Neighbors Caring for Neighbors Clinic
ObjectivesObjectives
1.
2.
NCNC General InformationNCNC General Information The Neighbors Caring for Neighbors
Clinics are Nurse Practitioner run clinics providing needed medical care to low income persons who are without insurance.
This model of a free clinic, in which the staff is hired, provides continuity of care for the patient enabling better health outcomes.
The mission of the Neighbors Caring for Neighbors Clinic (NCN Clinic) is to provide primary health care services to persons who are of low income, without insurance or underinsured and reside in Macomb County. This is done with respect and loving embracing care for each person at each encounter.
Neighbors Caring for Neighbors Clinic
BackgroundBackground• Opened February 4, 1998Opened February 4, 1998 through a
3 Year Emily George (Sisters of Mercy) Grant
• June 1998June 1998; Second site added in Romeo (Now Washington Township) through a
4 County Foundation Grant
• July 2000July 2000 operations fully funded by St. Joseph’s Mercy Hospital (Henry Ford Macomb Hospitals)
Service FeaturesService Features• Continuity of Care
• Eligibility:
>Uninsured persons of all ages
>Macomb County residents
>Household income less than
$30,000
• 3 Days per week – Mt. Clemens
• 1 Day per week -- Washington
• 2 Days per week -- Warren
UNIQUE PATIENTS COMPARISON BY AGE2001-2004: 3935 2005-2008: 4639
0
500
1000
1500
2000
2500
0-19 20-30 30-50 51-64 65+
AGES
NU
MB
ER
S O
F P
ATI
EN
TS
2001-2004
2005-2008
Income Range at First Visit
0
200
400
600
800
1000
1200
$0.00 $1.00 -5,000
$5,001-10,000
$10,001-15,000
$15,001 -20,000
$20,001 -30,000
Income Ranges
Num
ber o
f Pat
ient
s
2002-2005
2006-2008
Total patients served since the Clinics openedIn 1998
Mt. Clemens – 12,600 Active: about 1,860 Washington - 3,065 *************************************************************** Generally about 33 new patients per week
******************************************************** Total Visits: Mt. Clemens + Washington Twp. 2008 January to June: 2710 2009 January to June: 3338
STATISTICS
Types of ServicesTypes of ServicesIn Collaboration with Assigned Medical
DirectorFamily and Adult Nurse Practitioners provide
the following medical and nursing care:• Management of acute and chronic
medical problems• Well person, employment and school
physicals• Education on diseases and healthy
living
0% 5% 10% 15% 20%
1
TOBACCO ABUSE
STD
RESPIRATORY
OBESITY
NEUROLOGICAL
MUSCULOSKELETAL
MENTAL/EMOTIONAL
HYPERLIPIDEMIA
HTN
HEALTH MAINTENANCE
GI
ENDOCRINE
DIABETES
CARDIOVASCULAR
ADDICTION
ACUITE ILLNESS
ALL DIAGNOSES by %1998-2008 NEIGHBORS CARING FOR NEIGHBORS CLINIC
Clinic Visits by Diagnoses 2006-2008
0 500 1000 1500 2000 2500 3000 3500 4000
1
Dia
gnos
es
Visits
TOBACCO ABUSE
STD
RESPIRATORY
NEUROLOGICAL
MUSCULOSKELETAL
HTN
HEALTH MAINTENANCE
GY/GYN
GI
ENDOCRINE
DIABETES
CARDIOVASCULAR
ADDICTION
ACUITE ILLNESS
IMPACT ON CHRONIC DISEASES PERCENT IMPROVEMENT OVER ONE YEAR
249
98
72
288
263
131
0
50
100
150
200
250
300
350
BLOOD PRESSURE 45.4%
WEIGHT 39.7% SMOKING 27.3%
NU
MB
ER O
F PA
TIEN
TS
TOTAL NUMBER
NUMBERIMPROVED
Outcomes From the Outcomes From the Diabetic ProjectDiabetic Project
Changes in Hgb A1c %96 Patients had two or more Hgb A1c tests done in
2008 showing an average drop of 1.4%
40 Patients (42%) lowered their A1c to less than 7%
47 Patients (49% lowered their A1c by 1% or more
NCN Clinic Cost Savings ToolNCN Clinic Cost Savings Tool
Piloted 2006-2007 Revised to meet Clinic
Needs CY 2008
$892,880.00$892,880.00
Neighbors Caring for Neighbors Clinics for the Uninsured
