1. Santa Cruz County Project Connect Measuring Cross-System Outcomes for Enrolled Frequent Users - Methods and Findings to Date 9/28/2006

2. Outcomes Measured zPost-enrollment change in service utilization for the following settings/services: y2 Hospital Emergency Departments xChange in number of ED visits and related charges y2 Hospital Inpatient Units xChange in number of admissions, and number of inpatient days and related charges

3. Outcomes Measured y1 Hospital Inpatient Behavioral Health Unit xChange in number of inpatient days and related charges y Ambulance Services (County served by one ambulance company) xChange in number of transports yCounty Detention Services xChange in number of jail bookings and number of days incarcerated

4. Outcomes Measured zAlso measuring: zChanges in housing status: yCounting number of enrolled individuals entering permanent housing zChanges in benefits status: yCounting number of enrolled individuals qualifying for Soc. Sec. Disability benefits with a new link to Medi-Cal

5. Methodology zCollect data on service utilization for each enrolled client from each setting/service for the 12-month period prior to enrollment zCollect post-enrollment service utilization data from each source at 3-month intervals

6. Methodology zCompare 12-month pre-enrollment service utilization (averages for cohort) to: yAnnualized post-enrollment service utilization for cohort of all enrolled yPost-enrollment 12-month service utilization for 2 smaller cohorts: 1) those who have been enrolled at least 12- months, and 2) those who have been enrolled at least 24-months

7. Methodology zData Collection Methods: yHospitals: We provide medical record numbers for each enrolled client back to hospitals and they provide us an updated data base with post-enrollment visits and admissions yAmbulance: County EMS program supports ambulance service data base that we are able to access directly

8. Methodology zJail Data: Health Services Agency is provided access to jail data base for relevant time periods zAnnualizing: yExample: yTotal potential days pre-enrollment year = 365 yTotal post enrollment days for cohort = 455 y365/455=.80 yPost-enrollment ambulance transports 466 x 365/455= 374 yCompare 836 transports during 12 mo. Pre-enrollment to 374 transports (annualized) post-enrollment = 55% reduction

9. Methodology zCharges and Cost: yAn average charge-to-cost ratio across 2 hospitals was calculated Spring ‘06. Ratio is used to convert charges to estimated cost yAn average cost per booking and jail day was provided by the Sheriff yCharges for ambulance services are based on cost and an average pt. Charge is calculated by AMR each month

10. Findings to Date zLast data analysis completed includes service utilization through June 30, 2006 zN = 86 individuals enrolled

11. 51% FEWER JAIL BOOKINGS/COST REDUCTION

12. 12 37% DECREASE IN JAIL DAYS/HOUSING COSTS

13. 55% DECREASE IN AMBULANCE RUNS

14. DECREASES OF 56% AND 37% IN NUMBER OF ED VISITS AT RESPECTIVE HOSPITALS

15. 51% AND 47% DECREASE IN HOSPITAL INPATIENT DAYS AT RESPECTIVE HOSPITALS

16. TOTAL ANNUAL REDUCTION IN INPATIENT CHARGES DOMINICAN: $1,310,512 WATSONVILLE: $1,471,050 46% AND 52% REDUCTION IN INPATIENT CHARGES AT RESPECTIVE HOSPITALS

17. Example of Different Methodology Presenting ED Visit Data Clients enrolled at least 12 months Compare 1 year pre to 1st year post Clients enrolled at least 24 months Compare 1 year pre to 2nd year post

18. Project Connect Estimating Costs from Charges at 2 Hospitals Total Cost Reduction as of March 2006 Inpatient Total Costs Prior and Since $1,561,238 Total Days Prior and Since 753 Cost/Day $2076 Inpatient Total Days Prior 469 Total Days Since 283 Reduction: 186 Inpatient Cost/Day $2076 x 186 Days = $386,136 ED Total Costs Prior and Since $400,864 Total Visits Prior and Since 946 Cost/Visit $424 ED Total Visits Prior 634 Total Visits Since 312 Reduction: 322 ED Cost/Visit $424 x 322 Visits = $136,528

19. Intensive Service Model for Frequent Users Requires a Bigger Investment, but Produces Significant Annual Savings