Saint Johns Access Initiatives

Indiana Community Health Worker SymposiumIndiana State Department of HealthMonday, October 15, 2012

Sherry E. Gray, DirectorJane Clawson, Health Access Worker

How Health Access Workers Measure Outcomes for Community Based Care Coordination

Why We Do What We Do:A Whole Different Kind of 99%-ers 21% = for 25% of health care costsAvg,$100,000 per year in ER, hospital, MD visits and RX5% of patients =50% of all healthcare spendingconsume 55% of all healthcare servicesContributing factors: chronic disease (diagnosis, treatment, management); health care coverage; financial resources; provider access; system complexity; social support

Why We Do What We Do: Indianas Vulnerable Citizens (A Snapshot)36.5 million Hoosiers21% of Hoosiers live in poverty1.1 million Hoosiers = some type of Public Assistance (i.e. Medicaid coverage, etc.)180% Increase in Food Stamp Recipients in the last 10 years800,000+= Medicare Coverage800,000+ = Uninsured 47% of Hoosier public school kids receive free/reduced lunch

Indianas Health: Hoosier Snapshot4High % teens giving birthLow Birth weight %OverweightHeart DiseaseHigh Blood PressureDiabeticSmokersModel that tends to be treatment/procedure oriented vs. preventative health/wellness/disease management oriented.

Why We Do What We Do:Opportunities:5Provide/increase access: the 5 rightsRight CareRight TimeRight PlaceRight ProviderRight Payer

Quality, evidence-based clinical/public health care is provided consistently to all

Become better stewards of existing resources: both human and financial: minimize duplicative and/or repetitive processes and services

Work with key partners and stakeholders to own this work together: as a community

Demonstrate outcomes that make a real & observable impact (documented!)

Meaningful differences/improvements in the lives of our friends, families and neighbors

Who We Are:Rural and Urban Access to Health (RUAH)6Purpose: To connect our friends, family, and neighbors to a comprehensive, integrated delivery network of health, human and social services resulting in improved access and removal of barriers to needed resources.Meaning and Mission: The word ruah, in yiddish means Breath of Life. The Goal? to breathe new life into a health care system to better serve our most vulnerable community members

How We Got our Start: (a little history)7RUAH Partnership initiated: 2000SV Health Inpatient, Outpatient medical care providerIndiana Health Centers, Inc.Federally Qualified Health Center (FQHC)Health and Hospital Corporation of Marion CountyCounty Health DepartmentADVANTAGE Health Plans, Inc.Insurance Provider (public and private plans)Butler College of Pharmacy, later addedPharm D studentsPharmaceutical Assistance Program (PAP) ConsultationProject Management/OversightCommunity Interface Groups: local partner groups responsible for program implementation.Health centers, health departments, physician offices, civic groups, and health, human and social service agencies

Funded by HRSA, Ascension Health from 2001-2005

Additional private funding through the Anthem Foundation: establish 3 additional sites

Sustained through local hospital funding and captured reimbursement through enrollment efforts

How We Do our Work: Our Resources

89.5 HAWs

6.5 MACsDirect HiresCommunity-agency based

System Administrative Support1 Health Access Manager1 Operations Facilitator1 Administrative Assistant3 Language Access Staff1 System Director

Annual Budget$1.1 million

What Weve Done So Far:Program Outcomes 9Four community programs expand to Eight community programs

Outcome Focused: Pathway Model Integration5 Pathways implementedData reporting effective 9/11Used to count what we did to/for clients vs. outcomes!

AHRQ Innovation SiteCommunity Care Coordination Learning Network SiteNational Institute of Health Research PartnerIndiana CHIPRA granteeMadison County Community HUB

$39.8 million worth of low/no cost drugs provided

Language Access1253 interpreters trained through Bridging the Gap1094 documents translated

Integration with Federal, State and County StakeholdersHow Weve Changed: Moving from a Volume Based to an Outcome Based Measurement ModelOur 1st 8 years:Counted number of encountersRecorded initial vs. follow up visitsReported EVERY thing we did ToForWithOur ClientsHigh Volume; Low Outcome Measurement

10Our last two years, and moving forward:Record number of clients referred to us for a baselineCollect BarriersReport PathwaysOpenedIn-ProgressCompletedIncompletedStarting the Benchmarking and ROI Process

How & Why We Decided on PATHWAYS:11Best Practice ResearchCommunicating with our sister programsAssessing how other disciplines were doing their work and/or changing how they viewed their workScanning the environment for current and future changesAddress how all of the above fit with our goal, our mission and our sustainability12 Focusing on Outcomes

How We Design our Pathways:13Review and Discuss Available Data and Community InputPrioritize Areas of FocusDiscern and Decide the Desired Outcome (start with the end goal in mind)Agree to the Initiation Step for the Pathway (with whom and how does a specific Pathway get started)Identify the KEY steps that are consistently taken to work towards a successful outcomeIdentify barriers to be collected (and later used as a way to problem-solve)Build the Measurement ToolStart the Work14

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The Pathways Model: SVH RUAHMedical HomeMedical ReferralPregnancySocial ServicesEnrollment

