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

2. 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

3. 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

4. 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)

5. 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

6. 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

7. 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

8. 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

9. Questions and Discussion