1 NYS Balanced Incentive Program (BIP) Innovation Fund Urgent Care for People with I/DD Terri Seppala President, Telehealth Associates, Inc. ACA Urgent Care Project Director 2 Ur DOH/OPWDD awarded $2.6 million to Advance Care Alliance to pilot innovative urgent care program Brooklyn, Queens, Bronx, Staten Island, Nassau & Suffolk Counties Our goal is to enroll 2,000 Individuals by March 31, 2016 Currently we have 1,104 enrolled IRAs Both Supervised and Supported Family Care People living at home ISS/CSS NO ICF Creates a system of urgent care services to reduce reliance on hospitals and emergency rooms Services began March 2015 and continue through March 31, 2017 Does not replace MSCs, Residential Nurses or other existing providers Is NOT long term care management No cost to agencies or participants BIP Grant Award 3 Visiting Home Nurses (Urgent Care Team) 24/7 Call Center Urgent Care Model for I/DD: An integrated system of services Remote Patient Monitoring Patient Activation Measurement Immediate Clinic Care with Transportation Quality Care At Night and Weekends Mobile Crisis Team Team Health Call Center Mobile Crisis Unit Instructions for home PCP/Article 28 walk-in clinic appointments same day with transportation Call 911 In-home Urgent Care Teams under Article 16 license DDI UCP Suffolk FREEHealthCare Choices AdvantageCare Physicians EEDA FREE IRI FREE DDI Block 24/7 Medical/Behavioral Triage Call Center 4 5 UCT Home Visit Responsibilities 6 pm -10 pm weeknights 10 am-6 pm weekends Perform Clinical Assessment and Behavioral Assessments Initiate intervention based on findings Contacts supervising physician for medical consults Notify Residence Nurse/PCP of encounter Determine most appropriate telehealth equipment for individual Coaching Individuals for Activation based on PAM score Respond to Urgent Care Needs within 90 Minutes of Alert Thermometers BP Monitors Wireless Scales Pulse Oximeters Kiosks Stethoscopes Glucose Meter Adapters Cellular Modems Telehealth Devices Adapted for I/DD Population Interactive Voice Response 6 Description Opti-Healthcare Population Hypertension1 Lipid Disorders2 Upper Resp Infections3 General Medical exam4 Diabetes Mellitus5 Dermatitis6 Impacted Cerumen7 Hypothyroidism8 Reflux esophagitis9 Allergic Rhinitis10 Back Pain11 Asthma12 General Convulsive Epilepsy13 Urinary Tract Infections14 Otitis Media15 Constipation16 Dermatophytosis17 Pharyngitis18 Edema19 Conjunctivitis20 BP Monitors Glucose Meter Adapters Interactive Voice Response USING TELEHEALTH TO MONITOR MOST COMMON MEDICAL CONDITIONS Patient Activation Measure PAM measures the knowledge, skills, and confidence necessary for activation with 95% accuracy PAM measures the knowledge, skills, and confidence necessary for activation with 95% accuracy Activation: Four segments along a continuum Overwhelmed & disengaged Becoming aware, but still struggling Taking action Maintaining behaviors and pushing further Level 1 Level 2 Level 3 Level 4 Medicaid: 52% to 60% in the lower two levels. Urgent Care Enrollees: 57%-69% 10 The Language of Activation-Level One I dont understand the cause I just know I was told I have diabetes My doctor takes care of me Find me a (pain management) doctor 11 The Language of Activation-Level Four I have to be my own advocate when it comes to my health My doctor can only do so much. I have to manage my health it has to be a team effortthe patient needs to be proactive about it Helpful Resources Tools available to help you enroll individuals you serve Link to videos, flyers, FAQs and Talking Points for Discussion with Potential Participant and/or Family:2-Minute Introductory Videos to Show Family Also available on YouTube at:Link to Digital Enrollment Packet:12