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1
Indigent Care CollaborationHIE Supports Community Collaboration
February 9, 2007February 9, 2007Ann Kitchen Executive DirectorIndigent Care Collaboration Austin, Texas804-2090 ext.201 [email protected]
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:
0
5
10
15
2003 4 2 1 1
2004 10 0 1 0
2005 11 0 6 5
2006 2 0 0 3
ER Inpatient out-patient clinic
5
ICC Regional Membership
Medical Residency
Hospital District
HospitalSystems
FQHCs Clinics
Health Depts
Medical Society
MHMR
School of Nursing
Williamson County
Travis County
Hays County
6
2006 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
Exhibit 4:
Demographic Characteristics of Uninsured and Underinsured Patients Visiting Indigent Care Collaboration (ICC) Providers in 2005
Female Male All
All Patients
Number of Patients (%) 1 121,188 (61.7) 75,176 (38.3) 196,442 (100.0)
Race / Ethnicity % African-American Caucasian
Hispanic / Latino Other 2 Unknown / Not specified
11.6 36.3
39.9 1.7
10.4
12.3 29.0
43.2 1.2
14.2
11.9 33.5
41.2 1.5
11.9
Number of Patient Visits n (%) 1 403,309 (67.8) 191,130 (32.1) 594,685 (100.0)
Average Encounter Rate 3 3.3 2.5 3.0 1. Some numbers may not be additive across rows due to a small number of patients with unspecified gender that are included in the last column. 2. ‘Other’ includes American Indian / Eskimo, Asian /Pacific Islander and Multi-Racial. 3. Gender disparity persisted after correcting for encounters related to pregnancy and reproductive health.
18
Ratio of ED Visits to Overall VisitsExhibit 6:
Emergency Department Encounters as a Percentage of All Encounters for Uninsured and Underinsured
Patients Accessing Care through Indigent Care Collaboration (ICC) Providers in 2005, Stratified by
Age, Gender and Race
0-17 Years 18-44 Years 45-64 Years ≥ 65 Years
Gender 1
Female 33.6 17.2 15.3 4.5
Male 38.0 48.1 21.7 5.5
Race / Ethnicity
African American 50.3 38.0 19.2 3.3
Caucasian 45.2 25.1 20.4 7.0
Hispanic Latino 29.0 15.0 12.6 3.4
Other 2 37.0 11.8 10.5 4.2
Unknown 48.1 46.7 27.8 11.1
1 Gender difference persisted after correcting for encounters related to pregnancy and reproductive health. 2 ‘Other’ includes: American Indian / Eskimo, Asian American / Pacific Islander and Multi-Racial.
19
Patients with ED Encounters OnlyExhibit 5:
Pattern of Emergency Department (ED) Utilization by Uninsured and Underinsured Patients Attending Indigent
Care Collaboration (ICC) Providers in 2005, Stratified by Age and Gender
Age Band (Years) 0-17 18-44 45-64 ≥65 All
PATIENTS WITH ED ENCOUNTERS ONLY
Number of Patients (%)1
Female 10,352 (40.6) 12,535 (49.1) 2,368 (9.3) 262 (1.0) 25,517 (100.0)
Male 11,164 (37.4) 15,809 (52.9) 2,700 (9.0) 201 (0.7) 29,874 (100.0)
All 21,516 (38.8) 28,344 (51.2) 5,068 (9.1) 463 (0.8) 55,391 (99.9)
Patients with ED Encounters only as a % of All Patients with Encounters
Female 31.2 18.1 17.0 7.1 21.2
Male 34.7 53.5 25.2 10.7 40.2
All 32.9 43.4 20.5 8.3 28.4
1 Some percentages across rows may not add to 100.0, due to rounding.
20
Differences in ED Use by Payer
0.00
10,000.00
20,000.00
30,000.00
40,000.00
50,000.00
60,000.00
70,000.00
80,000.00
90,000.00
100,000.00
Uninsured Commercial Medicaid Medicare
Payer
Vis
it r
ate
per
100
,000
po
pu
lati
on
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.
01234567
12 Months Prior to CaseClosure
12 Months After CaseClosure
ED Visits Clinic 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
24
00
5
10
15
20
25
9/ 1/ 06 11/ 1/ 06
Asthma 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
53
10
0
10
20
30
40
50
60
9/1/06 11/1/06
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:
0
5
10
15
2003 4 2 1 1
2004 10 0 1 0
2005 11 0 6 5
2006 2 0 0 3
ER Inpatient out-patient clinic
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 78741.
Mapping by Census Tract
32
Value of Prescription AssistanceICC Prescription Assistance Program
Cumulative***
Total number of applications sent 41,880
Total unduplicated patients who applied for PAP meds* 4,916
Total number of prescriptions filled 30,031
Total unduplicated patients receiving PAP meds* 3,599
Total # patients served by multiple locations 269
Cumulative***
Total AWP Value of PAP Meds** $9,031,756 * This number may include a small number of duplicates from patients who were seen by more than one site and were given separate patient numbers.
** 2 ICC members do not always verify that patients received drugs; therefor, # prescriptions filled, # pts who received meds, and AWP values are under-reported.
*** Cumulative data represents all the data from the inception of the shared ICC database in MDS in June of 2004, up until the end of this reporting period