    13. Massachusetts Division of Health Care Finance and Policy - 13 More than of ED Visits by Medicaid Patients Were Attributable to Frequent ED Users Frequent Users and Visits by Frequent Users by Payer Type, FY08 More than 6% of Medicaid ED patients were deemed frequent users, accounting for 26% of the ED visits by Medicaid patients. Medicare patients had the second highest proportion of frequent ED users. Fewer than 2% of the uninsured ED visitors were frequent users, making up 9% of ED visits for the uninsuredMore than 6% of Medicaid ED patients were deemed frequent users, accounting for 26% of the ED visits by Medicaid patients. Medicare patients had the second highest proportion of frequent ED users. Fewer than 2% of the uninsured ED visitors were frequent users, making up 9% of ED visits for the uninsured

    14. Massachusetts Division of Health Care Finance and Policy - 14 Medically Underserved Populations (MUPs) Consistently Associated with Higher Preventable/Avoidable ED Visit Rates Rate of Preventable/Avoidable ED visits per 1,000 population in designated Medically Underserved Populations (MUPs) All but one designated underserved population areas (due to low income) had a higher rate of preventable/ avoidable visits per 1,000 residents compared to the state average. In many cases, this higher rate also coincides with a higher rate for emergent visits for these areas, but in each case the proportion of all ED visits that are preventable/ avoidable is higher. Despite being designated a medically underserved population, Lowell has a lower rate of preventable/avoidable ED visits. The Greater Lowell Community Health Network Area also showed a lower than average rate of preventable/avoidable ED visits. (see page 27). Lowell also has a larger and growing Asian population compared to the state average and all other low income areas depicted in this slide (17% compared to 4% in 2000*). The Asian population group is also associated with lower rates of preventable/avoidable and general ED use HPSAs do not show consistent relationship (so the geographic thing) All but one designated underserved population areas (due to low income) had a higher rate of preventable/ avoidable visits per 1,000 residents compared to the state average. In many cases, this higher rate also coincides with a higher rate for emergent visits for these areas, but in each case the proportion of all ED visits that are preventable/ avoidable is higher. Despite being designated a medically underserved population, Lowell has a lower rate of preventable/avoidable ED visits. The Greater Lowell Community Health Network Area also showed a lower than average rate of preventable/avoidable ED visits. (see page 27). Lowell also has a larger and growing Asian population compared to the state average and all other low income areas depicted in this slide (17% compared to 4% in 2000*). The Asian population group is also associated with lower rates of preventable/avoidable and general ED use HPSAs do not show consistent relationship (so the geographic thing)

    15. Massachusetts Division of Health Care Finance and Policy - 15 Infants and Children Under Age 5 Have Highest Rate of Preventable/Avoidable ED Visits per Capita, FY08 Infants and young children (age 0 to 4) have the highest per capita rate of preventable/avoidable ED visits--69% higher than the state average. A substantial proportion of these visits were for infant fever considered primary care treatable. The rate of preventable/avoidable ED visits for adults age 18 to 24 is also significantly higher than the state average. This age group makes up a large proportion of the newly insured and may have yet to establish primary care relationships. Infants and young children (age 0 to 4) have the highest per capita rate of preventable/avoidable ED visits--69% higher than the state average. A substantial proportion of these visits were for infant fever considered primary care treatable. The rate of preventable/avoidable ED visits for adults age 18 to 24 is also significantly higher than the state average. This age group makes up a large proportion of the newly insured and may have yet to establish primary care relationships.

    16. Massachusetts Division of Health Care Finance and Policy - 16 Black and Hispanic Communities Had Highest Preventable/Avoidable ED Visit Rates per Capita, FY08 The Hispanic and Black communities experienced the highest per capita rates of preventable/avoidable ED visits at 319 and 322--75% and 76% higher than the state average respectively. Although the rates of emergent visits are also higher in the Black and Hispanic communities, preventable/avoidable visits are disproportionately higher. Asians had a much lower per capita rate of both preventable/avoidable and emergent ED visits. The Hispanic and Black communities experienced the highest per capita rates of preventable/avoidable ED visits at 319 and 322--75% and 76% higher than the state average respectively. Although the rates of emergent visits are also higher in the Black and Hispanic communities, preventable/avoidable visits are disproportionately higher. Asians had a much lower per capita rate of both preventable/avoidable and emergent ED visits.

