1 February 9, 2007 Indigent Care Collaboration HIE Supports Community Collaboration February 9, 2007 Ann Kitchen  Executive Director Indigent Care Collaboration  Austin, Texas ext.201 

2 Introduction to the ICC

3 ICC Mission Affordable access to effective healthcare for the uninsured in central Texas. ICC initiatives designed to give safety net providers collaborative tools  to undertake initiatives together  that none could do as effectively alone  that result in increased revenues or reduced costs  in providing health and mental health care to low income patients

4 Asthma Patient Utilization History 44 year old male, height: five foot ten, weight: 205 with BMI of 29.4 History of asthma and type II Diabetes In the I-Care database since 5/14/2002 Pharmacist started working with patient on 12/28/05 Resource use, before and after Pharmacist intervention:

5 ICC Regional Membership Williamson County Travis County Hays County

Regional Priority Projects ICare Capacity Building Project  PECSYS Care Coordination Project  RWJ Connecting Public Health Project Primary Care Capacity Report Affordable Health Insurance Project Clinical Pharmacy Case Management Respite Care Project

7 ICC Initiatives and Data Emerge Program Seton Nurse Hotline Katrina Help Line and Evacuee Data Regional Emergency Department Study Eligibility Screening – Medicaider and MedData Proxy Pricing Methodology

8 HIE Information

9 ICare Vision Goal - fully operational, physician and user friendly System containing timely and complete data sufficient to support two primary uses – program evaluation and clinical care. Aggregate Health Data Supports: Shared Health History Supports: Program Evaluation and Grant Requests Population Research / Planning including Regional Care Profiling Managing Chronic Conditions / Diseases Physicians in Understanding and Improving Clinical Care

10 I-Care System Two different databases (MPI/CDR & PECSYS), each with a different focus, that can talk to each other. MPI/CDR includes a shared health history for all patients of demographic, encounter (diagnosis, procedures), pharmacy and other clinical data. PECSYS includes a more detailed level of clinical data for a subset of case managed patients, including lab data, referrals, care planning information and more.

11 ICare Shared Health History ICC Members share patient demographic, encounter, pharmacy and other data electronically with the ICC through HIPAA compliant Business Associate Agreements. Master Patient Index/Clinical Data Repository created using Application Service Provider. Aggregate data available for all patients. Providers access individual shared health records after authorizations are signed and in system. No duplicate data entry required.

12 47 locations: 13 hospitals, 31 clinics, 1 Mental Health Authority, 2 Physicians Networks. 628,312 patients (uninsured / underinsured) 2.5 Million encounters, from 2002 – present. 426,298 prescriptions. Data includes ICD-9, CPT-4, Provider, Payer Encounter Types: Inpatient, Outpatient, ED, Lab, Call Center, Clinic Visits, Prescriptions ICare Snapshot December 2006

13 HIE Supports Collaboration Support collaborative initiatives with data Identify problems Measure results Improve communication Calculate value and community benefit of collaboration

14 HIE Supports Accountability HIE data = broader picture to measure results and calculate community value Data uniquely supports sophisticated outcomes analysis:  Measure patient-specific utilization patterns over time  Factor in cost shifting across community systems  Compare costs for program enrollees to control groups  Design program evaluation to determine effectiveness

15 Attacking Fragmentation What’s missing - integration of medical management across safety net system Using data for community-wide care coordination  Identify patients that benefit from care coordination  Standardize interventions, data collection, measures  Share information to improve care  Measure results and calculate community benefit

16 Data Analysis Examples

17 Demographic Characteristics

18 Ratio of ED Visits to Overall Visits

19 Patients with ED Encounters Only

20 Differences in ED Use by Payer Population-Adjusted Emergency Department Encounter Rates for Travis County Patients by Payer, 2005 Note: Population data from the 2005 U.S. Census Bureau report were applied to the ICC 2006 ED report data for patients with a Travis County zip code to obtain an estimate of the ED encounter rate by payer per 100,000 population. Source: Charting the Future: Recommendations for Increasing Access to Primary Care for Central Texas Residents, Report of ICC Primary Care Capacity Team, February 2007

21 Trends in Health Care Utilization by Patients Completing EMerge Program Health care utilization by a subset of 160 patients who had their cases closed b/w 1/1/2005 and 3/31/2005 was reviewed using ICare data. In the twelve months prior to their case being closed, these patients averaged 6.3 clinic visits and nearly 3 ED visits per person for non- mental health related diagnoses. In the twelve months following case closure, the number of clinic encounters declined to an average of 4.5 encounters / person while there was a 16 % reduction in ED visits. During CY 2005, the EMerge program counselors saw 2,373 patients for a total of 5,243 encounters, or an average of 2.2 encounters per patient.

22 PharmCare Preliminary Results:  Snapshot of the results for 50 patients from reporting period of 9/1/06 to 11/30/06  Change in the number of Inpatient Admissions

23 PharmCare Preliminary Results:  Snapshot of the results for 50 patients from reporting period of 9/1/06 to 11/30/06  Change in the number of Emergency Room Visits /1/0611/1/06 Change in ER encounters

24 Asthma Patient Utilization History 44 year old male, height: five foot ten, weight: 205 with BMI of 29.4 History of asthma and type II Diabetes In the I-Care database since 5/14/2002 Pharmacist started working with patient on 12/28/05 Resource use, before and after Pharmacist intervention:

25 I-Care Encounter History 2005/2006

26 I-Care Encounter History 2005

27 I-Care Encounter History 2005/2004

28 I-Care Encounter History 2004/2003

29 I-Care Encounter History 2003/2002

30 Mapping Emergency Visits 2005 Ten Zip Codes: Highest volume of self pay (uninsured) ED visits; and Highest rates of potentially preventable ED visits per NYU algorithm Source: Charting the Future: Recommendations for Increasing Access to Primary Care for Central Texas Residents, Report of ICC Primary Care Capacity Team, February 2007

31 Census tract level analysis, comparing utilization, chronic conditions, demographic and other relevant data - Can be useful in informing efforts to address barriers and needs re primary care access at the neighborhood level. Example: I-Care ED Visits b/w 8am and 6pm by Adult Patients (18-64) with a Diagnosis of Hypertension, in 2005, by Census Tract within Zip Code Mapping by Census Tract

32 Value of Prescription Assistance