Emergency Department Disposition Support Program Overview EM Grand Rounds March 10, 2016

Shift toward value-based contracts is motivating delivery changes Blue Cross Blue Shield of Michigan’s Value Base Care Initiative (VBK) Supports hospital and physician partner efforts to improve the delivery of integrated and coordinated care for their shared patient populations HFHS prioritization of the ICC population HFHS actively soliciting ACO business in the last year (Reliance) HFHS is now entering the ACO arena itself with the Next Gen ACO Significant upside and downside risk

Opportunity to reduce inpatient stays To reduce observation and inpatient admissions from the ED, need to: Offer outpatient resources to ED physicians Coordinate the delivery of resources selected by ED physicians ED Disposition Support Program designed to meet these needs

Proposed EDS program Pilot at Henry Ford Hospital New staff member—“Navigator”—embedded in ED Investigates available outpatient resources Discusses resources with ED physician and coordinates use of selected resources EMT complements skillsets of other team members (e.g., medical social worker)

High-level EDS workflow ED staff alerted of patient’s Next Gen ACO or HAP MA status upon opening chart Asked to discuss case with Navigator if patient may benefit from outpatient resources / possibly avoid an admission ED staff alerted again when admission request made Alerts align with proposed process for Reliance ACO EDS-specific iPAS physician involved if case fails admission criteria 4-way call between ED physician, EDS iPAS physician, Navigator, and ATMO nurse

Navigator “toolbelt” Navigator Toolbelt Urgent PCP/ specialist appt ED Physician EDS Navigator Appt with RN diabetes educator Patient Navigator Toolbelt Amb case management ED Care Team Home Health referrals SNF direct admit Community paramedic visits

Navigator toolbelt Urgent ambulatory appointments Schedule appointment with PCP or specialist Appointment with Advance Care Center when appropriate Ambulatory case management Update case manager or arrange case management Appointment with RN diabetes educator Schedule appointment ACCs provide comprehensive tertiary care services to medically complex, high-risk patients Team-based model Smaller panel sizes Ability to treat acute exacerbations of chronic conditions on site

Navigator toolbelt Home Health referrals & SNF direct admits Expedite urgent referrals to Home Health Care Facilitate direct admissions to skilled nursing facilities Next Gen waiver Community paramedic visits Paramedic visits patient in the ED, shortly after discharge, and maintains stability until next ambulatory appointment Build on Readmission Avoidance Program piloted at Wyandotte in 2015

Questions and Discussion