Transylvania Regional Hospital

Health Resources Navigation Program

Navigate-To Steer; To Travel; To find one’s way and keep one’s course

Program Mission:

To identify uninsured, low-income Transylvania county residents that frequently utilize the emergency department for non-emergent, or acute care as a result of complications from chronic medical conditions, and connect them with a medical home, medication assistance, financial assistance and any other community services that will contribute to their overall wellness and disease management.

Program Criteria:

Uninsured residents of Transylvania County between the ages of 18 to 64 at or below 200% of the federal poverty level who come to the Emergency Department at least three times in a six month period.

Program Procedures and Policies:

Potential clients for the Health Resources Navigation Program will be identified by:

Report abstracted from Medical Records Daily ED reports from previous day’s

patients Referrals from the ED staff

Program Referral Process:

Contact potential clients from abstracted list by phone

Meet with potential clients in the ED when appropriate

Weekly meeting with ED staff to review list of potential clients

Weekly meeting with financial counselors

Program Enrollment:

Intake Eligibility determined Release and Agreement signed ID card issued Medical Provider assigned Appointment scheduled if necessary Community agencies contacted

Follow-up and Tracking System:

Ancillary Care for clients will be scheduled through Navigator

Follow-up with Community Resources Client status, progress and ancillary care

tracked on database

Program Policy:

Enrollment good for one year unless circumstances change prior to anniversary date

Adherence to Patient and Pain Management Agreement or client is disenrolled from program

If client is disenrolled medical provider’s point person contacted and client receives certified letter

Measurements of Success

Health Improvements: Decreased visits to

ED Patient compliance

with primary care Disease management

Financial Improvements: Decreased bad debt Decreased overall cost

of care for targeted patients

More efficient & appropriate usage of the ED

Patient profile: 6 Month Snapshot

Most common diagnoses:– Dental problems– Acute URI– Abdominal pain, headaches, bronchitis

296 patients = 1665 visits in 6 months Average # of visits per patient: 5.6

Consistent Primary Care = one key

Primary care can lead to successful disease management

AND

Overall wellness is achieved by identifying additional issues impacting healthcare and connecting the individual with resources to address those needs

Primary Care Keys:

TRH Physicians Free Clinic Etowah MAP (Medical Access Plan) Francis Ward Health Service Local Physicians

Many more hidden “keys” in the community Alliance Counseling Services for Substance

Abuse and Mental Health Center for Women-Crisis pregnancy Children’s Center-Victim Assistance Fund American Red Cross-Community

Education, CPR for Everyone and First Aid WCCA’s Self-Sufficiency and SavingsPlus

Better Care Management = Healthcare Efficiencies Annual targets have been set

– 100 patients in full “navigation” – 100 patients receiving secondary navigation

service – Reduce uninsured ED visits among targeted

patients by 300

This is new – potential is very real. We will monitor closely and adjust efforts as needed.

Snapshot of potential efficiencies: 100 patients

Patient Average Charge

Average # of Visits/Year &

Total Charge/Patient

Emergency Department

(before enrollment)

$450/visit(excludes ancillaries)

12 visits/year

$540,000

Navigation patient in

Primary Care $120/visit

(excludes ancillaries)

4 visits/year

$48,000

Transylvania Regional Hospital:

Health Resources NavigationProgram

2008-2009 Results

Annual Targets Set for First Year: 100 patients in full, Primary Navigation 100 patients receiving Secondary

Navigation-those they don’t fit criteria, but receive resources

Reduce uninsured ED visits among targeted population by 300

October 1, 2008-September 30, 2009Results: 98 patients in Primary Navigation 94 patients received Secondary Navigation Uninsured ED visits among targeted

population reduced by 311 visits

October 1, 2008-September 30, 2009

Total number of patients navigated in Primary Navigation- 98 (Target was 100)

Total number of ER visits of these 98 patients six months prior to Navigation-422

Average number of visits per patient: 4.3 Total number of visits after primary

navigation-106 visits-average 1 per patient

Secondary Navigation Results:

94 people who had a total number of 155 ER visits prior to receiving resources

After receiving resources these people had a total of 85 visits

Total of 114 referrals made which included community agencies and other departments of the hospital needing resources for someone

Participant ED visits:

Total # of visits

Six months prior to enrollment

Average # visits

Per patient

Total charge for visits in 6 months prior to enrollment*

422 4.3 $257,420*Excludes ancillaries

Secondary Navigation ED Visits:

Total # of visits to ED prior to receiving resources

Total # of visits to ED after receiving resources:

Total charge for visits before and after receiving resources:

155 85

Before:

$94,550

After:

$51,850

Participant PCP/ED Visits:

Total # of PCP visits since enrollment

Total # ED visits since Enrollment

Average # of visits per enrolled patient since enrollment

Total charges for visits since

Enrollment(Does not include ancillary)

324 97

ED: 1

PCP: 3.3

ED:

$59,170

PCP:

$41,200

Charge Comparison for PrimaryNavigation PatientsTotal ED charge for patients 6 mos. Prior to enrollment:

Total charge for patients 10/1/08-9/30/09:

Variance

(System-wide):

$257,420

@$610 per visit

(no ancillary)

$152,121.31

(includes ancillaries)

$105,298.69 plus secondary:

Total Savings: $153,608.65

Additional Measures:

10 participants enrolled in Medicaid1 participant got private insurance through her employer

Who do we thank?

Dr. Frederick Bahnson-donated consults,discounted procedures

Dr. Leland Berkwits-discounted rates Dr. Carmello Hernandez-donated consults Dr. Gerald Martin-seeing patient Dr. Dale Nash-advisory role, seeing patient Dr. Minerva Pinerio-seeing patient Dr. Emily Sawyer-advisory role

And more… Asheville Radiology-for discounts Asheville Cardiology-for donated echocardiograms Brevard Racquet Club-a 6 week scholarship Children’s Center of Transylvania County-Victim

Assistance Fund for counseling Carolina Mountain Gasroenterology-for a consult PML Lab for donating all pap smears to Navigation patients Toxaway Charities-Medications, diagnostics, labs and

specialty care for Dr. Buehler’s patients who are Toxaway residentsAll the scheduling people and office staff in the practices for fitting patients in that would have otherwise gone to the ED

What have we learned?

To be more aware and discerning when interviewing potential Navigation patients in relation to chronic pain issues

Educating potential clients more about the limitations of the program (Specialty care)

More reminders to clinical assistants about what resources are low cost or free to the uninsured such as pap smears at the health department, discounted medications,etc.

What’s Next?

Meeting with other area providers of the uninsured to brainstorm about a regional approach to specialty care

Transitioning Navigation clients after their first year of care into the Patient AssistanceProgram

Emphasis on preventative approach and secondary navigation in ED during first or second visit

Targets for Primary and Secondary Navigation 2010

Primary Navigation October-September 2009-2010:

25 new patients enrolled as of 6/22/10

Target for 2010:

50 new enrollees

Secondary Navigation October-September 2009-2010:

332 patients seen and given resources in the ED during first or second visit as of 6/22/10

Target for 2010: 300 patients

Any Questions?

Thank you again!

Di Ucci, MA Ed., LPN

Transylvania Regional Hospital

260 Hospital Drive

Brevard, NC 28712

828-885-5732 ducci@trhospital.org

828-883-5111 Fax