1 SPRING 2014 REDUCTION OF EMERGENCY DEPARTMENT ADMISSIONS UNDER THE MAINECARE MANAGEMENT...
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Transcript of 1 SPRING 2014 REDUCTION OF EMERGENCY DEPARTMENT ADMISSIONS UNDER THE MAINECARE MANAGEMENT...
1S P R I N G 2 0 1 4
REDUCTION OF EMERGENCY DEPARTMENT ADMISSIONS UNDER
THE MAINECARE MANAGEMENT COLLABORATIVE
4
THE APPROACH
Hospitals Primary Care
Emergency Personnel
Community Care
Behavioral Health
State Agencies
9
Schedule AppointmentArrange Ride
Send Letter
Close Case, Inform Hospital
Establish PCP
Identify Member
Check Eligibility
Verify PCP
No
Pull Patient Data
Send LetterNoContact MemberNo
Review Case
Yes
Contact Providers
Contact Member No
Discuss ED UsageIdentify Barriers
INITIAL PROCESS
Yes
Yes
Yes
Yes
10
VARIATIONSIdentify Member
Review Case
Yes
Presents in ED w/Anxiety Dental Pain, Infection
Report to Providers
Contact BH Providers
Offer to Coodinate Care
Partner w/Community Outreach to Home
Partner w/Hospitals on placement
Coordinate w/local Dentist
Partner w/Hospital and Dental community for
referral and treatment plan
Arrange Transport
Report to Providers
Behavioral Health Dental Health
Partner for Affordability
11
Meet w/Hospital and PCP office Care Managers
No
FOLLOW-UP PROCESS
Discuss Findings, set goals
Close case and monitor useED visit in past 4 months
Notify All Providers
Formulate Next Steps
Troubleshoot w/Providers No Community MeetingYes
Contine to Manage
13
LOWER TOTAL COSTS
December 2011
Tracking Begins
*Data courtesy of Wendy Waltz, MaineCare
November 2012 – May 2014Intervention Interval
14
FEWER ED VISITS
*Data courtesy of Wendy Waltz, MaineCare
December 2011
Tracking Begins
November 2012 – May 2014Intervention Interval
15
BETTER OUTCOMES
Robert Wood Johnson Foundation: Caring for Health Care’s Costliest Patients 15
Before After
CareMgmt
Mobility problems
Weight problems Hearing-loss No support Frequent ED
trips Hospitalization Missed
appointments
KVCCT Walking program Meals on Wheels Free hearing
aids Arrange
transport
17
NEXT STEPS
• Pilot an Admission/Readmission initiative with 2 pilot hospitals
• Partner with APS to identify members in need of services
• Enhance and improve reporting to hospitals• Increase in-home member contact• Partner with Community Care Teams and Partner
in Wellness• Implement the MaineCare member lock-in
program