    17. Potentially Preventable Hospitalizations

    18. Massachusetts Division of Health Care Finance and Policy - 18 Thirteen percent of Adult Inpatient Admissions in MA Potentially Preventable in FY08 ($639M) Preventable and Non-Preventable Inpatient Admissions for MA residents age 18+, FY08

    19. Massachusetts Division of Health Care Finance and Policy - 19 Congestive Heart Failure and Bacterial Pneumonia Most Common PHs in FY08 Percent of Total PHs by Condition, FY08

    20. Massachusetts Division of Health Care Finance and Policy - 20 Massachusetts PH Rates Similar to or Lower than the Nation for 9 of 12 Conditions in FY08 Risk Adjusted Admission Rates per 100,000 Population for Individual PH Conditions, FY08: MA and U.S.

    21. Massachusetts Division of Health Care Finance and Policy - 21 Overall PH Rates in Massachusetts Decreased 7% FY04-FY08 Change in Risk Adjusted PH Rates per 100,000 Population for Individual Conditions FY04-FY08

    22. Massachusetts Division of Health Care Finance and Policy - 22 Plymouth, Essex, and Worcester County Residents Showed Highest PH Admission Rates in FY08

    23. Massachusetts Division of Health Care Finance and Policy - 23 Eighteen Percent of Hospitalizations among Medicare Patients Considered Preventable in FY08 PH Admissions as a Percentage of Total Hospitalizations by Payer Type, FY08

    24. Primary Care Supply

    25. Massachusetts Division of Health Care Finance and Policy - 25 The Importance of a Robust Primary Care Workforce in Improving Health Outcomes Evidence from the literature: Research shows that there is a strong relationship between the supply of primary care physicians (PCPs) and overall population health. Studies have shown that states with higher ratios of primary care physicians to population have lower rates of all causes of mortality such as mortality from heart disease, cancer, or stroke; infant mortality; and low birth weight. Evidence also shows that a greater emphasis on primary care can be expected to reduce the cost of care, improve health through access to more appropriate services, and reduce inequalities in the populations health The primary care physician plays a central role in coordinating patients care. For example, research suggests that for every 10,000 people, adding one more primary care doctor reduces cancer mortality by an average of 5.3%.For example, research suggests that for every 10,000 people, adding one more primary care doctor reduces cancer mortality by an average of 5.3%.

    26. Massachusetts Division of Health Care Finance and Policy - 26 MA among Top 3 States in Nation for Ratio of PCPs Providing Patient Care per Population In 2008, there were approximately 108 active patient care primary care physicians for every 100,000 residents in Massachusetts. This ratio was about 39% higher than the national average of 79 active patient primary care physicians per 100,000 population. Active patient care PCPs are physicians whose self-designated specialty is either internal medicine, family medicine, general practice, or pediatrics and who report that they provide direct patient care. In 2008, there were approximately 108 active patient care primary care physicians for every 100,000 residents in Massachusetts. This ratio was about 39% higher than the national average of 79 active patient primary care physicians per 100,000 population. Active patient care PCPs are physicians whose self-designated specialty is either internal medicine, family medicine, general practice, or pediatrics and who report that they provide direct patient care.

    27. Massachusetts Division of Health Care Finance and Policy - 27 More than One in Five MA Residents Report Difficulty Obtaining Health Care While more residents may have a PCP, 22% of Massachusetts residents in 2009 still reported experiencing difficulty obtaining health care in the past year. *Difficulty obtaining health care may be the result of any of the following: inability to get appointment when needed, doctors office/clinic not accepting health insurance, or doctors office not accepting new patients. While more residents may have a PCP, 22% of Massachusetts residents in 2009 still reported experiencing difficulty obtaining health care in the past year. *Difficulty obtaining health care may be the result of any of the following: inability to get appointment when needed, doctors office/clinic not accepting health insurance, or doctors office not accepting new patients.

    28. Massachusetts Division of Health Care Finance and Policy - 28 Percentage of PCPs, as a Proportion of Total Physician Workforce, Is Lower in MA than Nation Although the PCP to population ratio generally ranks higher in Massachusetts compared to the nation, its PCP workforce, as a share of the states total physician workforce, was below national average and among the lowest in the New England region. The low ratio of PCP to total physician workforce suggests a higher proportion of specialists in the state. Primary care physicians include physicians whose self-designated primary specialty is one of either internal medicine, family medicine, general practice, or pediatrics. Although the PCP to population ratio generally ranks higher in Massachusetts compared to the nation, its PCP workforce, as a share of the states total physician workforce, was below national average and among the lowest in the New England region. The low ratio of PCP to total physician workforce suggests a higher proportion of specialists in the state. Primary care physicians include physicians whose self-designated primary specialty is one of either internal medicine, family medicine, general practice, or pediatrics.