HAW MONTHLY REPORT September 2012Source of ReferralField Based283Clinic/Office 134Hospital42Emergency Room38Med Assist 10SPN4Total511

Participant Visit LocationHome52HAW Office384ER7Community22Clinic/MD Office31Total496

HAW MONTHLY REPORT September 2012Financial ClassUninsured 337Private Insurance43Medicaid78Medicare37Other7HIP2VA Health Benefits1Total505

Initial vs. Follow-up VisitsFollowup Visit328Initial Visit168No Purpose Listed15Total511

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HAW MONTHLY REPORT September 2012Open PathwaysEnrollment116Medical Home29Pregnancy0Medical Referral41Social Services241Total427

Pending PathwaysEnrollment97Medical Home26Pregnancy0Medical Referral30Social Services56Total209

Completed PathwaysEnrollment70Medical Home23Pregnancy0Medical Referral46Social Services236Total375

Completed Historical PathwaysEnrollment947Medical Home694Medical Referral327Pregnancy23Social Services2734Total4725

HAW MONTHLY REPORT September 2012Incomplete PathwaysEnrollment321Medical Home38Pregnancy8Medical Referral20Social Services47Total434

HAW MONTHLY REPORT September 2012

Why We are Planning for The Future:24Affordable Care Act Pay for Performance InitiativesReadmission Accountability State -FederalInsurance ExchangesACOsPrimary care Medical HomesHow We Plan To Contribute: 25Un/underinsured community members can receive care sooner vs. laterConsistent and familiar care is provided along with follow up & follow through: treatment is across time and not episodicResources are used as effectively as possible, including:Human Providers, Practitioners, Care Coordinators, Administrative support, etc.Financial Reimbursement, Funding, Cost-Avoidance, Write-OffsTechnological Connecting Information in a timely, meaningful waySupport (wrap-a-round) Services Connecting medical treatment, public health practices, & psychosocial principlesVital connections are madeIntegrate and coordinate care not duplicate and replicate careBest Practice Learning's are shared; and solutions are not re-created

Questions?healthaccess@stvincent.org26

Find

Treat

Evaluate

1

2

3

Identify individuals who are most at risk

Confirm evidence-based intervention

Measure the outcome in health and cost savings

Identify pregnant womenconfirmed by pregnancy test

Confirm patient kept monthly appointments with prenatal care provider

Healthy baby weighing more than 5lbs. 8oz.

Example:

