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Grant Submission
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- 4. 3 The three programs comprising the ICN project are: (1) a Mobile Integrated Healthcare Program (MIHP); (2) a Mobile Clinic; and (3) expansion of Behavioral Health Services. These programs are summarized below: 1) An MIHP will be developed in partnership with Manatee County Emergency Services (EMS) and Manatee County Technical College (MTC) to replicate Community Paramedicine Best Practices established in comparable communities (Ft. Worth, TX; Wake County, NC). The MIHP program will provide targeted case management and primary care services to frequent utilizers of emergency departments (ED), patients at risk for readmission, and patients in need of chronic disease management. The community paramedic will partner with EMS on 9‐1‐1 calls to appropriately direct patients to the right level of care in non‐ emergent cases. The community paramedic will also provide post‐ED case management to assist with connecting uninsured community members to sustainable primary care resources, increasing quality of healthcare and diverting future unnecessary emergency room visits. 2) A Mobile Clinic will be developed in partnership with Manatee Memorial Hospital to pre‐ emptively target patients without primary care physicians who would otherwise utilize the ED. The unit will be used to provide basic, community‐based medical services such as primary care, maternal and women’s health care, and basic laboratory services. The mobile clinic will be staffed by health professionals capable of delivering culturally sensitive care, including local doctors, nurses, and bilingual staff. Staff in the mobile clinic will also understand the local referral system and be able to direct patients as needed to local hospitals and providers of dental, behavioral, and other health services. The mobile clinic will include a health education station. The station will be used to deliver educational workshops to inform all patients served by the mobile unit about their own personal health conditions, as well as common health problems, behavioral health, prevention, and important screening tests. Whereas the community paramedicine program will target frequent users of the emergency room, the mobile clinic will be brought to neighborhoods of high need for community‐wide medical access to prevent unnecessary and costly trips to the ED. 3)In partnership with Centerstone of Florida, Behavioral Health Services will be expanded for uninsured and underinsured residents in Manatee County. This will reduce unnecessary emergency room visits and preventable hospitalizations by supporting hospital emergency room diversion, and by expanding and coordinating behavioral health and primary care clinical services. To accomplish this, the MIHP will incorporate behavior health intervention training, case management, and referral programs for community paramedics. Additionally, the mobile clinic will implement depression, suicide, and drug use screening, provided by a licensed clinician. The clinician will engage patients using Motivational Interviewing techniques, linking patients to clinical treatment by providing service referrals, and assisting in making appointments when outpatient treatment is indicated. This integration of behavioral health services will assist with diversion of patients from EDs through crisis
- 5. 4 intervention, service linkage, and behavioral change for improved health and decreased emergency services (9‐1‐1, EMS) usage. Finally, Centerstone will provide behavioral health transportation for MIHP and mobile clinic patients in cases where it has been determined that there is no medical emergency and that admission for psychiatric services is necessary to ensure immediate safety. This is necessary as EMS can only provide transfer to ED, and there is no transport available for patients in need of behavioral health inpatient or outpatient services, other than via Centerstone. The roles of the five partnering organizations in the ICN project are as follows: Florida Department of Health in Manatee County (DOH‐Manatee) serves as the applicant for the grant. DOH‐Manatee facilities the Manatee Healthcare Alliance and will manage the mobile clinic and provide oversight to all components of the ICN. Manatee County Emergency Medical System (EMS) provides all of the EMS visits in Manatee County. It will lead and manage the ICN’s Mobile Integrated Healthcare Program. Manatee Technical College (MTC)provides training for paramedics and will develop and provide the curriculum for the ICN’s Mobile Integrated Healthcare Program. Manatee Memorial Hospital (MMH) serves as Manatee County’s safety net hospital, treating a majority of the county’s uninsured and underinsured patients. MMH also receives the majority of county’s ER visits. The 319‐bed acute care facilities sees approximately 15,500 ER visits annually that are uninsured. This represents 20% of all ER visits in the hospital. Centerstone of Florida (COF) serves as Manatee County’s psychiatric and mental health services hospital and addiction center. It will provide the training for the behavioral health component of the program, as well as linkage to behavioral health and addiction rehabilitation services. The project will also be supported by the Manatee Health Care Alliance (MHA), whose broad membership under the facilitation of DOH‐Manatee includes representatives from local governments, universities, hospital administrators, non‐profit and private business representatives, equality advocacy organizations, and concerned citizens. The Focal Population to be served by the ICN includes the following groups: (i) current frequent users of the emergency department and EMS (Frequent System Users); (ii) persons currently receiving no primary care preventive services or primary care treatment for their illness; (iii) persons recently discharged from the hospital who would benefit from a few in‐home monitoring sessions to prevent complications; (iv) persons with inadequately treated behavioral, mental health, or substance abuse problems. (Demographic characteristics of these groups are given below, in the Statement of Need.) The ICN project and its component programs (MIHP, Mobile Clinic, and expanded Behavioral Health Services) will improve health service delivery to members of the Focal Population throughout Manatee County.
