Emanuel Medical Center Emanuel Medical Center Case ManagementCase Management

By: Deadre Hadden, RNBy: Deadre Hadden, RN

Emanuel Medical Community Case Emanuel Medical Community Case Management History:Management History:

• Program started May 2000.

• Program started to target the costly uninsured “frequent flyers” of ER.

• Programs initial “frequent flyer” charges reduced $112,586.94 in the 1st year.

• 382 patients enrolled in Case Management since 2000.

What are the benefits for the What are the benefits for the hospital?hospital?

• Decrease in re-admissions.

• Decrease in unnecessary ER visits.

• Patient compliance.

• Healthier community.

Why are patients referred?Why are patients referred?

• Non-compliance of medical treatment

• Frequent ER visits

• Education

• New diagnosis

• Diabetes Education

• Medication non-compliance

• Medication assistance

What does the case manager do?What does the case manager do?

• Initial home visit

• Education

• Screening for needed services

• Transportation to appointments

• Frequent phone calls

• Home visits as needed

• Food drives

Assistance for Case Management Assistance for Case Management PatientsPatients

• A small food bank was established• A handicap van was purchased to

transport patients to various services• Coordinated care with Primary Provider• Individualized care plan• Individualized health education• Blood glucose testing machines and strips

ContinuedContinued

• Free medication through Prescription Assistance Programs

• Screening for the following services:– Medicaid– Food Stamps– Energy Assistance– Meals on Wheels– Access Emanuel– Transportation to Appointments– DFACS Caseworker

What is tracked financially?What is tracked financially?

• Emergency Room visits

• Emergency Room charges

• In-Patient visits

• In-Patient charges

• Out-Patient visits

• Out-Patient charges

How does this work?How does this work?

After being referred into the program, a home visit is scheduled. The date of the home visit is the initial assessment date. Hospital information is collected on the patient for 1 year back. This is their prior year information which is used as a baseline to determine progress.

Actual Charges for Actual Charges for the Patients in the Patients in

Case ManagementCase Management

Patient SuccessPatient Success

The most successful patient was a The most successful patient was a 26 year old female with Diabetes 26 year old female with Diabetes Mellitus Type 1 with complications Mellitus Type 1 with complications of depression, blindness, of depression, blindness, neuropathy and gastroparesis. She neuropathy and gastroparesis. She was uninsured. With the assistance was uninsured. With the assistance of Case Management she was of Case Management she was approved for Medicaid.approved for Medicaid.

Prior year to implementation of Prior year to implementation of Case Management Case Management

Actual ChargesActual Charges• 14 ED visits - $19,395

• 10 Inpatient stays - $110,615

• 4 Outpatient visits - $6,636

• Total prior year charges: $136,646

Charges after 1 Year of Case Charges after 1 Year of Case ManagementManagement

• 9 ED visits - $4,510

• 2 Inpatient stays - $19,284

• 4 Outpatient visits - $4,265

• Total charges for year 1: $28,059

Case Management Year One (1)Case Management Year One (1)

• Prior Year Charges - $782,777

• Case Management charges - $414,439

• 76% of the patients experienced reductions in charges at Emanuel Medical Center

Case Management Year Two (2)Case Management Year Two (2)

• Prior year charges - $575,291

• Case Management charges - $421,185

• 64% of the patients experienced reductions in charges at Emanuel Medical Center

Case Management Year Three (3)Case Management Year Three (3)

• Prior year charges - $685,263

• Case Management charges - $386,834

• 71% of the patients experience reductions in charges at Emanuel Medical Center

Case Management Year Four (4)Case Management Year Four (4)

• Prior year charges - $1,033,774.34

• Case Management charges - $622,827.27

• 70% of the patients experienced reductions in charges at Emanuel Medical Center

What is the criteria to be referred?What is the criteria to be referred?

• The patient must be under the care of a Physician on Emanuel Medical staff.

• The patient must have a chronic health condition.

Clinical trackingClinical tracking

• Hemoglobin A1c

• Total Cholesterol

• Gestational Diabetes/Birth Wt

• Any pertinent lab values

Clinical ResultsClinical Results

Hemoglobin A1c

• Initial HbA1c 10.6

• Current follow-up HbA1c 8.37

Clinical ResultsClinical Results

• Initial Total Cholesterol 230.29

• 1st follow-up Total Cholesterol 202.33

Clinical ResultsClinical Results

Average birth weight at EMC of neonates born to Gestational Diabetic mothers

6.96 lbs.

(The national average is 9.1lbs.)

Other Components:Other Components:

Prescription Assistance programs

Most pharmaceutical companies offer

free medications to individuals that do not have prescription insurance and

financially qualify based on the Federal Poverty Guidelines.

Our Rx Assistance ProgramOur Rx Assistance Program

• Individual must see a participating physician in Emanuel County.

• Individual must have no prescription drug coverage.

• Individual must provide proof of income.• Medications are ordered by the Case

Management Department and shipped to the physicians office where they are dispensed.

• Case Management is responsible for reorders.

Since 2001Since 2001

• $6,124,791.12 in retail value of prescription medications given to the uninsured of Emanuel County.

• 827 individuals served since inception of program.