Successful Social and Financial Outcomes for Complicated Patients


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In 2010 Mercy Hospital sought community partnerships to assist in meeting the needs of individuals presenting to the hospital’s emergency room repeatedly who, due to their substance use disorders, mental health disorders, and/or co-occurring disorders, were not able to successfully access and engage in community-based services to address needs. This webinar will chronicle the process of development of the project by community stakeholders, implementation, highlight challenges and successes, delineate measurable one-year outcome data and return on investment.

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Successful Social and Financial Outcomes for Complicated Patients

  1. 1. This presentation will: Chronicle the process of development and implementation of the project by community stakeholders. Identify and share how barriers were addressed. Present outcome data after one year of operation.
  2. 2. After attending this presentation participants will be able to: Identify two key components of community outreach that successfully engages individuals at high risk for multiple emergency room visits. Identify two key components for a successful partnership between emergent health care system and the substance use disorder treatment system. Identify return on investment to communities supporting community outreach projects, financially and in terms of improved healthcare outcomes.
  3. 3. Mercy Hospital reached out to community partners in 2010asking for assistance in meeting the needs of individualspresenting to the hospital’s emergency room repeatedly whodue to their substance use disorders, mental health disordersand/or co-occurring disorders were not able to successfullyaccess and engage in community-based services to addressneeds.
  4. 4. A wide array of community stakeholders were invited to attend meetings to helpdevelop and implement a number of initiatives related to the health and wellbeing of the communities served by Mercy Hospital in Cadillac, Michigan.Anyone who had an interest was allowed access to these meetings. A samplingof stakeholders involved included: Community Mental Health NMSAS (the regions Substance Use Disorders Coordinating Agency) Public Health Catholic Human Services (a provider of both SUD and Mental Health services in the area) Representatives from the area Homeless Coalition Clergy Wexford/Missaukee ISD Mercy Hospital - Medical Social Workers, Nurses and ER staff
  5. 5. Issues of concern to the community that were discussed during the coalition meetings were: homelessness poverty mental illness substance use public transportation medical care of low income indigent individuals and families school attendance/truancyOf particular concern to the coalition was the lack of coordination of care for individuals whofrequented the hospital emergency room for issues that could and should be handled in a PrimaryCare setting. Care Coordination occurs routinely for individuals who have commercial insuranceproviders, but rarely occurs for uninsured or under-insured individuals and families. The coalitiondecided to concentrate efforts in this area and were able to secure funding for the CommunityOutreach Practitioner in October 2011.
  6. 6.  Costs to families 75% domestic violence 50% homicide Productivity Child abuse 20% of all suicides
  7. 7.  Suicide and substance abuse and; Suicide and mental illness (particularly depression) 90% of people who die by suicide have a mental illness  or substance abuse disorder. 
  8. 8. Mission: To improve the care to people with mental health and substance use disorders. Vision:  To provide an informed, coordinated, comprehensive community system of services for individuals with mental health and/or substance use disorders. Goal:  Establish a bridge from the ED to community for clients/patients to interface with community services or establish community services resulting in improved mental stability and/or longer periods of sobriety and reduced inappropriate accessions of ED services. 
  9. 9. Results/Accomplishments: Interagency collaboration. Establishment of resource lists for the ED and local providers.  NMSAS funding for a Community Health Worker (practitioner – CHP) secured.  Community Benefit Ministry support for CHP for the poor.
  10. 10. Outcome Evaluation: 20% of patients contacted without a medical home will have a PCP. 50% of appointments are kept.  Appropriate health utilization:  reduction in inappropriate ED visits.  Medication compliance. Demonstrates knowledge change.Process Evaluation: Numbers contacted.  Numbers served.
  11. 11.  Improve care transitions. Reduce preventable hospital admissions. Reduce readmissions. Avoidable ED visits. Improved problem solving; stable mental health, improved  quality of life. Sobriety, not using for longer periods of time.
  12. 12.  Referrals  105 Number served   66 Provider contacts  971 Number of referrals provided 418 Medication assistance  23 Transportation assistance  23 Co‐pay assistance  6
  13. 13. 454035302520 4215 2410 50 Inhouse ‐ 64% Community ‐ 36%
  14. 14. 504540353025 47201510 15 5 40 Co‐Occurring Primary Mental Primary Substance 71% Health  23% Abuse  6%
  15. 15.  Female ‐ 58% Male ‐ 42% Homeless ‐ 22% Pregnant, just gave birth ‐ 6%
  16. 16. 3530252015 29 2610 15 16 5 11 60 2 18‐20 21‐25 26‐30 31‐40 41‐50 51‐60  11% 61 and 2% 14% 15% 28% 25% older 6%
  17. 17.  Face to face/phone contacts Case coordination Empathic listening Modeling Motivational interviewing Advocacy Validation
  18. 18.  51% had a Primary Care Provider 24% obtained with Community Outreach Practitioner 5% pending 15% dropped out/moved  5% unable to obtain
  19. 19.  Kept healthcare appointments ‐ 73% Medication compliance  56% ‐ compliant  19% ‐ zero prescriber  Unaffordable  13% ‐ non‐compliant  13% ‐ unknown SUD  65% ‐ annual average not using  28% ‐ still using  11% ‐ unknown
  20. 20.  Year‐to‐date = 132Examples of “Appropriate Healthcare Utilization” include:   Medical and psychiatric appointments kept. Free clinic utilized. Medications obtained through outpatient provider. Accessing homecare services. Detox accessed through SA treatment provider. Emergency MH services accessed through CMH.
  21. 21.  89 x 650 = $57,850   Utilization of a primary care provider, urgent care or  specialist instead of the Emergency Room.  Procurement of necessary medications, especially  psychotropics.  Meeting with patients in crisis and developing a stabilized  plan.  Utilization of public dental clinics for urgent needs.  Pursuit of residential substance abuse treatment.  Sustained sobriety and/or mental health stability  resulting in reduced ED/IP visits.  Referrals to Mercy Homecare and/or Hospice.
  22. 22.  Year‐to‐date = 148“Demonstrated Knowledge Change” refers to behaviors indicative of increased knowledge/understanding regarding the availability of healthcare and community resources, and/or of improved self‐care with regard to medical, MH and/or SA diagnoses. 
  23. 23.  Northern Michigan Substance Abuse Services Catholic Human Services