Implement Medicaid Programs for the Reduction of Avoidable Visits to the Emergency Department BEACON Council Meeting September 29, 2010 Mina Chang, Ph.D., Section Chief Ohio Department of Job & Family Services

2 IMPROVE Collaborative Progress Report Background & Overview Children Focus Regional Collaborative Progress

3 Background  ODJFS’ external quality review organization (EQRO), Health Services Advisory Group [HSAG], conducted a program evaluation  Findings: There is no “gold standard” regarding initiatives to reduce avoidable visits to the ED ODJFS strategies were consistent with those used by other states ED utilization issues are unique to a community  Recommendation: A Collaborative Approach: working with key community stakeholders to identify issues and create quality solutions that are meaningful for the community.

44 IHI: Institute for Healthcare Improvement

5  Ohio’s overall ED utilization rates have consistently exceeded the national average National ED Utilization of All Payors

6 Classification of ED Visits  NYU Algorithm: ◦ Developed with advice of panel of ED and Primary Care Physicians (PCPs) after examination of nearly 6,000 full ED records by panel ◦ Grouped ED visits into categories:  Non-emergent  Emergent Primary Care Treatable  Emergent Preventable/Avoidable  Emergent Not Preventable/Avoidable  Behavioral Health ED Visits Without Resulting in Hospitalization

7 ED Visits by Covered Family & Children (CFC) 73% (775,846) Non-emergent ED Visits Primary Care Treatable Preventable/Avoidable Data Source: CY2008 ODJFS Administrative Data

8 Top 10 Non-Emergent/PCP Treatable/Preventable Diagnoses—CFC Data Source: CY2008 ODJFS Administrative Data

Children HospitalAB Number of Non-Emergent/ PCP treatable/ Preventable ED Visits (CFC) 45,58636,053 Percent of Regional Total Non- Emergent/ PCP treatable/ Preventable ED Visits (CFC) 27.2%33.4% Top 5 Diagnoses 1. Other upper respiratory infections 2. Otitis media and related conditions 3. Viral infectionAsthma 4. Allergic reactionsViral infection 5. Noninfectious gastroenteritis Skin and subcutaneous tissue infections 9 Data Source: CY2008 ODJFS Administrative Data

Children’s Patient Streams† – Upper Respiratory Tract Infection (URI) RegionCentralEast CentralNortheastNorthwestSouthwest Population Children - 6 months – 6 years old - CFC Children - 6 months - 6 years old - CFC Children 2-17 years old - CFC MCP For the Stream CareSourceCareSource*Wellcare*Paramount* Amerigroup Caresource Molina Health System For the Stream Nationwide Children’s Hospital* Children’s Hospital Akron University Hospital Toledo Children’s Hospital Cincinnati Children’s Hospital* Additional Definition ED visit during office hours, 3 or more visits to ED in 6 months n/a Downtown & Liberty Campuses – Separate samples 10 † Patient populations: homogeneous, well defined boundaries, and a large volume to warrant interventions * Responsible Party for Patient Follow-up Calls

11  Common Themes ◦ Number 1 facility in each region for avoidable ED visits for CFC is a children hospital or a hospital with children facility ◦ Top two diagnoses for avoidable ED visits for CFC are URI and Otitis Media, most prevalent among children ◦ All five regions chose URI for Children as a patient stream ◦ Three regions chose age group 6 mos-6 yrs old ◦ Two regions chose age group 2-17 yrs old ◦ All regions used patient census from ED/Health Systems to conduct patient follow-ups ◦ MCPs and health systems worked together to identify patients and conduct patient follow ups

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13 Developed strategies for patient stream identification and responsible parties for patient stream calls Review patient input, determine if data are actionable  Yes → develop potential strategies/solutions meaningful to these patients  No → refine patient streams, or move on to other streams Oct Follow up calls to patients post ED discharge, collect patient perspectives, analyze patient data Sep Aug Identified at least 3 patient streams as a community priority to reduce avoidable/preventable ED visits June Regional Collaborative (All Five Regions) Year 2010 Status

14 Questions? IMPROVE Contact Mina Chang, Ph.D., Chief Health Services Research & Program Development Section Bureau of Health Services Research Ohio Department of Job & Family Services Phone: Fax: