Presented to Florida Hospital Association WebinarFebruary 18, 2010

By

Wally Plosky, Program Director HERAPDuval County Health Department

HERAP Focus

Uninsured and low income populations.

Patients without a family physician.

Patients requiring case and disease management assistance (for diabetes, cardiovascular, pulmonary and other chronic conditions).

Patients who have trouble filling prescriptions.

Zip codes with high hospital use for Ambulatory Care Sensitive conditions.

HERAP Components

Coordination of hospital ER and inpatient referrals. Primary care medical homes. Multi-disciplinary disease management services. Free walk-in medical condition management

centers (MCMCs). Neighborhood community living rooms (CLRs). Medication assistance program (MAP). Expanded clinic hours – evenings and Saturdays. Stanford Medical School’s Chronic Disease Self

Management Program (CDSMP) - Living Healthy. Regional health information exchange (JHIN).

HERAP Staffing

RN disease managers Financial eligibility specialists Clinical pharmacologists/pharmacists Registered dietitians/certified diabetic

educators Health educators Mental health counselors Patient navigators

2009 HERAP Accomplishments

Received 2,697 client referrals from hospitals and community partners.

Connected 70% of hospital-referred patients with medical homes in the community.

Reduced emergency room utilization of HERAP-enrolled clients by 55.4%.

Reduced hospitalization of HERAP-enrolled clients by 89.8%.

Coordinated with hospitals to recoup over $1M in billable Medicaid dollars.

Helped hospitals in accessing over $75,000 in billable Medicaid under the Medically Needy Share of Cost program.

2009 HERAP Accomplishments (cont’d)

Submitted 264 medication assistance applications totaling $83,841.

Provided chronic disease management services for an average of 200 patients monthly

Conducted three 6-week Stanford Medical School Chronic Disease Self Management Programs (CDSMP), graduating 30 participants

Held 28 CLR outreach events, attended by 1007 participants, resulting in 227 HERAP enrollments

Implemented innovative technology to streamline financial eligibility for hospital-referred clients needing access to medical homes within 72 hours

Provided office space and IT support for the Duval County WE CARE program and a volunteer Project Dentists Care

Key HERAP Partners Baptist Health (BMC – Baptist South) Memorial Hospital (HCA) St. Vincent’s Medical Center (includes St.

Luke’s) Jacksonville Health Information Network

(JHIN) DCHD Institute for Public Health Informatics

and Research (IPHIR) Agape Community Health Center Network

(Co-Applicant public entity FQHC with DCHD) WE CARE, Inc.

HERAP Referral Sources

Hospitals/ ERs

Community physicians

Self referral I M Sulzbacher

Communityoutreach

Agape CHCNetwork

HERAP

DCHDprograms

Community partners

Volunteers in Medicine We Care

HERAP Referrals by ZIP Codes

>40

30-3924-2910-23<10

Duval County HERAP Cost Effectiveness Review

Objectives Evaluate the impact of HERAP’s comprehensive

multi-disciplinary disease management and medical home program on:

Emergency room utilization In-patient hospital admissions/stays

Evaluate the effectiveness of a health information exchange in monitoring HERAP effectiveness (Jacksonville Health Information Network – JHIN)

Measure the effectiveness of a multi-hospital partnership model with individual hospital-specific program elements

Duval County HERAP Impact Analysis

Methods/Procedures Data set stratification

521 uninsured patients formally enrolled in HERAP’s disease management program with at least one emergency room visit or one in-patient admission

January 1, 2009 – September 30, 2009 “Before and after” utilization rate comparison

Time bounded: 180 days immediately prior to and following HERAP admission

Duval County Hospital Emergency Room Alternatives Program (HERAP) Impact Analysis

Emergency room visits Reduction: 55.5% Projected six month savings:

$176,490

Hospital in-patient admissions Reduction: 89.8% Projected six month savings:

$4,324,260

Resources Our Partner Hospitals Want for Their Discharged Patients

Assistance with non-compliant clients. Primary care medical home. Prescription access. Chronic disease care and case

management. Knowledge of available community

resources and how to connect clients to those resources.

Dental access. Behavioral health and substance abuse

services.

HERAP Contact Information

Hospital Emergency Room Alternatives ProgramDuval County Health Department MC-92

900 University Blvd. N., Suite 202Jacksonville, FL 32211Tel: (904) 253-1444Fax: (904) 745-3005

http://www.dchd.net/herap.htm

Wallace B. Plosky, MBA, Program AdministratorWally_plosky@doh.state.fl.us

Brenda Bernardez, MSN, Project DirectorBrenda_bernardez@doh.state.fl.us