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Monarch HealthCare Inc.

Monarch HealthCare Inc. Efficiency Collaborative Focus Group: “Exploring Variation in the Frequency of Emergency Department Visits Among PCP Panels” Tuesday, May 13 – Pediatricians. California Quality Collaborative.

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Monarch HealthCare Inc.

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  1. Monarch HealthCare Inc. Efficiency Collaborative Focus Group: “Exploring Variation in the Frequency of Emergency Department Visits Among PCP Panels” Tuesday, May 13 – Pediatricians

  2. California Quality Collaborative • The California Quality Collaborative (CQC) is a healthcare improvement organization dedicated to advancing the quality and efficiency of patient care in California. • The CQC is supported by a state-wide leadership alliance of healthcare purchasers, providers and health plans, all working toward a shared goal of accelerating quality improvement in California.

  3. Efficiency Collaborative Goals • Increase health care affordability through the reduction of unnecessary variations in care. • Promote reduction in the underuse, misuse and overuse of medical services, ensuring patients get the care they need, when they need it, and in the correct setting.

  4. Participants • Six (6) Medical Groups across California • Monarch HeatlhCare • Hill Physicians (Northern CA) • Mills Peninsula Medical Group (Northern CA) • Physicians Medical Group, Santa Cruz • Torrance IPA (Southern CA) • Physicians Associates of San Gabriel Valley

  5. Efficiency Collaborative Goal • “Reduce Emergency Department Utilization for Non-emergent Conditions” • Monarch consistently performs poorly on this measure • Not the quality of care we expect for our patients • Profound financial implications • Improvement directly affects practicing physician reimbursement

  6. Objectives of the Focus Group • Understand variation in ED Utilization among PCP panels • Determine what is working and what is not • Learn preferred methods of communication and define IPA/ PCP partnership • Share what Monarch is currently doing to help reduce inappropriate ED utilization

  7. ER Utilization Variance Among MHC PCPs Actual=Expected * Larger spread between actual vs. expected utilization indicates higher ER utilization; Ranked among PCP invitees to this focus group (individual PCP or group)

  8. YOUR THOUGHTS? • What causes High Utilization of the ED for Non-emergent conditions? • What can “low utilizing” PCPs do to keep the utilization appropriate? • What are the “high utilizing” PCPs doing or not doing that can contribute to higher rates?

  9. Sample Practitioner ER Utilization Report DRAFT, Not Real Data! * 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

  10. YOUR THOUGHTS? • Is this a useful report? • What can be done to make it more useful?

  11. What Monarch is Doing • Ambulatory Case Management • Disease Management • ED Frequent Flyer Lists • Outreach to Patients and PCP’s • Information to Patients • Urgent Care Locations • Defining “Emergent Care”

  12. THANK YOU • What we will do with the information from tonight: • Create a user-friendly template to present variance data to Monarch’s PCPs • Formulate interventions and create support tools to reduce inappropriate ED utilization - revising systems where necessary to improve the quality of care our patients receive

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