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Indigent Care CollaborationHIE Supports Community Collaboration

February 9, 2007February 9, 2007Ann Kitchen Executive DirectorIndigent Care Collaboration Austin, Texas804-2090 ext.201 akitchen@icc-centex.org

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Introduction to the ICC

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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

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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

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ICC Regional Membership

Medical Residency

Hospital District

HospitalSystems

FQHCs Clinics

Health Depts

Medical Society

MHMR

School of Nursing

Williamson County

Travis County

Hays County

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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

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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

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HIE Information

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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

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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.

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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.

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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

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HIE Supports Collaboration Support collaborative initiatives with data

Identify problems

Measure results

Improve communication

Calculate value and community benefit of collaboration

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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

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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

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Data Analysis Examples

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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.

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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.

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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.

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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

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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.

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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

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00

5

10

15

20

25

9/ 1/ 06 11/ 1/ 06

Asthma Inpatient Admissions

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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

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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

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I-Care Encounter History 2005/2006

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I-Care Encounter History 2005

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I-Care Encounter History 2005/2004

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I-Care Encounter History 2004/2003

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I-Care Encounter History 2003/2002

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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

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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

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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