1S P R I N G 2 0 1 4

REDUCTION OF EMERGENCY DEPARTMENT ADMISSIONS UNDER

THE MAINECARE MANAGEMENT COLLABORATIVE

2

ROADMAP

The Approach

How it Works

Results

Next Steps

Goals and Barriers

3

ROADMAP

The Approach

How it Works

Results

Next Steps

Goals and Barriers

4

THE APPROACH

Hospitals Primary Care

Emergency Personnel

Community Care

Behavioral Health

State Agencies

5

ROADMAP

The Approach

How it Works

Results

Next Steps

Goals and Barriers

6

GOALS

Before After

CareMgmt

7

BARRIERS

Can’t contact

Homelessness

Substance Abuse

Behavioral Health

Blackballed

Voluntary

GOAL

8

ROADMAP

The Approach

How it Works

Results

Next Steps

Goals and Barriers

9

Schedule AppointmentArrange Ride

Send Letter

Close Case, Inform Hospital

Establish PCP

Identify Member

Check Eligibility

Verify PCP

No

Pull Patient Data

Send LetterNoContact MemberNo

Review Case

Yes

Contact Providers

Contact Member No

Discuss ED UsageIdentify Barriers

INITIAL PROCESS

Yes

Yes

Yes

Yes

10

VARIATIONSIdentify Member

Review Case

Yes

Presents in ED w/Anxiety Dental Pain, Infection

Report to Providers

Contact BH Providers

Offer to Coodinate Care

Partner w/Community Outreach to Home

Partner w/Hospitals on placement

Coordinate w/local Dentist

Partner w/Hospital and Dental community for

referral and treatment plan

Arrange Transport

Report to Providers

Behavioral Health Dental Health

Partner for Affordability

11

Meet w/Hospital and PCP office Care Managers

No

FOLLOW-UP PROCESS

Discuss Findings, set goals

Close case and monitor useED visit in past 4 months

Notify All Providers

Formulate Next Steps

Troubleshoot w/Providers No Community MeetingYes

Contine to Manage

12

ROADMAP

The Approach

How it Works

Results

Next Steps

Goals and Barriers

13

LOWER TOTAL COSTS

December 2011

Tracking Begins

*Data courtesy of Wendy Waltz, MaineCare

November 2012 – May 2014Intervention Interval

14

FEWER ED VISITS

*Data courtesy of Wendy Waltz, MaineCare

December 2011

Tracking Begins

November 2012 – May 2014Intervention Interval

15

BETTER OUTCOMES

Robert Wood Johnson Foundation: Caring for Health Care’s Costliest Patients 15

Before After

CareMgmt

Mobility problems

Weight problems Hearing-loss No support Frequent ED

trips Hospitalization Missed

appointments

KVCCT Walking program Meals on Wheels Free hearing

aids Arrange

transport

16

ROADMAP

The Approach

How it Works

Results

Next Steps

Goals and Barriers

17

NEXT STEPS

• Pilot an Admission/Readmission initiative with 2 pilot hospitals

• Partner with APS to identify members in need of services

• Enhance and improve reporting to hospitals• Increase in-home member contact• Partner with Community Care Teams and Partner

in Wellness• Implement the MaineCare member lock-in

program

18

QUESTIONS