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- 8. 7 emergency room visits and preventable hospitalizations by supporting hospital emergency room diversion, and by expanding and coordinating behavioral health and primary care clinical services. To accomplish this, the MIHP will incorporate behavior health intervention training, case management, and referral programs for community paramedics. Additionally, the mobile clinic will implement depression, suicide, and drug use screening, provided by a licensed clinician. The clinician will engage patients using Motivational Interviewing techniques, linking patients to clinical treatment by providing service referrals, and assisting in making appointments when outpatient treatment is indicated. This integration of behavioral health services will assist with diversion of patients from EDs through crisis intervention, service linkage, and behavioral change for improved health and decreased emergency services (9‐1‐1, EMS) usage. Finally, Centerstone will provide behavioral health transportation for MIHP and mobile clinic patients in cases where it has been determined that there is no medical emergency and that admission for psychiatric services is necessary to ensure immediate safety. This is necessary as EMS can only provide transfer to ED, and there is no transport available for patients in need of behavioral health inpatient or outpatient services, other than via Centerstone. Roles of Partnering Organizations Florida Department of Health in Manatee County (DOH‐Manatee) serves as the applicant for the grant. DOH‐Manatee facilities the Manatee Healthcare Alliance and will manage the mobile clinic and provide oversight to all components of the ICN. Manatee County Emergency Medical System (EMS) provides all of the EMS visits in Manatee County. It will lead and manage the ICN’s Mobile Integrated Healthcare Program. Manatee Technical College (MTC)provides training for paramedics and will develop and provide the curriculum for the ICN’s Mobile Integrated Healthcare Program. Manatee Memorial Hospital (MMH) serves as Manatee County’s safety net hospital, treating a majority of the county’s uninsured and underinsured patients. MMH also receives the majority of county’s ER visits. The 319‐bed acute care facilities sees approximately 15,500 ER visits annually that are uninsured. This represents 20% of all ER visits in the hospital. Centerstone of Florida (COF) serves as Manatee County’s psychiatric and mental health services hospital and addiction center. It will provide the training for the behavioral health component of the program, as well as linkage to behavioral health and addiction rehabilitation services. Focal Populations to be Served. The Focal Population to be served by the ICN includes the following groups: (i) current frequent users of the emergency department and EMS (Frequent System Users); (ii) persons currently receiving no primary care preventive services or primary care treatment for their illness; (iii) persons recently discharged from the hospital who would benefit from a few in‐home monitoring sessions to prevent complications; (iv) persons with
- 9. 8 inadequately treated behavioral, mental health, or substance abuse problems. (Demographic characteristics of these groups are given below, in the Statement of Need.) Area to be Covered. The ICN project and its component programs (MIHP, Mobile Clinic, and expanded Behavioral Health Services) will improve health service delivery to members of the Focal Population throughout Manatee County. Demographic data (reviewed below, see Statement of Need) and a recent analysis of EMS data suggest that the ICN will have most impact (namely, improving access to primary and behavioral healthcare and preventing unnecessary emergency department visits and inpatient hospitalizations) in areas of greatest need, including five zip codes: 34203, 34205, 34207, 34208, and 34221. These five zip codes account for almost 50% of the population in Manatee County, but 74% of Frequent System Users.1 Expected Overall Outcomes. The ICN project will have monthly evaluations in the implementation phase. Evaluations will focus on overall project performance, by direct patient populations after the reduction of Emergency Room diversions. Additional details are provided below in the Evaluation Plan. Improved outcomes are expected in the six domains outlined below. 1. Referral Process. Three outcomes related to the Referral Process will be tracked. 