MHC Overview Approx. 3300 unduplicated BH members (all fund types - - PDF document

Emergency Department (ED) Visits

MHC Overview

 Approx. 3300 unduplicated BH members (all fund types including

NTXIXSMI, TXIX, Private Insurance, Self-Pay/Nominal Fee)

 Approx. 2500 RBHA-enrolled members

 SMI – 366 (269 TXIX, 97 NTXIX)  GMH – 1269  SU – 301  Child – 569

TXIX SMI (Who and Where)

 269 TXIX SMI Members

 Main (IHCC/CWC) - 178  Clinica Del Alma - 15  Wilmot - 53  Santa Catalina - 17  Dove Mountain - 6

2 or More ED visits

 37 TXIX SMI Members w/2+ ED Visits (as of June ‘16)

 19 w/2 ED Visits  6 w/3 ED Visits  12 w/4+ ED Visits

 Majority of 37 at our Main location (IHCC/CWC)

0% 10% 20% 30% 40% 50% 60% 70% 80% Child SU GMH SMI 56% 76% 69% 80% 44% 24% 31% 20%

Primary Care Providers – From 2016 Data

Internal Provider External Provider (302/540) (198/260) (800/1160) (284/355)

ED Utilization

Definition: This measure reports on medical use of the ED and excludes principle diagnosis of mental health or chemical dependency, psychiatry, electroconvulsive therapy, alcohol or drug rehabilitation or detoxification.

Our Aim

To decrease the average number of ED Visits by 25% for our TXIX SMI integrated population by February 1, 2017, resulting in decreased cost.

Our Cross-Functional Team

 Jon Reardon, Director of Behavioral Health  Selena McDonald, PHA  Stefanie Lockery, Clinical Director  Stephanie Speidel, RN Clinic Manager  Vickie Duran, RN Case Manager  Maria Borquez, RN Case Manager  Recovery/Dedicated Recovery Coaches/RSS  Therapists  Providers and MAs

Initial State

RC works with assigned member RC staffs member care with Supervisor General Coordination of Care with PCP Member utilizes ED RC outreach and engagement Member inconsistent use of PCP for intervention/prevention Member accesses ED for primary care concern RC outreach, reengagement and coordination efforts continue

Baseline Data

2 ED VISITS 3 ED VISITS 4+ ED VISITS COMBINED 2+

Total Cost – June 2016

6 12 19 37

$614,247.37 TOTAL COST $292,717.89 $32,129.53 $289,399.95 *Cost not solely related to ED Visits

ED Visits per Member

20 14 10 9 7 7 5 5 4 4 4 4 MBR 12 11 10 9 8 7 6 5 4 3 2 1

JUNE 2016

Selected Interventions

 Start w/members with 4 or more ED visits  Assign RN Case Management (if not already

assigned) for individualized chronic disease management and care coordination (plus chronic disease education bi-weekly provided to team)

 Consider step up from RC to DRC  Staff members bi-weekly (include PH & BH staff),

utilizing standardized tools

Hypothesis

We will experience a decline of 25% in the average number of ED visits for those with 4+ visits, for our TXIX SMI Integrated members, by August, 2016.

Initial State

RC works with assigned member RC staffs member care with Supervisor General Coordination of Care with PCP Member utilizes ED RC outreach and engagement Member inconsistent use of PCP for intervention/prevention Member accesses ED for primary care concern RC outreach, reengagement and coordination efforts continue

Current State

RC/DRC IDs Member Accessing ED Mbrs/ED usage staffed w/supervisor (1-2 ED visits) Coordination of Care is completed, records requested Mbrs/ED usage scheduled/staffed in bi-weekly Care Management for 4+ ED visits RN Case Management involved if not already Consider step up from RC to DRC ART Meeting scheduled and all stakeholders included (update ISP to reflect new services) Reviewed at following Care Management to monitor follow- through on action items, etc. Keeping in mind some ED visits are appropriate and/or cannot be avoided

6 Months of ED Visits per Member

20 14 10 9 7 7 5 5 4 4 4 4 4 15 4 4 1 1 2 2 MBR 12 11 10 9 8 7 6 5 4 3 2 1

6/16-1/17

ED Visits per Member

12 7 6 6 6 5 5 5 5 5 4 4 4 4 4 4 4 4 15 7 5 4 11 4 4 2 3 3 4 5 3 4 5 1 4 MBR 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

11/16-1/17

Risk Ranking Improved

8308 13086 PRE-INTERVENTION POST INTERVENTION

Total Risk Score Decreased

123 76 PRE-INTERVENTION POST INTERVENTION

ED Visit Decreased

113 94 89 84 ORIGINAL POPULATION (6 MTHS) ADDITIONAL IDENTIFIED MEMBERS (3 MTHS)