Maria X Martinez 1. Urgent/Emergent Care and challenge 2. HUMS - - PowerPoint PPT Presentation

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Nov 12, 2022 290 likes •491 views

Maria X Martinez 1. Urgent/Emergent Care and challenge 2. HUMS hypothesis 3. High users, multiple systems, and multiple domains of disorders 4. Was FY 11-12 different? 5. IDS goals: 1. Targeted Street Outreach (EST) 2. Coordinated Case

SLIDE 1

Maria X Martinez

SLIDE 2

1. Urgent/Emergent Care and challenge
2. HUMS hypothesis
3. High users, multiple systems, and multiple

domains of disorders

4. Was FY 11-12 different?
5. IDS goals:

1. Targeted Street Outreach (EST) 2. Coordinated Case Management 3. Ambulatory Acuity Index

SLIDE 3

Medical System

 EMS transports  ED medical  Inpatient – 24hr  Medical Respite (hospital

ffset)

 Urgent care clinics at

TWHC, hospital

*Programs in red are the only ones studied in other communities.

Psychiatric Sytem

 PES, Dore St (PES offset)  Psych Inpatient – 24hr  Adult Diversion Units

(hospital offset) – 24hr

 Crisis clinics at Westside,

Mobile Crisis Substance Abuse System

 Sobering Center  Res Medical Detox – 24hr  Res Social Detox – 24hr

SLIDE 4

 “High Users of Multiple Systems”  2007 study showed common features for high

ambulance users: costly, multi-disordered, receiving care in multiple service agencies, unknown to individual systems, not sticking to any stabilizing services, and no care coordination.

 HUMS Hypothesis: Coordinated care,

supported by integrated data, can be an effective intervention to reduce costs and improve health outcomes.

SLIDE 5

 $200 million annual urgent/emergent care

estimated actual costs

 50,000 – 55,000 unique individuals served

annually

 Top 1% of individuals account for 25% of

costs.

 Top 5% account for 55% of costs.

SLIDE 6

Summary of FY 10-11

# Patients Total Costs % Total Costs Ave Cost/Pt Ave # Svcs Top 1% 511 $49,793,566 25% $97,443 89 Next 2 - 5% 2,078 $58,527,401 30% $28,165 30 Remaining 95% 49,207 $88,187,508 45% $1,792 2.5 Totals 51,796 $196,508,475 100%

SLIDE 7

Number patients in each group, FY 10-11

Any 1 sys Any 2 sys All 3 sys totals Ave Top 1% HU 199

175

137 511 Next 2-5% HU 1,009 800 269 2,078 Remaining 95% 46,344 2,654 209 49,207 Totals 47,552 3,629 615 51,796

HUMS 312

SLIDE 8

Average Urgent Care Cost per Individual FY 10-11

Any 1 sys Any 2 sys All 3 sys totals Ave Top 1% HU $94,375 $98,148 $101,000 $97,443 Next 2 - 5% HU $27,311 $28,281 $31,028 $28,165 Remaining 95% $1,584 $4,913 $8,308 $1,792 Totals n/a n/a n/a

HUMS

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FY 10-11 1 sys 2 sys 3 sys TotAve FY 11-12 1 sys 2 sys 3 sys TotAve

Top 1% 86 90 93 89 Top 1% 85 91 92 89 Next 2 - 5% 29 30 33 30 Next 2 - 5% 28 30 33 30

HUMS HUMS No, average number services per urgent care patient is same.

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FY 10-11

1 sys 2 sys 3 sys TotAve

FY 11-12

1 sys 2 sys 3 sys TotAve Top 1% HU $94,375 $98,148 $101,000 $97,443 Top 1% HU $104,365 $82,862 $57,488 $85,449 Next 2-5% HU $27,311 $28,281 $31,028 $28,165 Next 2-5% HU $32,073 $21,367 $17,703 $26,498

HUMS HUMS

Yes, average cost per patient decreased for multi-system users, but increased for single system users.

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 Ambulatory Acuity Index  Targeted Outreach  Coordinated Case Management

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Multiple Systems 1 system 2 systems 3 systems SA Psy Med SA-Med SA-Psy Psy-Med Tri Totals Top 1% HU

143

44 6 125 137

511 Multi-disorders measured by Elixhauser Co-morbidity Index Domains* Diagnosis in 1 Domain Co-Morbidity Diagnosis Tri- Morbid No Elix SA Psy Med SA- Med SA-Psy Psy- Med Totals Top 1% HU 12 5 8 52

81 63 58 232

511

* 0 Domains usually means the patient received urgent care services for acute, resolving condition; not chronic, progressive condition

SLIDE 13

 30 diagnostic measurements add together to

form final score.

 Even a single positive response predicts early

mortality if untreated.

 All conditions are progressive without

treatment.

 Most conditions are chronic. They can be

ameliorated and stabilized with treatment.

 Some conditions are acute. They can be cured

with treatment.

SLIDE 14

Circulatory System Cardiac Arrhythmias Valvular Disease Congestive Heart Failure Hypertension, Uncomplic. Hypertension, Complic. Peripheral Vascular Dis. Pulmonary Circulation Dis. Digestive System Liver Disease Peptic Ulcer Disease, Excl Bleeding Endocrine System Diabetes, Uncomplicated Diabetes, Complicated Obesity Weight Loss Hypothyroidism GenitoUrinary System Renal Failure MusculoSkeletal System Rheumatic Arthritis / Collagen Vascular Disease

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Hematology System Deficiency Anemia Blood Loss Anemia Coagulopathy Fluid and Electrolyte Disorders Neurological System Paralysis Other Neurological Disorders Respiratory System Chronic Pulmonary Disease Cancer Solid Tumor w/o Metastasis Metastatic Cancer Lymphoma Immune System AIDS/HIV Psychiatric Disorders Psychoses Depression Substance Use Disorders Alcohol Abuse Drug Abuse

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 SFHOT Engagement Specialist Team  Targeted street outreach with the goal of more

effectively engaging and placing HUMS into care (warm handoffs and follow-up)

 24-hr schedule  Covers grid based upon CCMS knowledge of

ambulance pickup histories

 Responds to 311, police, EMS for street intervention  Transportation to & from urgent/emergent facilities

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 Current:

HUMS Clinical Case Conference – monthly
EST

 Planned:

Central call-in line for EDs to consult with EST and

RNs at Sobering Center (use of CCMS)

Addition of electronic case coordination tools

including provider communication and oversight of “community care plan”

EST assist in finding patients who were engaged with

case managers but have been “lost to follow-up”