1. R5 Initiative Improving Access to the Right Care in the Right Place at the Right Time for the Right Reason at the Right Cost Project Overview February 2010

2. The Problem Disparate system Inadequate level and use of primary care Sub-optimal patient engagement

3. Examples of Gaps in Patient Flow Primary care doctor does not receive emergency room record Patients don’t have primary care medical home Medicaid enrollees must wait to choose primary care physician Patient engagement sub-optimal – such as calling the ambulance to get a ride to ER to fill Rx for nebulizer

4. Project Goals / Outcomes Causes of sub-optimal ER utilization identified Promising practices identified and widely adopted Patient & provider engagement increased through collaborative interventions resulting in better health outcomes

5. Examples of Promising Interventions CHF management (NE Health) Diabetes management program (Seton) Asthma coaches (CDPHP) Patient navigators (Ellis) Physician incentive program to see new Medicaid enrollees (Fidelis) CHOICES program (St. Peter’s) Etc.

6. Target Population: Sub-optimal ER Suboptimal ED Use  Non-emergent  Frequent flyers  Preventable and chronic illness Individual Forces  Knowledge of health resources  Work conflicts  Transportation  Social support Health System Forces  Primary care availability  Referral policies  Support services  Intake/discharge policies  Inter-organizational communication The R5 Initiative Improving Access to the Right Care in the Right Place at the Right Time

7. Methods of Analysis Non-emergent, preventable ED Utilization Analysis – By payer mix, disease category, geography, age, time of admission, etc. using SPARCS data Consumer Service Selection Study – Patient surveys, focus groups, provider contacts System Analysis – Patient communication and care coordination policies

8. Project Structure HCDI Board of Directors Staff Health Services Workgroup Executive Committee Data Analysis Workgroup CON Workgroup

9. Project Products Community health assessment – Non-urgent emergency department (ED) utilization analysis – Gap & root cause analyses of target populations – Analysis of provider barriers related to target populations Menu of recommended best practices Patient-level care utilization initiative Provider & payer ED utilization initiative Policy paper on the CON process