    29. Massachusetts Division of Health Care Finance and Policy - 29 Rate of MA Residents Living in HRSA-defined Primary Care Health Professional Shortage Areas Among Highest in New England Despite the gains in physician workforce and increased access, Massachusetts still faces primary care challenges. In 2009, Massachusetts had one of the highest rates of residents living in primary care health professional shortage areas (HPSAs) in the New England region. Gaps in the PCP workforce has increased the time practices spend recruiting physicians, leading to increased vacancy rates as well as staff retention issues. Despite the gains in physician workforce and increased access, Massachusetts still faces primary care challenges. In 2009, Massachusetts had one of the highest rates of residents living in primary care health professional shortage areas (HPSAs) in the New England region. Gaps in the PCP workforce has increased the time practices spend recruiting physicians, leading to increased vacancy rates as well as staff retention issues.

    30. Massachusetts Division of Health Care Finance and Policy - 30 Residents in Boston and Western MA Are More Often Unable to Get Appointments Due to Physicians Not Accepting New Patients In 2009, of all regions in Massachusetts, more people in the Boston and Western regions were unable to access care because physician offices were not accepting new patients. In 2009, of all regions in Massachusetts, more people in the Boston and Western regions were unable to access care because physician offices were not accepting new patients.

    31. Massachusetts Division of Health Care Finance and Policy - 31 Residents in Essex and Suffolk Counties Face Longer Wait Times for Non-urgent Primary Care The time it takes for new patients to get appointments for non-urgent medical visits has increased since implementation of health care reform. In 2009, new patients had to wait an average of 44 days to get an appointment with a physician for non-urgent primary care. The time it takes for new patients to get appointments for non-urgent medical visits has increased since implementation of health care reform. In 2009, new patients had to wait an average of 44 days to get an appointment with a physician for non-urgent primary care.

    32. Massachusetts Division of Health Care Finance and Policy - 32 MA Residents with Public Insurance Are More Likely to Have Difficulty Obtaining Health Care Public coverage includes residents that have insurance coverage under MassHealth, Commonwealth Choice, or Commonwealth Care. In 2009, among residents who reported difficulty obtaining care, the majority were covered by some type of public insurance. Compared to residents without insurance, residents with public coverage were almost twice as likely to experience difficulty obtaining health care. Public coverage includes residents that have insurance coverage under MassHealth, Commonwealth Choice, or Commonwealth Care. In 2009, among residents who reported difficulty obtaining care, the majority were covered by some type of public insurance. Compared to residents without insurance, residents with public coverage were almost twice as likely to experience difficulty obtaining health care.

    33. Massachusetts Division of Health Care Finance and Policy - 33 Opportunities for Improving Primary Care Access Coordinated care systems with focus on patient-centered primary care Improving primary care compensation and practice environment Focus on incentives for students to choose primary care MA sponsored student loan repayment incentives Federal health reform includes several initiatives: Increasing pay levels for primary care Debt reduction in exchange for service in health care shortage areas and CHCs Initiatives focused on patient-centered medical homes Efforts to compensate for extra-work Recent DHCFP reports (www.mass.gov/dhcfp/costtrends) recommend that integrated care organizations with strong focus on primary care should be created to ensure that providers work collaboratively to meet patient care needs. Testimony provided at related public hearings noted that because primary care providers are key to a better coordinated care system, investments should be made in primary care. Recent DHCFP reports (www.mass.gov/dhcfp/costtrends) recommend that integrated care organizations with strong focus on primary care should be created to ensure that providers work collaboratively to meet patient care needs. Testimony provided at related public hearings noted that because primary care providers are key to a better coordinated care system, investments should be made in primary care.

    34. Massachusetts Division of Health Care Finance and Policy - 34 Implications and Next Steps Report findings highlight the need for better care coordination to improve the quality of care for MA residents. Better care coordination and patient education can also translate to cost savings: reports identified approx. $1.2B in potential opportunity savings. In addition, the reports outlined several opportunities and needs to improve access to primary care--patient-centered primary care is essential to moving to fully integrated care systems.

    35. Questions?

More Related