Reducing Avoidable ER Visits

1. Reducing Avoidable ER Visits Jackie Huck Community Health Network of Washington

2. History • Community Health Plan(CHP) of Washington was formed in 1992 by 19 community and migrant health centers throughout the state of Washington • CHP serves as the safety net for low-income and disadvantaged communities • Our Community Health Centers are the front line, providing essential medical and behavioral-health care within their communities • CHP operates from the core belief that increasing the access to health care translates into healthy families and strong communities

3. Products/Enrollment Through Medicaid, state-sponsored, and Medicare programs CHP offers some type of medical care product in all 39 counties in Washington State, serving more than 275,000 members and more than 20%of the Medicaid population. The Network serves close to 40% of the of the Medicaid population

4. Economic Impact • CHP with its CHCs act as significant employers and make significant economic contributions to their communities • The Network now serves over 700,000 unique patients in Washington state per year…more than 10% of the entire pop of the state.

5. Enrollee ER Visits • Increasing number of ER visits each year • Fairly high percentage of “avoidable” visits based on MediCal criteria

6. Data Requirements CHP & CHNW • Patient Name • DOB and current contact information • Admit/discharge dates for inpatients • ER visit date • Attending physician • Follow-up care plan/discharge instructions • For CHP enrollees- the member number • Diagnosis

7. CHP Initiatives • Case management • 24/7 Nurse Advice Line available to all enrollees and clinic patients • Continuity and Coordination of Care • Patient-centric education regarding appropriate ER use and establishing and maintaining Health Care Home

8. CHNW Initiatives • Developing community partnerships • Patient-centric education and outreach • Health Literacy: group classes and one-on-one education with families/caregivers • Identification and spread of best practices • Strengthened work towards moving to patient-centered health care homes • Improving access and developing a culture of performance excellence

9. 2010 Quality Grant Focus: reduction in ER utilization Success Stories • Providence Everett and Providence Centralia partnership with local CHCs • Lowest level of total ER visits in three years despite ongoing upward trend nationally

10. 2010 Quality Grant Lessons Learned/Barriers • CHCs need timely actionable data from hospitals • Developing partnerships not easy, but is essential • Sharing best practices strategies important • Cultural and linguistic considerations for developing educational materials

11. Desired Outcomes • Improving overall quality and coordination of care, while reducing costs • Accurate and timely admission notification • 24 hour turn-around notification of patients seen in ER sent to CHC for all clinic patients • ER utilization reports to plan for all enrolled CHP members

12. How hospitals can help • Work closely with safety-net clinics in their area to help patients get assigned to a medical home • Also a need to have hospitals work as partners to develop programs providing alternatives to patients coming to the ER without emergent care needs

13. Questions and Comments • Jackie Huck Network Quality Program Director Community Health Network of Washington jackie.huck@chnwa.or g 206-613-8937