2. Frequent Emergency Department and EMS System Users. Frequent emergency department and EMS system users will be identified and monitored. 3.Bed Hours Saved. Four outcomes related to Bed Hours Saved will be tracked. 4. Patient and Network Provider Satisfaction. A survey will be used to evaluate satisfaction outcomes. 5. Program Discharge. The program will monitor the amount of time needed for patients to be discharged from the community paramedic program. 6. Quality Assurance. Three outcomes will be monitored for Quality Assurance. The program seeks to maintain medical quality assurance following Florida statute 401, utilizing a peer review process. Patient outcomes and established benchmarks will be monitored. Data will be gathered and shared with participating community partners. Overall program success will be measured by the multiple system benchmarks. This will allow program manager to redirect, improve, and prioritize program needs to ensure overall success. The program manager will periodically meet with community stakeholders and reevaluate community health care gaps. Applicant’s Experience Related to Provision of Proposed Activities. DOH‐Manatee provides a wide range of essential clinical and community services to the Manatee County community, 1 Community Paramedicine, presentation by J Crutchfield and P DiCicco, September 2015, Board of County Commissioners Healthcare Workshop)
- 10. 9 both directly and through collaborative community partnerships. These services include health education, counseling, examinations, treatment, medical management, immunization, drug assistance programs (for AIDS, diabetes, epilepsy), testing and screening (for diseases, hearing, and vision), lab testing, and outreach. Organization’s Capacity & Ability to Direct, Perform, and Complete the Proposed Activities. DOH‐Manatee is a well‐respected agency, in large part due to the strong working relationships it has forged over the past 20 years with key organizations and partners at all levels of the community. Employing over 120 staff, with an annual budget of 12 million dollars, DOH‐Manatee has demonstrated immense fiscal responsibility with a long history of exceptional management. Under the leadership of Dr. Jennifer Bencie, DOH‐Manatee Administrator, and Eddie Rodriguez, Assistant Administrator responsible for fiscal oversight, DOH‐Manatee has demonstrated foresight in effectively managing its many programs and funds. DOH‐Manatee’s extensive grant‐ and project management‐related experience includes recently funded projects for Tobacco Prevention, AIDS Prevention, Breast and Cervical Cancer Screening, WIC Breastfeeding Peer Counseling, Colorectal Cancer Screening, Chronic Disease Prevention and Health Promotion, Family Planning, Immunization, and Teen Outreach. In the past five years alone, DOH‐Manatee’s successes in public health administration have been recognized at the national level by the National Association of City and County Health Officials, the Robert Wood Johnson Foundation, the American Public Health Association, Project Public Health Ready, the Society of Public Health Educators, and the National Institute for Children’s Health Quality; and at the state level by the Florida Department of Health and the Florida Sterling Board for Quality Improvement. 4.5 Statement of Need Demographic and health data show a mixed picture of community health in Manatee County. The county is comprised of coastal and other areas of relative affluence, together with areas characterized by financial challenge, low health care access, and unmet health needs. Focal Population Demographic Information. As noted above, the Focal Population to be served by the ICN includes the following groups: (i) current frequent users of the emergency department and EMS (Frequent System Users); (ii) persons currently receiving no primary care preventive services or primary care treatment for their illness; (iii) persons recently discharged from the hospital who would benefit from a few in‐home monitoring sessions to prevent complications; (iv) persons with inadequately treated behavioral, mental health, or substance abuse problems. Also as aforementioned, five zip codes account for almost 50% of the population in Manatee County, but 74% of Frequent System Users. These zip codes are: 34203, 34205, 34207, 34208, and 34221. Although the Integrated Care Network will target the Focal Population throughout the county, demographic and socioeconomic characteristics of these five zip code areas help illustrate needs of the Focal Population.
