Alaska ER Project Speakers Anne Zink, MD, FACEP Board certified - - PowerPoint PPT Presentation

Alaska ER Project

• Anne Zink, MD, FACEP
• Board certified emergency physician at Mat-Su Regional
• Alaska Chapter ACEP President
• Becky Hultberg
• ASHNHA President/CEO
• Connie Beemer, PMP
• ASHNHA Program Officer

Speakers

Why the AK ER Project?

• Increasing health care costs

Why the AK ER Project?

Graphs from ISER presentation: http://www.iser.uaa.alaska.edu/Publications/presentations/2016_02_02-AnIntroductionAKFiscaFactsChoices.pdf

• Decreasing state budget

• Need for a better design
• Medicaid Redesign Meetings held at the end of 2015
• Recommendations based on groups input and actuarial

reporting

Why the AK ER Project?

5

Learning from Others: Washington State Model

Goal was to save $30 Million dollars - $34 saved the first year! 9.9 percent reduction in overall ED Medicaid visits 10.7 percent reduction among frequent utilizers. 14.2 percent low-acuity visits dropped 24 percent, reduced narcotic prescriptions from the ED Better patient care!

Washington Seven Best Practices

1. Adopt an electronic emergency department information system 2. Implement patient education 3. Institute an extensive case management program 4. Identify frequent users of ED 5. Develop patient care plans for frequent users of ED 6. Implement narcotic guidelines to discourage narcotic-seeking behavior and monitor patients who are prescribed controlled substances 7. Track progress of the plan to make sure steps are working

What about Alaska? - 2012 data

What about Alaska? - 2012 data

2012 HIDI discharge data (Mat-Su not included)

What about Alaska? - 2012 data

2012 HIDI discharge data (Mat-Su not included)

The average yearly charge total for patients

• < 5 visits was $14,235/year
• 6-9 visits $20,790/year
• >10 visits $45,385/year

A closer look

• Partnership between State, ACEP, and ASHNHA
• About SB 74
• Could have positive impact for all patients, not just

Medicaid

Background and process resulting in SB 74 Hospital Based ER Project

Alaska’s ER Project

(1)an interdisciplinary process for defining, identifying, and minimizing the number

• f frequent users of emergency department services;

(2) to the extent consistent with federal law, a system for real-time electronic exchange of patient information, including recent emergency department visits, hospital care plans for frequent users of emergency departments, and data from the controlled substance prescription database; (3) a procedure for educating patients about the use of emergency departments and appropriate alternative services and facilities for nonurgent care; (4) a process for assisting users of emergency departments in making appointments with primary care or behavioral health providers within 96 hours after an emergency department visit; (5) a collaborative process between the department and the statewide professional hospital association to establish uniform statewide guidelines for prescribing narcotics in an emergency department; and (6) designation of health care personnel to review successes and challenges regarding appropriate emergency department use.

Implement electronic ED information system

• Information pushed to providers with pertinent information and used

to provide efficient and safe care

• Emergency departments will receive flags identifying high utilizers
• The information system will reduce unnecessary medical tests
• It will provide access to care/treatment plans
• The system does not create any new legal right to information. If an

information request is for the purposes of providing immediate treatment, HIPAA permits disclosure of information to another provider.

• System demonstrations begin June 20

Goal: Exchange patient information among Emergency Departments

An example of the electronic record possibility

Identify frequent users

• This project will…

– Define – Identify – Minimize the number of frequent users of emergency department services

Goal: Ensure hospitals know when they are treating a frequent patient and treat accordingly

Patient Education

• Active distribution of educational materials
• Partnership with primary care providers
• ACEP/ASHNHA/AK DHSS collaborative approach to education
• Discharge instructions

Goal: Help patients understand and use appropriate sources of care

Primary Care & Behavioral Health Coordination

• Contact the primary care provider when frequent patient visits

the ED

• Make efforts to schedule an appointment with the primary care

provider within 96 hours when appropriate

• If no appointment required, notify primary care provider that a

visit occurred

• Relay barriers to care coordinators
• Use care plans

Goal: Create a process for assisting users of EDs in making appointments with primary care or behavioral health providers within 96 hours

• Implement statewide guidelines for prescribing and monitoring
• f narcotics
• Direct patients to better resources
• Track data and follow up with providers who excessively

prescribe

• Integrate ED information system and Prescription Drug

Monitoring Program (PDMP)

Goal: Reduce drug-seeking and drug-dispensing to frequent ER users

ED Narcotic Guidelines

• Get patient feedback
• Monitor and report on ER utilization trend
• Designate ER leader and quality manager to receive, review, and

act on utilization management reports

• Involve executive-level leadership
• Report successes and challenges to Legislature and other

stakeholders

Goal: Review reports, ensure interventions are working, make improvements

Review Successes and Challenges

Goal: Move from fee-for-service towards value

Shared Savings

As providers look at moving from a volume-based system to one based on value, the ability to engage in shared savings and other forms of risk is important for us to understand moving forward.

https://www.healthcatalyst.com/

Ultimate Goal

• Improve patient care via timely, coordinated care in the emergency

department

• Reduce over all health care cost by minimizing redundancy and

improving care

Participating Organizations

• American College of Emergency Physicians

– Alaska Chapter

• Alaska State Hospital and Nursing Home

Association

• State of Alaska – DHSS
• Alaska eHealth Network
• Alaska Primary Care Association
• 673d Medical Group, JBER
• Alaska Native Medical Ctr
• Alaska Regional Hospital
• Bartlett Regional Hospital
• Central Peninsula Hospital
• Fairbanks Memorial Hospital
• Mat-Su Regional Medical Ctr
• North Star Behavioral Health
• NorthStar Behavioral Health
• Providence Alaska Medical Ctr
• Providence Kodiak Island Medical Ctr
• South Peninsula Hospital

More to come as we broaden stakeholder engagement!

• Many groups doing great work
• Break down silos
• Here to support the work many of you are already doing
• Please get involved
• Broke things into 3 parts:
• Education
• IT
• Care Coordination
• Next meeting: June 20 vendor demonstrations at ANC Neighborhood Health Center

4951 Business Park Boulevard Room 301 from 8 am – noon.

• Care Coordination and Narcotics Guidelines meetings beginning in August
• September 7 tentative project meeting

Next Steps

Questions?

AK ER Project Contacts:

Anne Zink, MD annezink@gmail.com

Connie Beemer, ASHNHA Program Officer

connie@ashnha.com 907-646-1444