Improving Health Outcomes through Faith-Based and Community Partnerships:
Best Practices from Health Systems in the Field
Tracking Data and EvaluationMaking the Case for Community Partnerships
Ameldia R. Brown, M.Div., BSN, RN -Co-FacilitatorDirector, Faith & Community Health, HFMH
[email protected] - 586.263.2119
U.S. Department of Health and Human Services200 Independence Avenue, SW
Washington, DCFebruary 16-17, 2012
Cost Savings and Avoidance:•A Process for Tracking•A Tool for Measuring•An Indicator of Community Benefit
•Wise Use of Dollars•Evidence of Improved Client Centered Outcomes
Faith Community NursingDemonstrates GoodStewardship of CommunityBenefit Dollars Through CostSavings and Cost Avoidance
Ameldia R. Brown, MDiv, BSN, RN; Patricia Coppola, RN; Marian Giacona, RN; Anne Petriches, RN, OTR; Mary Ann Stockwell, MSW, BSN, RN
Family & Community HealthVol. 32, No. 4, pp. 1–9Copyright c_ 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
MEASUREMENTSCost Avoidance/Savings• Hospitalizations #s• Hospitalizations Dollars Saved• Hospital Days #s• Hospital Days Dollars Saved• ER Visits #s• ER Visits Dollars Saved• Physician Visits • Physician Visit Dollars Saved• Miscellaneous & DME
FAITH COMMUNITY NURSING/HEALTH MINISTRY NETWORK OF HFMH
A Network of Faith Community Nurses & Other Health Ministry Workers:•FCNs/HMs meet professional practice standards•Must meet Network standards•May be unpaid or paid by congregations•Ministries belong to the congregation•Written/formal agreements in place to partner•Participate in at least one Network project per year
www.fcndocumentation.com
A Typical Story• Patient on new antihypertensive 3 days. • Reporting dizziness and lightheadedness. Bilateral
tingling in hands. • Refused to go to ED. Medications reviewed. BP taken
lying, sitting, and standing. Orthostatic hypotension noted.
• Physician contacted. Following orders given: bed rest foreight hours, hold next dose of medication. Bp checked q 4 hrs Xs two. Next day, Bp in normal ranges. Symptoms gone.
• New med held for 3 days based on parameters given by physician. Medication discontinued.
• ED visit prevented. Because of the history that the FCN knows: Hospitalization (potential medication overdose) and/or potential fall related to hypotension prevented.
A Typical StoryPatient unable to afford prescriptions and therefore only takes cardiac and antihypertensives in half doses. Heart failure (HF) poorly controlled and patient is unable to leave the house because ofatigue and SOB. Referred to patient medication assistance program facilitated by HFMH.
Meds obtained. After six months of taking full dosesof medications and FCN coaching in managementof HF, the patient is now able to go shopping unattended. Quality of life improved. Nursing homeor hospital placement prevented.
Data Entry Sheet
Summary Sheet
Summary SheetPart 2
Cost Benefit Ratio1 : 1.96
($225K : $441K)
Cost Savings & Avoidance Comparison of the Average of Three Networks to
HFMH FCNN CYs 2008 to 2011
FCN CS/A CYs 2004-2011
$-
$50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
CY2004 CY05 CY06 CY07 CY08 CY09 CY10 CY11
HFMH FCNN/Health Ministry Cost Savings and Avoidances to the Community*
*Includes decreased ED, Hospital, Physician Office visits, Nrg Home placements, medication, DME and other out of pocker expenses.
j
# Individuals Readmitted
% Clients Readmitted
DRG Reimbursement for Hospital Stay
# Occurrencesof Admissions for any Diagnosis
% Difference in Admissions (N=494)
Total Cost of Readmissions
o Declined Service Readmitted ( N=660) 158 20% 4,295.00$ 320 65% 1,374,400.00$ nts Readmitted (N=150) 61 8% 4,295.00$ 174 35% 747,330.00$
TOTALS 219 27% 494 100% 2,121,730.00$
636,519.00$
Cost of Readmitients Readmitted 78 10% 4,295.00$ 335,010.00$ nts Readmitted 37 5% 4,295.00$ 158,915.00$
% Difference in Readmission Numbers n Clients Who Declined Services and
Those Served 50%
Total Cost of Readmissions <30 Days 493,925.00$
% of Total Cost % of Total Cost % LESS ADMITS Cost Savingsons < 30 Days 7% 158,915.00$ 16% 335,010.00$ 8% 176,095.00$ ons 31days to < 60 Days 7% 150,325.00$ 9% 193,275.00$ 2% 42,950.00$ ons 61- to < 90 Days 4% 77,310.00$ 6% 128,850.00$ 2% 51,540.00$ ons > 90 Days 17% 360,780.00$ 34% 717,265.00$ 17% 356,485.00$
TOTALS 35% 747,330.00$ 65% 1,374,400.00$ 30% 627,070.00$
cona [email protected] & Anne Petriches [email protected]
alled to Care CHF/DM Readmission Comparison of Clients Served to Those Who Met Criteria and Declined Services
Cost SavingsOccurrences ofClients Served Occurrences of Those Who Declined Served Clients
< 30 DAY READMISSIONS
OVERALL (Total Number Clients: Those Who Declined Service and Those Served, N=810)TO DATE (3/31/2011)
gs related to 30% Lesson Rate for Served Clients
e-Admission Data from CTC Proje
Expanded Use of the ToolInternally (HFHS)
Used to track community-based Cost Savings and Avoidances for Free Clinic for Uninsured, low income clients: CY 2011 with > $1.2 Million savings/avoidance recorded - Henry Ford Macomb -Business Unit
Henry Ford Health System – FCNN, Detroit Region
Exploring future use of the concept in other system Safety-Net services
Expanded Use of the Tool-Externally
OTHER FCNN/HEALTH MINISTRY NETWORKS:
~ Trinity Health System - Oakland County, MI~Alegent Health System - Omaha, NE~Texas Health Presbyterian Hospital - Plano, TX
PENDING:~Northwest Parish Nursing Health Ministry~Memorial Hospital and HCC FCN Health Ministry-Jasper, IN
HIGHLIGHTS OF DOCUMENTED INDIVIDUALINTERACTIONS:N = 14,814 Contacts
All Networks CY 2011Male = 4,902 33%
Non-Member = 2,070 14%
Home Visits = 3,017 20%
Office Visits = 3499 24%
Phone Visits = 3168 21%
Ages 66-80 = 5471 37%
Ages 81-90 = 3590 24%
Ages 91+ = 948 6%
An Issue of Spiritual Well-Being Pot. For Enhancement
12%
Stress 11%
Hypertension 26%
Mobility Altered 13 %
Arthritis 11%
Cardiac 15%
Live Alone 10%
Contact Initiated by FCN 54%
Contact Initiated by Member 27%
Referral to: N=2562Community 20%
Congregational Resource 20%
Pastoral Staff 10%
Physician 33%
Uninsured Help: N=246
Dental 19%
Hospital 9%
Medication Coverage 18%
Physician 22%
INSURANCE CODE: N=6792
Medicaid 10%
Medicare 33%
Interventions: N = 48465
Active Listening 19%
Presence 14%
Touch Hug 10%
Client’s Goals Met 43%
Coping 18%
Knowledge of Options 16%
8,524
530,054
$95,149
4,93036,884
$159,325
7,779
43,509
$226,472
0
100,000
200,000
300,000
400,000
500,000
Faith CommunityEducation/Information
Screenings Support Groups
Hours Contacts Cost Savings/ Avoidance