- 11. 10 Incomes, access to health insurance, and educational level are also unfavorable within these 5 zip codes compared to Manatee County and Florida as a whole (see table below). Within these 5 zip codes, approximately 22% of the patients or 77,931 are uninsured. As shown in the table below, about 45% of residents in the five zip codes can be classified as low income (< 200% of the poverty level), 24% are uninsured, and 18% have less than a high school education. Location Post Office Name Total Population % Low‐ Income Population % Population Uninsured % Population w/ Less Than High School Education Zip code 34203 Bradenton 36,806 42% 20% 15% Zip code 34205 Bradenton 29,687 45% 27% 18% Zip code 34207 Bradenton 30,082 50% 27% 19% Zip code 34208 Bradenton 34,315 52% 28% 24% Zip code 34221 Palmetto 41,287 40% 22% 17% All 5 zip codes n/a 172,177 45% 24% 18% Manatee County n/a 329,487 35% 19% 12% Florida n/a 19,091,156 38% 20% 14% Another set of demographic factors contributing to a cycle of unfavorable economic and health outcomes in Manatee County is the relatively high numbers of births to mothers without a high school education and to teenage mothers. Data for the year 2014 (single‐year rates) provided by the Florida Department of Health Bureau of Vital Statistics show the following: The percentage of births to mothers ages 18 and over without a high school education stands at 23% in Manatee County compared to 13% in Florida as a whole; this places the county in the least favorable quartile among Florida’s 67 counties. The rate of births to mothers ages 15‐19 stands at 33 per 100,000 in Manatee County compared to 22 per 100,000 in Florida. The percentage of repeat births to mothers ages 15‐19 was 22% in Manatee County versus 17% in Florida as a whole. These high rates of teen births and births to women without a high school education underscore the importance of outreach, education and expansion of primary care services to ensure maternal, fetal, and young child health as well as family planning and women’s health services. Impact of the Problem & Prevalence of Issues in the County. The 2014 ALICE report on financial hardship in Florida sheds light on the interrelated challenges associated with low
- 12. 11 income, lack of health insurance, and poor health outcomes.2 The ALICE report estimates that 43% of households in Manatee County are either living under the poverty level or earning less than the basic cost of living. According to the report, households under the ALICE threshold often lack health insurance or are underinsured. The ALICE report points to a clear link between financial hardship and poor health outcomes, contributing to a cycle of further hardship: As a result of financial hardship, these households forgo preventive health care, incur more out‐of‐ pocket expenses, visit the emergency department for non‐emergencies, and suffer lost work time and productivity due to poor health. 2014 Hospital Emergency Room Visit (ER Visit) data provided by the Health Statistics and Performance Management office of the Florida Department of Health show the large impact of lack of access to health services in Manatee County. Two categories of ER Visits and charges reflect conditions that should be manageable on an outpatient basis without the need for ER services: Ambulatory Sensitive Conditions and Dental Conditions. These data are displayed in the table below, showing significant numbers of visits and charges in both categories: Ambulatory Sensitive Conditions. There were a total of 28,658 ER Visits for Ambulatory Sensitive Conditions in Manatee County in 2014. Of these ER Visits, 21% resulted in a hospital admission and 79% did not. The total charges for these ER Visits was $312,945,087. Of these charges, 77% were associated with ER Visits resulting in hospital admission, and 23% were associated with ER Visits not resulting in admission. Dental Conditions. There were a total of 1,152 ER Visits for Dental Conditions in Manatee County in 2014. Of these ER Visits, 2% resulted in a hospital admission and 98% did not. The total charges for these ER Visits was $2,079,831. Of these charges, 31% were associated with ER Visits resulting in hospital admission, and 69% were associated with ER Visits not resulting in admission. ER Visits for Ambulatory Sensitive Conditions In Manatee County (2014) # ER Visits % Total Charges % ER Visits resulting in Admission 22,644 79% $ 70,967,265 23% ER Visits Not resulting in Admission 6,014 21% $ 241,977,822 77% Total ER Visits 28,658 $ 312,945,087 ER Visits for Dental Conditions In Manatee County (2014) # ER Visits % Total Charges % ER Visits resulting in Admission 1,132 98% $ 1,437,985 69% ER Visits Not resulting in Admission 20 2% $ 641,846 31% Total ER Visits 1,152 $ 2,079,831 2 ALICE (Asset‐Limited, Income‐Constrained, Employed) Report Florida (Fall 2014, United Way of Florida).