The Pathways Model

St. V HealthST. VINCENT HEALTH, INC.ST. VINCENT HEALTH, INC.INDIANAPOLIS, ININDIANAPOLIS, INCONSOLIDATED SUMMARYCONSOLIDATED SUMMARYCARE OF PERSONS LIVING IN POVERTY & OTHER VULNERABLE PERSONS AND COMMUNITY BENEFIT REPORTCARE OF THE POOR AND COMMUNITY BENEFIT REPORT[IRS METHODOLOGY](Excludes Bad Debt Expense from RCC)(Excludes Bad Debt Expense in RCC)(Excludes Bad Debt Expense in RCC)Actual(Excludes Bad Debt Expense in RCC)ActualActualFY 2009AnnualizedActualActualFYE 6/30/2011FYE 6/30/2010FYE 6/30/2009YTD @ 02/28/2009FY 2009FY 2008FY 2007Category I$52,739,731$50,718,894$29,623,496Category I0.00.0$28,048,377$26,186,108Category II$97,100,455$94,797,731$84,080,610Category II0.00.0$76,413,309$69,312,331Category III$4,523,133$4,086,618$3,459,225Category III$4,523,133$6,784,699$4,023,149$3,974,168Category IV$36,966,815$29,623,763$27,004,174Category IV$36,849,682$55,274,524$22,197,609$19,280,384Subtotal$191,330,134$179,227,006$144,167,505Subtotal0.00.0$108,484,835$99,472,607Category VI$157,213,641$106,507,694$101,014,618Category VI$69,843,109$139,686,218$134,509,687$101,354,902Total$348,543,775$285,734,700$245,182,123Total0.00.0$265,192,131$220,107,893PERIOD 12 FYE 6/30/2011RESTATED FY 2007PERIOD 08 FYE 6/30/2009IIIIIIIVVIIIIIIIIIVVI(Traditional(Unreimbursed(Care of the(Community(Unreimbursed(Traditional(Traditional(Unreimbursed(Care of the(Community(UnreimbursedCharity)Medicaid)Poor)Benefit)Sub TotalMedicare)TotalCharity)Charity)Medicaid)Poor)Sub TotalBenefit)Medicare)TotalFACILITIESFACILITIES26ECarmel$2,142,584$4,328,988$184,650$373,223$7,029,446$11,240,919$18,270,365$1,199,987Carmel0.00.0184,6500.0373,223$5,159,9450.03,528,250$800,73827QClay973,5831,724,76114,400148,0272,860,771(79,049)2,781,722280,688Clay0.00.014,4000.0148,027(39,246)0.01,368,648$356,11228AFDunn1,049,2032,852,64316,80066,5813,985,227(126,004)3,859,2230.0$2,852,64329OFrankfort774,478(1,734,129)39,137105,666(814,847)(90,208)(905,055)802,313Frankfort0.00.039,1370.0105,666(51,471)0.01,850,947$(3,585,076)30AAHeart Center of Indiana2,058,0991,793,8778041,0253,893,08112,684,54416,577,6251,798,563Heart Center of Indiana0.00.0800.041,0256,497,8330.01,224,924$568,95331DIndianapolis21,932,78939,243,9902,304,73326,830,26490,311,77666,749,341157,061,11711,030,970Indianapolis0.00.02,304,7330.026,830,26436,254,7870.039,148,727$95,26432NJennings1,410,6992,259,818156,82957,0423,884,388(64,273)3,820,1151,488,732Jennings0.00.0156,8290.057,042(40,090)0.02,238,448$21,37033AELafayette Lab3,02232,9620.00.035,984600,303636,2870.0$32,96234MMercy1,873,0212,389,16581,85960,0934,404,138(94,065)4,310,0721,089,175Mercy0.00.081,8590.060,093(55,810)0.01,875,504$513,66135KNew Hope0.01,446,8030.0601,446,8630.01,446,8630.0New Hope0.00.00.00.0600.00.0569,695$877,108-11747236ABMCNE539,9551,485,5080.031,6482,057,1111,470,9403,528,051MCNE0.00.00.00.031,64880,6720.01,398,290$87,21837IPhysician Network276,9111,271,216129,5008,9431,686,5702,104,3203,790,890358,239Physician Network0.00.0129,5000.08,9431,798,7410.04,940,407$(3,669,191)Physician Network-Randolph404,336948,0800.00.01,352,416443,2111,795,627Physician Network-Frankfort127,953893,3810.00.01,021,334509,4821,530,816Physician Network-Jennings552,5381,061,3170.00.01,613,855415,6202,029,475Physician Network-Mercy58,384172,4240.00.0230,808174,058404,866Physician Network-St. John359,8901,157,8830.00.01,517,7731,108,2952,626,068Physician Network-Salem197,920521,8440.00.0719,764648,8941,368,657Physician Network-Dunn139,490730,4180.00.0869,908493,3171,363,225Physician Network-St. Joe139,204633,4160.00.0772,620789,6401,562,260Physician Network-Clay7,85574,2310.00.082,08611,67993,76538PRandolph1,751,442(287,152)126,740107,4381,698,468(96,237)1,602,2311,252,249Randolph0.00.0126,7400.0107,438(52,883)0.02,772,836$(3,059,987)39XSt. Joe - Kokomo2,246,0715,994,337352,796120,2568,713,46010,405,71119,119,1711,183,806St. Joe - Kokomo0.00.0352,7960.0120,2565,115,2080.05,662,709$331,628St. Joe - Primary Care[1]0.00.00.0St. Joe - Primary Care[1]0.00.00.041ZSt. John's - Anderson8,927,9719,803,851715,472264,24619,711,54015,729,78035,441,3204,215,306St. John - Anderson0.00.0715,4720.0264,24614,345,5360.07,954,530$1,849,32142SVH Corporate0.00.0340,0977,985,2898,325,3860.08,325,3860.0SVH Corporate0.00.0340,097340,0977,985,2890.08,325,3860.00.043ADSVMG-The CARE Group532,0663,202,6910.00.03,734,75729,999,57633,734,3330.0$3,202,69144ACSalem492,3361,756,04654050,5522,299,474(69,225)2,230,249664,629$1,091,41745SSeton - Indianapolis535,8351,106,04110,26081,9211,734,057223,8151,957,872160,650Seton - Indianapolis0.00.010,2600.081,921(360,831)0.01,487,855$(381,814)46USeton - Lafayette28,604618,8372,53046,829696,800690,4181,387,2187,412Seton - Lafayette0.00.02,5300.046,82980,0580.0374,186$244,65147FStress Center560,894983,21222057,1401,601,466659,1172,260,583199,009Stress Center0.00.02200.057,140556,5010.0669,393$313,81948LWilliamsport949,8181,493,4664,243208,3042,655,832(85,747)2,570,084346,154Williamsport0.00.04,2430.0208,304(39,555)0.01,288,918$204,54949GWomen's1,692,7809,140,52742,246322,26911,197,821765,47311,963,294772,855Women's0.00.042,2460.0322,269593,7150.015,778,836$(6,638,309)Total Facilities$52,739,731$97,100,455$4,523,133$36,966,815$191,330,134$157,213,641$348,543,775$26,186,108Total Facilities0.00.0$4,505,7930.0$36,849,682$69,843,1090.0$94,797,731$(3,890,270)ADSelf-Check$52,739,731$97,100,4554,523,13336,966,815$191,330,134$157,213,641$348,543,775$26,186,108Self-Check0.00.04,523,1330.036,966,81569,843,1090.00.00.00.00.00.00.00.00.00.00.0$(17,340)0.0$(117,133)0.00.0Per Hyperion COP1IRS$30,032,296$54,699,217$1,989,172$63,257,613$166,948,370$22,707,435$42,401,238$2,533,961$93,956,028$181,595,405

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