The Process of Cost Savings The Process of Cost Savings and Avoidance Measurementand Avoidance Measurement
1. NP completes Daily Sheet makes judgment re: CS/A
2. Daily Sheets entered into EXCEL spreadsheet quarterly
3. Data reviewed and reported for HFHS Community Pillar report card and to other interested
NEIGHBORS CLINIC DAILY SHEET
PT#__________ DATE:________ TIME IN_________APT:________ ADD ON:_______ WALKIN:________PROVIDER: Anne____ Denise______ Jean _____ Val___ Nadine____Suzanne:___ Dr Naughton____ Other_______ ER since last clinic visit? Yes____ NO____
TODAY’S PROBLEMS IF NEW1Dx______________________________Category
2Dx______________________________Category
3Dx______________________________Category
4Dx______________________________Category
LEVEL: A_ B_ C_ REFERRED TO:____________________
_____ER AVOIDED ____HOSPITALIZATION AVOIDED
OTHER DIAGNOSIS ADDRESSED TODAY
*** CIRCLE PRIMARY DIAGNOSIS***ACUTE ILLNESSADDICTIONCARDIOVASCULARCHFDENTALDERMATITISDIABETES: 1ST A1C_____ LAST_____EMPLOYMENT PEENDOCRINE 1ST TSH____LAST___ENTENVIRON. ALLERGIESGU/GYNGIHEALTH MAINTENANCEHEMATOLOGY
HEPATITIS: A__B__C__HTN:1ST__ _ ____STAGE_____ LAST_ ______STAGE_____HYPERLIPIDEMIAMENTAL EMOTIONALMUSCULOSKELETALNEUROLOGICALPVDOBESITY:1st_____LAST______OTHERRESPIRATORY: TX_________SCHOOL PESTDTOBACCO ABUSE 1ST_______ LAST_______TRAUMAED:_______________________
$892,880$892,880
Individual Diagnostic Group WorksheetsWorksheets were created for each Primary Diagnosis. It is on these worksheets that individual cost savings outcome data will be inserted. Below is a sample view of the worksheet tabs at the bottom of the spreadsheet. Each tab represents a different primary diagnosis. In EXCEL, each TAB (summary, ADD, CAR, DEN…) is a worksheet. Data is only entered on the worksheets, NOT the summary sheet.
REPLACE
SUMARRY CHA ADD CAR DEN DIAB END ENT GI GYN
Insert Tab Sheet - HTN
Insert Tab Sheet - Diabetes
NCNC AVOIDED CASES BY TYPE CY 2008
2%
0%
6%
92%
0%
AVOIDED IP CASES N=93 AVOIDED Therapy N=5ER VISIT N=277 Physician Office Visit N=4481Avoided Medication N=5
NCNC Cost Savings/Avoidance Dollars CY 2008
$340
$300
$113,570
$313,670
$465,000
AVOIDED IP CASES N=93 AVOIDED Therapy N=5 ER VISIT N=277
Physician Office Visit N=4481 Avoided Medication N=5
$-
$50,000.00
$100,000.00
$150,000.00
$200,000.00
$250,000.00
$300,000.00
$350,000.00
AvoidedHospitalization
ER Visits Physician office visit Total Savings
Cost Avoidance/Savings CY 2008 by Quater
1st
2nd
3rd
Total Savings: $737,590
62 10 11
163 34 38
1274
878 1080
0
200
400
600
800
1000
1200
1400
Avoided Hospitalization ER Visit Physician office visit
Cases Avoided for Other Services CY 2008 by Quarter
1st
2nd
3rd
Total: 83
Total: 235
Total: 3232
• Calculation of Cost Benefit -- NCNC Calculation of Cost Benefit -- NCNC CY 2008 Benefit: $1 Community Benefit Dollar to $2.5 Cost Avoidance to Community!
• Recruitment of Community PartnersRecruitment of Community Partners
•Reporting of Community Benefit contacts and Reporting of Community Benefit contacts and dollarsdollars
•Justification of philanthropy and operation dollarsJustification of philanthropy and operation dollars
•Evidence of benefit of clinics to community and Evidence of benefit of clinics to community and health systemshealth systems
USES OF COST SAVINGS/AVOIDANCE DATA
Hospital System of Choice DataShould be collected and shared!
• Demonstrates who (which system) clients view as their source of support
• Helpful to request support/ collaboration and partnerships for clinics
• Demonstrates where clients are likely to go for hospitalization
Thank You!
Questions?