- 13. 12 2014 ER data from Manatee Memorial Hospital indicate similar trends. There were 15,456 patients that presented in the ER which represents 21% of all ER visits for 2014. Of the 15,456 visits, about 50% of those visits could have been handled in a setting other than the emergency room. The top causes of death among Manatee County residents are as follows. Those highlighted in red demonstrate substantial racial health disparities that are more pronounced in Manatee County than in Florida as a whole. Death rates per 100,000 (age‐adjusted, 3‐yr. rolling) Manatee County Florida White Black White Black Heart Disease 151 230 152 170 Cancer 147 158 161 162 Motor Vehicle Deaths 11 24 13 12 Stroke 30 59 29 47 Kidney Disease 12 45 10 22 Diabetes 12 30 17 40 Homicide 5 28 4 17 HIV/AIDS 2 17 2 20 In terms of behavioral health, death rates from suicide and unintentional injuries (including drug overdoses) have increased substantially. Manatee county suicide deaths have increased 37% from 2005 to 2014, with county rates much higher than state rate ; suicide (Manatee county (16 per 100,000) vs. Florida (14 per 100,000); and Manatee county unintentional poisoning deaths have increased 23% from 2005 to 2014, with averages higher than state rate (Manatee county (44 per 100,000) vs. Florida (40 per 100,000). Behavioral health disorders affect millions of Americans annually. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 43.5 million adults and adolescents experienced a mental health disorder in 2014 and 20.2 million adults experienced a substance use disorder, while 7.9 million adults experienced both a mental health and a substance use disorder. The Agency for Healthcare Research and Quality (AHRQ) identifies mental disorders as one of the top five most costly health conditions in the US.
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- 15. 14 to access care. These designations are used by more than 34 federal programs to determine eligibility for services or funding preferences. For example, the designations can be used to determine the need and location of community and migrant health centers and rural clinics, or for eligibility for National Health Service Corps scholarships and loan forgiveness programs. MUA/MUPs use similar data, an index with scores ranging from 1 to 100 are assigned. A score of less than 62 is required for designation as an MUA/MUP. Manatee County has a designation as a Medically Underserved Population for low income and migrant farm workers county‐wide based on a score of 50.1. Manatee County Health Professional Shortage Areas by Type of Service, population and Year of Designation Discipline Population Year Designated Primary Care Low Income Bradenton/Manatee 2014 Primary Care Low Income Palmetto/Parrish 2014 Dental Low Income Bradenton 2011 Dental Low Income Palmetto/Parrish 2011 Manatee County, when compared to the State of Florida, has a lack of health care providers in the following areas: Dentists, Physicians, Internists, OB/GYN, and Pediatricians. This lack of providers contributes to high utilization of emergency department services. According to a 2012 study released by the Center for Disease Control and Prevention about Emergency Room Use, about 80% of adults visited the emergency due to lack of access to other providers; and uninsured adults were more likely than those with private health insurance to visit the Emergency Room due to having no other place to go. County State Providers Data Year Count (Annual Avg) Rate Per 100,000 Quartile Rate Per 100,000 Total Licensed Dentists (Fiscal Year) 2013 171 50.9 3 53.8 Total Licensed Physicians (Fiscal Year) 2013 721 214.7 3 275.7 Total Licensed Family Practice Physicians (Fiscal Year) 2013 103 30.7 4 25.5 Total Licensed Internists (Fiscal Year) 2013 143 42.6 3 51.8 Total Licensed OB/GYN (Fiscal Year) 2013 30 8.9 3 9.9 Total Licensed Pediatricians (Fiscal Year) 2013 48 14.3 4 23 Data Source: Florida Department of Health, Division of Medical Quality Assurance, Agency for Health Care Administration. *Data for providers are for a fiscal year, not a calendar year
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- 18. 17 4.6 Provision of Services Activities to be Conducted, Including Strategies, Potential Barriers, Collaboration Plan. Activities to be conducted, including strategies, and a collaboration plan are described below. Potential barriers and obstacles will be overcome through the project’s support from the Manatee Health Care Alliance (MHA), whose broad and highly engaged membership includes representatives from local governments, universities, hospital administrators, non‐profit and private business representatives, equality advocacy organizations, and concerned citizens. . Program Focal Population Total Number of Unduplicated Individuals (annualized numbers provided By ICN partner organizations) Mobile Integrated Healthcare Program Frequent utilizers of ER, Patients at risk for readmission, Patients in need of chronic disease management 2,920 Mobile Clinic Patients without primary care physicians who will likely otherwise utilize ER; Patients in need of family planning services 3,600 Behavioral Health Services Patients in need of social, mental support and drug addiction rehabilitation 800 Mobile Integrated Healthcare Program The specific roles and services of a community paramedic are determined by community health needs and in collaboration with local public health departments and medical directors. In this way, community paramedicine reduces unnecessary emergency department visits and contributes to a greater focus on population health. The MIHP will be a restructuring