John W. Robinson, MD, SM VP Medical Affairs & Chief Medical Officer Molina Healthcare of Washington, Inc. Reducing Preventable ER Visits April 19, 2011

Creating Community Partnerships and Data Planning between Hospitals and Health Plans

3 Molina Healthcare of WA (MHW), a managed care health plan, provides a wide range of quality health care services to families and individuals who qualify for government-sponsored programs, including Healthy Options, the Children's Health Insurance Program (CHIP), Basic Health+, Basic Health, WMIP and Medicare. Over 350,000 members are covered in Washington. MHW also operates two primary care clinics in Snohomish County.

The Problem 4 Molina members go to the ER over 15,000 times each month. Based on the NY Algorithm calculations, 55% of these ER visits are preventable.

Medical Management Initiatives Reduce ER Utilization Full Range of initiatives Low High # of Members High Low ED Use Consistent Care Program PR&C - lock down Case management – high ER users Outreach calls after ER visits using eCensus from hospitals Provider Initiatives and Partnerships Member welcome packets with ER reduction info to provider groups ACO with 2 large provider groups After Hours Nurse Advice Line message on provider answering service ER e Census from 10 hospitals Frequent ER Use Member Letter with Urgent Care Provider List, Quarterly Redirect members to Urgent Care by Nurse Advice Line IVR Nurse Advice Line Telephone Commercials to all ER users within 48 hours of ER visit. Daily files from PBM Nurse Advice Line available to all Molina members Booklet sent to all Member Households: "How to Take Care of Your Sick Family."

Medical Management Initiatives The Top of the Pyramid

Molina Healthcare of Washington wants to partner with hospitals serving Molina Healthcare members to receive daily census and ER information in a secure electronic format (“eCensus” data). eCensus data is used to: Improve turn-around time and accuracy of admission notification Ease the administrative burden on facility staff by eliminating time spent printing and faxing daily census Quickly identify Molina Healthcare members with potentially avoidable emergency department visits who might benefit from Molina Healthcare education and outreach efforts Started in CY2010 eCensus Background

HOLY FAMILY HOSPITAL KADLEC MEDICAL CENTER KENNEWICK GENERAL HOSPITAL MOUNT CARMEL HOSPITAL PROV EVERETT MED CTR PROVIDENCE CENTRALIA HOSPITAL PROVIDENCE ST PETER HOSPITAL SACRED HEART MEDICAL CENTER SEATTLE CHILDRENS HOSPITAL ST JOSEPH HOSPITAL OF CHEWELAH VALLEY MEDICAL CENTER HOSPITAL Current Hospitals Live on eCensus

eCensus Flow Chart

Pilot: eCensus data from 10 Hospitals Data fields transmitted to Molina daily: 1.Patient name 2.DOB 3.Policy number 4.Admission date 5.Discharge date (for I/P) 6.Status (active, discharged or blank) 7.Patient type (EMR, I/P, or OBO) 8.Admission Diagnosis 9.Unit 10. Patient phone 11. Adm Source (floor in hospital) 12. Adm physician

RESULTS Sample Data: January 2011 # of ER visits in eCensus data: 1673 # of f/u phone calls completed to those members: 716 # of members with scheduled f/u: 360 # of members assigned to CM/DM: 85 # of members contacted who refused assessment: 4

Questions and Comments

Presenter Contact Information John W. Robinson, MD, SM VP of Medical Affairs & Chief Medical Officer Molina Healthcare of WA Ph: