1. Emanuel Medical Center Case Management By: Deadre Hadden, RN

2. Emanuel Medical Community Case 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 1 st year. 382 patients enrolled in Case Management since 2000.

3. What are the benefits for the hospital? Decrease in re-admissions. Decrease in unnecessary ER visits. Patient compliance. Healthier community.

4. Why are patients referred? Non-compliance of medical treatment Frequent ER visits Education New diagnosis Diabetes Education Medication non-compliance Medication assistance

5. 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

6. Assistance for Case Management Patients 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

7. Continued 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

8. What is tracked financially? Emergency Room visits Emergency Room charges In-Patient visits In-Patient charges Out-Patient visits Out-Patient charges

9. 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.

10. Actual Charges for the Patients in Case Management

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

12. Prior year to implementation of Case Management Actual Charges 14 ED visits - $19,395 10 Inpatient stays - $110,615 4 Outpatient visits - $6,636 Total prior year charges: $136,646

13. Charges after 1 Year of Case Management 9 ED visits - $4,510 2 Inpatient stays - $19,284 4 Outpatient visits - $4,265 Total charges for year 1: $28,059

14. 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

15. 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

16. 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

17. 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

18. 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.

19. Clinical tracking Hemoglobin A1c Total Cholesterol Gestational Diabetes/Birth Wt Any pertinent lab values

20. Clinical Results Hemoglobin A1c Initial HbA1c 10.6 Current follow-up HbA1c 8.37

21. Clinical Results Initial Total Cholesterol 230.29 1 st follow-up Total Cholesterol 202.33

22. Clinical Results Average birth weight at EMC of neonates born to Gestational Diabetic mothers 6.96 lbs. (The national average is 9.1lbs.)

23. 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.

24. Our 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.

25. Since 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.