of existing healthcare resources, not a new means to increase healthcare spending. It is a strategy designed to support and augment other patient‐centered delivery models by providing an optimized mix of health care and patient navigation at a lower cost than traditional models. In the current situation, when a patient requests an ambulance, EMS will respond and then take the patient straight to the emergency department. In the proposed model, EMS will respond and partner with the community paramedics to redirect patients to other options such as mental health, in‐home care, or physician office rather than straight to the emergency department. Upon follow up, the community paramedics will provide home‐based follow‐up and preventive services to the members of the focal population. This will be accomplished by supporting the MIHP’s ER Diversion initiative through training of paramedics in recognizing and responding to acute behavioral health and comorbidity situations. This program will also expand behavioral health clinical services through expansion
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- 22. 21 Proposed Staffing Profile Program Staff Count Training or Experience Required Mobile Integrated Healthcare Program Program Manager 1 Community Paramedic training course (below) and experience in business development and operations; Experience in physician office, registration, and front office scheduling Medical Director 1 Board‐certified and practicing M.D. Community Paramedics 2 280 class hours and 140 clinical hours divided between the acute and behavioral health hospital Mobile Clinic Nurse Practitioner 1 Family Practice/Internal Medicine with training in chronic disease management Medical Assistant 2 Experience with health education and promotion, Ability to drive mobile clinic Clinic Manager 1 Will develop protocols, guidelines, partnerships Mental Health Licensed Clinician 1 Motivational Interviewing, Co‐ occurring competency, Baker Act, Marchman Act, Chronic medical conditions, Depression Screening, Suicide Screening and Prevention Supervisor 0.1 FTE Experience in supervision of behavioral health programs This program will also partner with local providers and organizations in the community to encourage active participation in these programs from both a clinical and operations perspective. Collaboration with Stakeholders This proposal will be supported by Manatee County EMS, Manatee Memorial Hospital, and Centerstone of Florida. Additionally, it is supported by the Manatee Health Care Alliance (MHA), whose broad membership under the facilitation of DOH‐Manatee includes representatives from local governments, universities, hospital administrators, non‐profit and private business representatives, equality advocacy organizations, and concerned citizens. With the support of the MHA, the group will plan the initiative, conduct the study, and disseminate study results. Patient, family member, caregiver, and organizational representative input will be methodically solicited via focus groups and programmatic evaluation and included in program
- 23. 22 development and study results. Partner agencies will work with stakeholders to develop and deploy a marketing and outreach plan targeting the focal population The marketing and outreach plan will be robust, culturally competent, and bilingual. Stakeholders identified in the 203‐2015 community health assessment will assist with this process. Additionally, project partners will coordinate with the United Way of Manatee County to insure the new healthcare model is incorporated into 2‐1‐1, an easy to remember three digit phone number which connects callers with an information and referral specialists. Intended Outcomes of ICN Reduced inappropriate ED utilization Increased patient access through utilization of alternative sources Improved health outcomes of chronically ill Reduced hospital readmissions Decreased inappropriate utilization of emergency medical services Transition toward population health management 4.7 Evaluation Plan The success of this program will be evaluated in terms of the Triple Aim set forth by the Institute for Healthcare Improvement: better healthcare, better health, lower costs. In terms of better healthcare, this program will focus on addressing patient satisfaction and experience, resource utilization clinical quality, and patient access. With better health, there will be an increased focus on improving the overall health of a population in terms of both individual and population health. Finally with lower costs, the goal is to reduce the total per‐capita costs of healthcare and to focus on the costs to the patients as well as the healthcare system. The program evaluation process will include a compilation of collected data into relevant performance measures, the benchmarking of results against established performance targets, and the use of effective reporting tools to provide a combination of patient‐centered, payer‐ centered and community health‐focused reporting. Once the evaluation is complete, the results will be made available to all program partners. In the initial phase, the program will have evaluations every month after implementation. The evaluations will focus on overall program performance, by direct patient populations after the reduction of Emergency Room diversions. Improved outcomes are expected in the six domains outlined below. Referral Process. Three outcomes related to the Referral Process will be tracked: 1) Evaluation of number of patient referrals. 2) Evaluation of number of participating community partners. 3) Evaluation of community resource locations.
