Molly HarperJoy Jin

Matthew LauckKaytriona Lewis

Project OverviewBusiness PlanGoals and ObjectivesFrequent User StatisticsHealthcare Reform ImpactExternal AssessmentInternal AssessmentFinancial Analysis and Patient VolumesOperational PlanMarketing RecommendationsFinal Recommendations

UIH Frequent Visitor ModelCare coordinationObservationAppropriate follow-up

Multidisciplinary nurse and social work teamInnovative payment solutions

Need in Cook CountyHospital Number of

ED VisitsNumber of ED visits from frequent users

Estimated number of frequent user patients

Number of ED visits with Medicaid

Number of uninsured ED visits

John H. Stroger

77,073 11,561 2,513 8,653 42,776

Rush University Medical Center

36,814 5,522 1,200 13,512 5,023

Mount Sinai 34,750 5,213 1,133 12,466 7,003Saint Anthony 28,130 4,220 917 14,466 3,480Norwegian American

18,555 2,783 605 7,395 4,589

Saints Mary and Elizabeth

49,266 7,390 1,607 22,578 8,148

UIH: 4,394 Frequent User Visits representing 835 unique patients

Service AreasService Areas

Primary Service AreaPrimary Service Area

($31,516)($28,799)

($27,012)

($13,777)

($21,320)

($28,237)

($34,224)

60624 60612 60644 60639 60651 60609 60621

2010 Median Household Income (Variance)

Median Household Income Cook County MedianHousehold Income

Primary Service Area-ED Covered Primary Service Area-ED Covered Services by PayerServices by Payer

Secondary Service AreaSecondary Service Area

($25,916)

60608

2010 Median Household Income (Variance)

Median Household IncomeCook County MedianHousehold Income

Secondary Service Area-Secondary Service Area-ED Covered Services by PayerED Covered Services by Payer

Service Areas- Expected Medicaid GrowthService Areas- Expected Medicaid Growth

Target PopulationTarget Population

Health Status-African Americans & Health Status-African Americans & HispanicsHispanics

Workforce DevelopmentWorkforce Development

Social Workers

Nurse Care Managers

What is an Observational Unit?What is an Observational Unit?

Types of Observational UnitsTypes of Observational Units

Patient Volumeand

Financial Analysis

Patient Volume

5-year reduction of frequent visitor (FV)

ED visits by 6,640

Daily observation unit patient volume 1-2

2013 2014 2015 2016 2017

Frequent VisitorsEnrolled in Program

187 234 428 476 476

Additional ED Visits resulting from Backfill

388 706 1656 1945 1945

Revenues

Direct Patient ServicesED visits for FVObservation visits for FVBackfill ED visits

Shared SavingsShared Savings paymentsCare coordination revenues

2013 2014 2015 2016 2017Revenues:

Net Revenues from Direct Patient Services

854,468 898,281 1,948,165 2,292,085 2,341,365

Shared Savings Revenues 500,591 1,278,385 2,390,832 2,719,308 2,777,773

Total Revenues 1,355,059$ 2,176,666$ 4,338,997$ 5,011,392$ 5,119,137$

Shared Savings RevenuesShared Savings revenues based on reduction in

payment for healthcare services for enrollees

Average annual Medicaid payments for ED FV were $33,946 more than ED non-FV

Each ED visit reduction will reduce payments by $5,132

The Shared Savings payments to UIH would be half

Expenses

New care coordination staff (FTE:Patient ratio)New I/S hardware and software Variable costs estimated with cost-to-charge

ratio

2013 2014 2015 2016 2017Expenses:

Fixed Costs

- New Hire Salaries & Benefits (38%)

717,193$ 833,829$ 1,281,265$ 1,418,499$ 1,448,996$

- New Equip & Supplies 265,868$ 46,185$ 48,125$ 48,610$ 48,610$

Total Fixed Costs 983,061$ 880,014$ 1,329,390$ 1,467,109$ 1,497,606$

Total Varible Costs 1,070,197$ 1,258,323$ 1,967,061$ 2,183,438$ 2,230,382$

Total Expenses 2,053,258$ 2,138,337$ 3,296,451$ 3,650,547$ 3,727,988$

New Staff DetailsStaff Title Year 1 Salary FTE Need

     

Program Administrator $50,000.00 1 for entire project

Medication Therapy Manager $115,000.00 1 for entire project

Nurse Case Manager $63,750.00 1 for 100 every patients enrolled

Health Social Workers $45,000.00 1 for every 50 patients enrolled

Information Systems / Technology Staff

$45,000.00 1.5 for entire project

AssumptionsMarket entry of 458 new Medicaid ED FV in 2015Half of current (and future) Medicaid ED FV will

enroll in programReduction of FV total ED visits by 2 per YearHalf of FV ED visits will be sent to observation unitBackfill ED visits have similar admission rateShared Savings payment model similar to MedicareProject cost of capital is 13.14%2.15% annual inflation rate

Financial Analysis Results2013 2014 2015 2016 2017

Total Revenues $ 1,355,059 $ 2,176,666 $ 4,338,997 $ 5,011,392 $ 5,119,137

Total Expenses $ 2,053,258 $ 2,138,336 $ 3,296,451 $ 3,650,546 $ 3,727,988

Net Income (Loss) $ (698,199) $ 38,329 $ 1,042,546 $ 1,360,846 $ 1,391,149

Net Present Value = $1,938,764Internal Rate of Return = 60.01%Payback Period = 2.53Favorable financial resultsProject Risk is encompassed by ability to

reduce total FV ED visits per year to goal

Marketing

Product Development Product Development Marketing StrategyMarketing Strategy

Primary Objectives:

Promote Medicaid frequent user enrollment into coordinated care

Increase awareness amongst staff, clinicians and external transport services

Empower patients

MarketingMarketing Reach

Channels of Distribution Objective

Time Frame

Internal

Frequent Users PostersPamphlets

Word-of-mouthAwareness

3-1 months before

program deployment

Clinicians

Staff

External Transport Services Meet with staff Awareness &

Collaboration

1 month before

program deployment

MarketingMarketingAdvantages

Easy to roll outLow costReach both internal and external audiences

DisadvantagesUnnecessary utilization of observation unitDependent on staff cooperation

Final RecommendationsWe recommend UIH to incorporate a short-stay observation unit within the hospital facility for the following reasons:Financial feasibilityMeet unaddressed needsMore time to improve care coordination and reduce return

Thank you to…UIHStephen Brown, Associate Director of Clinical Practice &

Business DevelopmentDavid Barishman, Nurse Manager of Emergency ServicesBill Devoney, Chief Financial OfficerDr. Gina Gaston, Assistant Professor at UICSheetal Gayal, Director of Business Planning & Decision

SupportMentorsBoyede Sobitan Jim Lifton