CENTER FOR INTEGRATIVE MEDICINECENTER FOR INTEGRATIVE MEDICINE

R. Corey Waller MD, MS, FACEP, ABAMDirector, Center for Integrative MedicineMedical Staff Chief, Division of Pain ManagementMedical Staff Chief, Division of Pain ManagementSpectrum Health

TERMSSuper Utilizer (SU) person with greater than 10 visits to Super Utilizer (SU)- person with greater than 10 visits to SH system ED’s in one year

System SuperUtilizer (SSU)- person with greater than Syste Supe Ut e (SSU) pe so w g ea e a 10 visits to any ED in one year

Primary Psych- patient who’s use of the ED revolves d th i hi t i di iaround their psychiatric diagnosis

Primary Medical- patient who’s use of the ED revolves around their medical issuesaround their medical issues

Primary SUD- patient who’s use of the ED revolves around their substance use issues

Direct Cost- money actually paid for the patient

THE NUMBERSSU’s

950 individuals per year20,000 visits per year, p y$50,000,000 in direct cost per year (includes MH/SUD treatment)

SSU’s2000 individuals per year (Kent County, 635K pop.)35,000 visits per year$87,500,000 in direct cost per year (includes MH/SUD treatment)$87,500,000 in direct cost per year (includes MH/SUD treatment)

State wide extrapolation based on population29 000 individuals per year29,000 individuals per year600,000 ED visits per year (total state ED visits 4,493,665, 455/1000 pts)$1,500,000,000 in direct cost per year (includes MH/SUD treatment)

THE BREAK DOWN

10-19 visits per year (62%)Mostly medical70% are transient HFUs (1 year only)

20-29 visits per year (28%)Mostly combination of medical, SUD and PsychHowever, trends toward SUD85% are consistent HFUs (more than 1 out of every 4 years)

30 or greater visits per year (10%)Mostly psychiatric95% are consistent HFUs (more than 1 out of every 4

)years)

CLINIC CONCEPT

Center for Integrative MedicinegComprehensive bio-psycho-social evaluationRisk reduction model of careNo firing of patients no contractsNo firing of patients, no contractsCare guides, Michigan Automated Prescription System (MAPS) check other systemsTake over care from PCP and specialists for time in Take over care from PCP and specialists for time in the clinic. Write all perscriptions and order all tests.

Outcomes from random patients (1st 100 pts)73% showed for first visit73% showed for first visit89% kept follow-up appointmentsGreater than 65% reduction in visits

k f h i di l b ll Works great for the primary medical, but not as well for the SUD and Psych until care plans are added

WHO OWNS THE EMPLOYEES

Physician, APP, Medical Assistant (x4), office y , , ( ),manager, (0.5 FTE) research assistant and administrative assistant are employed by Spectrum HealthSpectrum HealthLMSW x 2 are employed by Network180 (Kent County community mental health organization)Healthier Communities collaborative effort between hospitals (mainly spectrum health) and has case managers and CHWhas case managers and CHW

PAYMENT MODEL-EPISODE OF CARE

Pilot with local payer, episode of care for 1 yearLevel 1 patient $1000L l 2 ti t $1900Level 2 patient $1900Level 3 patient $3000

Total cost of the Clinic$850,000/yearSelf pay is 12-16%W 450 i We can see 450 new patients per year (will most likely increase)

So 400 paying patients x average $1900 = $760,000Leaving $90,000/year (currently covered by Spectrum)g , y ( y y p )

Spectrums payer has saved close to $500,000 in first year

Spectrum Health has shown a 3.2 million year over year decrease in charges for patients seen in CIM

COMMUNITYCONNECTIONS

Healthier Communities

Core Health

HIPPA

Metro

S it M 'Health Information

E hCHW

GRCC

Saitn Mary's

Community Clinics

Medical Practices

Exchange

CIMCommunity Medicine

Patient Needs

Housing

Transportation

Job Training

SHMG

Private

FQHCs

Job Training

General Stability

Food Pantry

Elder Care

Payer Relations

Priority HealthEmergency Departments

BC/BS-Michigan

Michigan Medicaid

Butterworth

Blodgett

Metro

Community Mental Health

Pine Rest

Arbor Circle

Saint Mary's Cherry Street

MHPs

CURRENT OUTCOMES

Reduction in ED visits at 6 months for the 20 or greater visits per year group is over 65%

Reduction for the 10-19 visits per year group is around 80%

Most difficult patients are those with a significant chronic illness (DM, Crohn’s, etc) and axis 2, cluster B disorder such as boarder-line personality disorder3 million dollar decrease in charges over 1 year3 million dollar decrease in charges over 1 year