- 24. 23 Within the first six months, the Community Paramedic Program seeks to include 30% or greater of the County funded Providers. This process is projected to add an additional 5% of County funded Providers every six months. Frequent Emergency Department and EMS System Users. Frequent emergency department and EMS system users will be identified and monitored as follows: 1) Community Paramedic program activation with 3 system uses within a 30‐day period. 2) Evaluation of appropriate diversion of program patients. The Community Paramedic will make contact with a patient after any three emergency department visits, any three ambulance transports, or a combination of the two within a 30‐day period. Bed Hours Saved. Four outcomes related to Bed Hours Saved will be tracked: 1)Emergency Room visit diversions. 2) Readmissions reduction. 3) Total bed hours saved. 4) Total health system savings. The Community Paramedic seeks to provide the correct referral resources, resulting in a reduction in Emergency Room visits, hospital readmissions, and an overall cost savings related to decreased bed hours. Patient and Network Provider Satisfaction. Pre‐ and post‐service surveys will be used to evaluate four outcomes: 1) Overall program satisfaction of services rendered 2) Total number of active registered patients within the program 3) Increase in health education knowledge 4) Intended behavior modification Program Discharge. The program will monitor the amount of time needed for patients to be discharged from the community paramedic program. 1) The number of patients who “graduate” the Community Paramedic Program with long term referral to outside resources will be recorded and reported. Quality Assurance. Three outcomes will be monitored for Quality Assurance: 1) Peer review of patient charts. 2) Tracking of outcomes. 3) Sharing of data with local partners.
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- 26. 25 Budget Summary Operating Expenses Mobile Integrated Healthcare Program 7‐months Program Manager and Paramedics (1) 99,462 Benefits (1) 52,956 Vehicles (2) 90,000 Portable Radio/Computer/Monitor (4) 88,795 IT Maintenance Replacement (4) 4,500 Gas / Oil (2) 11,242 Support Costs (Marketing) (3) 5,159 Training (5) 3,600 Vehicle Maintenance / Replacement (2) 14,042 Total Mobile Integrated Healthcare Program 270,294 Mobile Clinic Mobile Unit (6) 235,000 Insurance (6) 14,000 Gas/Oil (6) 7,000 Maintenance (6) 3,000 Equipment (7) 17,500 Clinic Manager (8) 23,000 Nurse Practitioner (9) 59,500 Medical Assistants (10) 52,240 Total Mobile Clinic Program 411,240 Mental Health Program Salaries (11)(12) 36,722 Benefits (11)(12) 10,016 Internet/ IT Replacement (13) 801 Insurance / Phone (14) 1,481 Vehicle Insurance (15) 1,138 Gas / Oil (15) 1,260 Vehicle Maintenance / Replacement (15) 4,935 Administrative costs (16) 8,000 Total Mental Health Program 64,353 Health Information Exchange Centerstone HIE Implementation (17) 48,040 EMS HIE Implementation (17) 25,000 Total HIE Expenses 73,040 Total Operating Expenses $ 818,927 Budget Narrative
- 27. 26 Budget Narrative Expenses Justification (1) MIHP Salaries These funds will be used for salary and benefits of two of 20 hour weekly community paramedic positions and one 40 hour Program Manager. The positions will be filled by existing paramedics who will each require completion of a 280 hour training class and 140 hour clinical rotation, to be provided by Manatee Technical College, in partnership with MMH and Centerstone of Florida. Following training, a community paramedic will operate between the hours of 9am to 9pm, seven days a week, excluding holidays. (2) MIHP Vehicles These funds will be used to purchase, fuel, and maintain two vehicles to support MIHP. One vehicle will be for the manager to use for stakeholder meetings, scheduling of programs, and community engagement initiatives. The other vehicle will be used for the community paramedic in the field. Manager vehicle available for other community paramedic use, as needed. (3) Marketing These funds will be used for development