“Reducing Avoidable ER Vi it ”ER Visits”

Dr. Michael Weiss Medical Director

Quality & Performance ImprovementMonarch HealthCare

9/28/111

AgendaAgenda

Building on CQC Efficiency Collaborative learningslearnings

Creating the internal infrastructure

Supporting physicians through resources and actionable data

Patient education outreach effortsPatient education outreach efforts

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Monarch HealthCareMonarch HealthCarePhysician NetworkPhysician Network

1,600+ Specialists700+ Primary Care Physiciansy24 Employed Hospitalists15 Employed ambulatory physicians/PAs

Member Network105,000 Commercial31,000 Medicare31,000 Medicare24,000 Medi-Cal13,000 Healthy Families25,000 PPO ACO

Health Plan ContractsCurrently contracted with all major plans in Southern

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major plans in Southern California

CQC Efficiency Collaborative (2008)CQC Efficiency Collaborative (2008)

A replicable model for improvement– Multi‐department collaboration

– High visibility and accountability

A l i i i d– Analyze variation in data

– Engage network physicians in the improvement processin the improvement process

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Focus Group ModelFocus Group Model

Validating the problems / identifying the solutionsIssues identified:– Access/availability of / y

urgent cares– Patient knowledge deficit– Misaligned incentives– Lack of “real time” ER

notification– Support for high-risk

patients5

Building the Internal SupportBuilding the Internal SupportER STEERING COMMITTEEER STEERING COMMITTEE

Set goals and monitor progressReview health plan programs and updatesPrepare progress reports for health plan meetings Prepare progress reports for health plan meetings Direction work groups as needed; address barriers

Member Physician Urgent Care Education

ySupport

gStrategy

Reporting Hospital

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Reporting Hospital

Physician StrategiesPhysician Strategies

1:1 visits to identify “root cause” of ER use– Review variation chart– Access opportunities– Resources for complex

patients– Urgent care options

Actionable data is key– Monthly ER reports– Semi-annual ER bonus

reports7

ER Utilization ReportState Objectives & Be Purposeful

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ER Utilization ReportIdentify Performance, Targets & Trends

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ER Utilization ReportFocus on the Opportunities

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ER Utilization ReportProvide Additional Resources

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Member StrategiesMember Strategies

Post-ER follow up callsInformation on accessing appropriate care– Urgent care brochures – New member welcome

guide– monarchhealthcare.com

Wh t T D Wh Y – What To Do When Your Child Is Sick book

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Urgent Care Collaboration PilotPersonalized Patient Magnets

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ER Utilization Goes DownER Utilization Goes Down10%

0%

10%

-10%

Commercial Senior Medi-Cal Total

-20%

-30%

-50%

-40%

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ER Utilization Before vs. After(Mailer)

ER Utilization Before vs. After(No Mailer)

Urgent Care Utilization Goes UpUrgent Care Utilization Goes Up50%

40%

50%

20%

30%

0%

10%

-10%

0%

Commercial Senior Medi-Cal Total

-30%

-20%

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Urgent Care Visits Before vs. After(Mailer)

Urgent Care Visits Before vs. After(No Mailer)

SummarySummary

Success requires a multidisciplinary approach to taking ownership and fostering collaboration –“Our Project Team”This can be resource intensive but ROI is highActionable data is KEYIncorporating physicians in the improvement Incorporating physicians in the improvement process is the fast track to getting buy-in Patient ed cation and engagement reall orks!Patient education and engagement really works!Don’t neglect working on your approach to the physician conversation!

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Questions?Questions?

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