Rural Health Network Development Grantee MeetingAugust 2, 2010

Diane M. Hughes, MBA

Executive Director

Mission Statement

Access Health Adams County (AHAC)

develops, supports, and coordinates programs

to provide appropriate access to healthcare for

individuals whose access to services are limited

due to insurance status and other factors

including health conditions, health literacy, and

social issues.

Three Main Components

Community Service Link Physician Led Access Network Care Management

Community Service Link

(CSL)

CSL Statistics

27 Participating Agencies

1,477 unduplicated Adams County residents

Quarterly provider audit Ongoing user training

159 Users Quarterly User Group

Meetings 35 referrals came to

AHAC from Oct - May

Medicaider statistics

Medicaider screens Adams County residents

for eligibility into all state and federal programs.

992 Medicaider screenings 238 clients screened eligible for programs Avg. interview time: 2.17 minutes 80 users community-wide

Community Service Link (CSL)

What makes the linking system and Medicaider valuable?

Community Service Link (CSL)

How could this software pay for itself?

Community Service Link (CSL)

What is AHAC doing to make systemSustainable and valuable? Require Participation Agreements Quarterly User Group Meetings Training Sessions Weekly emails to update users Participation Certificates Executive user group meeting planned for the

Fall 2010

Physician Led Access Network (PLAN)

Physician Led Access Network (PLAN) Blessing Hospital Clinical Radiologists SIU Quincy Family Practice Center Quincy Medical Group Blessing Physician Services Dr. Ronald Wheeler Dr. Duane Hanzel Dr. James Hayashi Community Outreach Clinic

Sliding Fee Scale

FEE CODE B C D E

Patient pays: 10% 25% 50% 75%

Family size: 0-125% ofHHSPG

126-150% ofHHSPG

151-175% ofHHSPG

176-200% ofHHSPG

1 $13,537 $16,245 $18,953 $21,660

2 $18,212 $21,855 $25,498 $29,140

3 $22,887 $27,465 $32,043 $36,620

4 $27,562 $33,075 $38,588 $44,100

PLAN statistics

Over 700 Adams County residents 79 clients on waiting list Value of $1.6 million has been donated in healthcare

from May 2008 to April 2010 62% of patients have had a medical physical in the

past two years 23 new providers in 2010 Provider Satisfaction had a score of 93% in 2009 100% of AHAC patients have a primary care home

PLAN Value and SustainabilityHow do we continue participation?

Care Management Patient accountability Cost savings (ROI) Referral source for network members Assessing satisfaction Systematic volunteer opportunity for

physicians/providers Equitable distribution Ensuring patient eligibility

Care Management

Who receives care management?

All clients enrolled in the Physician Led Access Network

Activities of Care Management

Client advocacy Connecting clients to community resources Coordination of healthcare services in PLAN Follow-up after medical appointments Assistance with applications such as

MedAssist, Community Outreach Clinic, charity applications

Activities of Care Management, cont.

Facilitate Referrals to CareLink for nursing care management

Provide or connect clients with appropriate disease education

Managing client healthcare appointments and ensuring eligibility to physician offices

Provide healthcare appointment reminders

Evaluation of the Program

What are we tracking to demonstrate value? Medical appointment attendance rates Charity care for local hospital to maintain tax-

exempt status Reduction in the cost of care per member per

month Reduction in Emergency Room and Inpatient

Utilization Appropriate utilization of healthcare system

for treatment of ambulatory sensitive conditions

Medical AppointmentsFebruary 2010 – April 2010523 physician appointments

Show

No-show

Cancelled

3% 16%

81%

Blessing HospitalFinancial Assistance Applications

2008 $83,570.26

2009 $817,580.53

2010 $1,503,734.93

Value of Donated Care

1st Quarter $9,556.01

2nd Quarter $31,348.25

3rd Quarter $80,721.68

4th Quarter $206,005.86

5th Quarter $257,334.97

6th Quarter $260,823.03

7th Quarter $286,025.08

8th Quarter $412,462.14

Results of program

Value of Donated Healthcare per member per month (pmpm)

$0.00

$100.00$200.00

$300.00

$400.00$500.00

$600.00

1 2 3 4 5 6 7 8

Quarter

$530.89

$267.49

Emergency Room/Inpatient Utilization

Hospital service data collected on AHAC enrollees

Group 1 May 1, 2008 – Nov 30, 2008 41 unduplicated individuals

ER Utilization – Group 1

ER encounters 6-months prior

to AHAC

Dollars in Charges

ER encounters 6-month POST

AHAC

Dollars in Charges

23 $45,855 17 $19,078

26% reduction 58% savings

Inpatient Hospitalizations – Group 1

Inpatient stays 6-months prior

to AHAC

Dollars in Charges

Inpatient stays

6-month POST AHAC

Dollars in Charges

9 $141,343 6 $154,557

33% reduction 9% increase

Emergency Room/Inpatient Utilization

Group 2 Dec 1, 2008 – April 30, 2009 (exclusive of

Group 1 clients) 114 unduplicated clients

ER Utilization – Group 2

ER encounters 6-months prior

to AHAC

Dollars in Charges

ER encounters 6-month POST

AHAC

Dollars in Charges

104 $139,007 51 $73,237

51% reduction 47% savings

Inpatient Hospitalizations – Group 2

Inpatient stays 6-months prior

to AHAC

Dollars in Charges

Inpatient stays

6-month POST AHAC

Dollars in Charges

20 $600,606 14 $276,413

30% reduction 54% savings

Ambulatory Sensitive Care Conditions Treated at the Hospital

2005 problematic conditions

1. Congestive Heart Failure

2. Bacterial Pneumonia

3. Urinary Infection

4. Dehydration

5. Diabetes

6. Chronic Obstructive Pulmonary Disorder

7. Hypertension

Group 1

254 individual hospital charges representing ER, inpatient, and outpatient charges

14% or 36 charges represented one of the seven ambulatory sensitive care conditions

6 charges associated with ER encounters and inpatient hospitalizations

Remaining 83% or 30 charges associated with outpatient service utilization

Group 2

630 individual hospital charges representing ER, inpatient, and outpatient charges

9% or 56 hospital charges represented one of the seven ambulatory sensitive care conditions

Of interest, 4 of 56 were associated with ER encounters PRIOR to the AHAC enrollment

NONE were associated with ER and Inpatient hospitalization after enrollment

93% of those ambulatory sensitive diagnosis codes were associated with outpatient hospital charges

Healthcare Reform: Where does AHAC fit in?

Strong network has been developed AHAC is known to tailor to its clients needs Care coordination Disease Management

Future Funding

Community Meeting “Celebration” May 18, 2010

Public Relations Patient highlighted in news Newspaper articles Radio interviews TV interviews

Notice of intent to grant from local health system

Diverse funding

Resources

www.CHSDonline.com Georgia Health Policy Center Sustainability

Formative Assessment Tool