and printing costs for educational campaign to target patients for MIHP and mobile clinic. Included in this are the plans to incorporate program into 2‐1‐1, an easy to remember three digit phone number which connects callers with an information and referral specialists. Participating agencies will work with community stakeholders to develop culturally competent and bilingual marketing and outreach materials. (4) MIHP Equipment Costs These funds will be used to purchase equipment including computer, monitor, portable radio, IT support, cell phone and maintenance, marketing supplies, and other supplies (stethoscope, EKG, pulse oximeter, thermometer, and glucometer) necessary for operating MIHP. (5) MIHP Training These funds will be used toward development and instruction of a 280 hour training course for four community paramedics. Current EMS paramedics will be identified for the community paramedic training, and will be paid salary while undergoing training. By training four paramedics, there will always be a community paramedic available to fill weekly hours. (6) Mobile Clinic Unit These funds will be used to purchase a mobile clinic (specially designed bus) which will provide accommodations for laboratory services and comprehensive primary care, including dental, behavioral health, health education, and OB‐GYN services. These funds will also be used to maintain the maintenance, insurance, and fuel for the mobile clinic over the 7 month project period. (7) Mobile Clinic Equipment These funds will be used to purchase medical equipment such as stethoscope, blood pressure cuffs, EKG, etc. for use in the mobile clinic.
- 28. 27 (8) Mobile Clinic Manager These funds will be used to employ a clinic manager to manage all mobile clinic operations including supplies, scheduling, community engagement, and marketing. (9)Mobile Clinic Nurse Practitioner These funds will be used to employ a family practice/internal medicine nurse practitioner, who will be critical in chronic disease management and providing primary care services for mobile clinic. (10) Mobile Clinic Medical Assistant These funds will be used for the mobile health clinic to employ two medical assistant to assist with intake, patient history, phlebotomy, and patient health education The Medical Assistants will also be trained and able to drive the mobile unit. (11) Behavior Health Licensed Clinician These funds will be used to provide salary and benefits to a LMHC/LMFT/LCSW who will provide behavioral health training to MIHP and mobile clinic staff; as well as behavioral health crisis intervention, engagement, assessment, certificate for involuntary examination, referral and resource linkage, behavioral health transportation, depression screening, suicide screening and prevention to target populations via MIHP and mobile clinic. (12 ) Behavioral Health Clinical Supervisor These funds will be used to offset applicable salary and benefits costs for program collaboration and clinical oversight of behavioral health component. (13)Behavioral Health Internet and IT These funds will be used toward internet and IT costs necessary for managing off‐site behavioral healthcare practice via MIHP and mobile clinic. (14)Behavioral Health Insurance and cell phone These funds will be used toward cell phone and workman’s comp insurance for behavioral health care staff being utilized for MIHP and mobile clinic. (15)Behavioral Health vehicle maintenance, insurance, gas/oil These funds will be used toward maintenance, insurance, and fuel for crisis vehicle to be used when non‐emergency crisis patient transport is needed to Centerstone behavioral health facilities, as EMS does not have the capacity to provide transport anywhere other than ED. (16) Behavioral Health administrative costs These funds will be used toward indirect administrative costs, including office space, human resources, resouces, and administrative staff support. (17) HIE Implementation These funds will be used to develop interfaces to be built for HIE with Centerstone and EMS, thus reducing duplicative services.