Posts Tagged ‘pain management’

3 Emergency Department Interventions to Curb ‘Ultra-Utilizer’ Use

March 31st, 2015 by Patricia Donovan

Drawing upon an 18-month pilot to curtail wasteful utilization in Ohio ERs, especially by Medicaid beneficiaries identified as ‘ultra-utilizers,’ Mina Chang, Ph.D., chief, health services research and program development section of the Bureau of Health Services Research for the Ohio Department of Job & Family Services, looks at three ED-based interventions targeting this population.

The ED care team approach is very similar for the three targeted ultra-utilizer groups: severe mental illness, non-mental health conditions, and chronic back pain. It’s based on a strong medical and clinical leadership oversight. The integrated interdisciplinary teams include managed care and community providers, and care management or care managers. They came together based on the patients’ medical profiles, developing an individual care treatment plan for each of the patients including the testing. The team would continue to outreach to those patients, to address their social and medical needs and to coordinate care for those patients.

The treatment plan at the summary level was made available to older participating EDs in the past intervention. The patient will be also flagged at those EDs. And the intent is if the member showed up at the ED, the ED attending physician would be able to reference on the treatment plan and also communicate with the interdisciplinary teams as necessary.

For the mental health stream, the designated provider is a comprehensive mental health center that works together with the managed care claims to develop treatment plans. And the summary level of the treatment plan will be shared with the participating EDs from the two health systems.

For these streams we also have a 24/7 crisis center so the EDs can tap into them to have the most updated treatment plan faxed over as needed.

We also have another integrated care team for the non-mental health population led by Metro Health’s medical home team. These designated providers work with our managed care plans to develop a treatment plan for each participating patient and the summary will be shared with the participating ED from the three health systems.

Finally, similar of design was a back pain stream with a pain clinic as the designated provider. This designated team works with our managed care plan care managers. In turn, they built a care treatment plan for those participating patients, and shared the treatment plan summary with the participating ED and the three health systems.

We already have very encouraging results. Almost all members reported their outreach from the team has been excellent or good. And that’s after we instituted the intervention. The majority of the members reported they have input into treatment plans, so most of them slowly follow up with their providers.

The unique area noted by the mental health team is that transportation, fear and timely appointments are the most common barriers preventing ultra-utilizer patients from seeking follow-up care after ED visits.

We also observed increasing success for members keeping appointments. Our teams also noted that communication is key, not only between the participating test site, since there are so many moving parts, but also within the test site, such as the pain clinics or the emergency department.

Source: 5 Interventions to Reduce Avoidable ER Use by the Medicaid Population

Reducing Avoidable ER Use

5 Interventions to Reduce Avoidable ER Use by the Medicaid Population looks at the collaborative effort among five Ohio regions to target key reasons for avoidable ER visits among Medicaid beneficiaries and roll out test interventions in a rapid cycle quality improvement approach.

Hospitals: Chronic Disease Leading Cause of Avoidable ER Visits in 2014

December 4th, 2014 by Cheryl Miller

High utilizers continue to be responsible for the majority of avoidable emergency room (ER) visits, with chronic disease edging out pain management as the top complaint among this population, according to respondents to the third comprehensive survey on reducing avoidable ER visits, conducted in August 2014 by the Healthcare Intelligence Network (HIN). A total of 125 healthcare organizations described tactics employed; nearly one third (32 percent) of which were identified as hospitals/health systems. A sampling of this sector’s results follows.

While the majority of hospitals/health systems were likely to have such a program in place (53 percent versus 69 percent of all respondents), of those that didn’t, just 25 percent planned a future program, compared to 47 percent of all respondents. Less than one half of hospital respondents (47 percent) felt that eased telehealth regulations would curb avoidable ER use.

This sector was twice as likely to find high utilizers generating the majority of avoidable ER visits (78 percent versus 31 percent of all respondents) and least likely to target Medicaid (10 percent versus 28 percent of all respondents). Chronic disease was the most frequently presented problem among this sector’s high utilizers (78 percent versus 54 percent).

In terms of patient level solutions, this sector was half as likely to utilize telephonic outreach (33 percent versus 60 percent), and twice as likely not to conduct follow-up phone calls with those discharged from the hospital (30 percent versus 15 percent). In terms of staff level solutions, this sector was more likely to use hospitalists (22 percent versus 10 percent for all respondents) and onsite educators/coaches (22 percent versus 11 percent for all respondents) and least likely to use disease-specific care coordination (11 percent versus 38 percent for all respondents). This sector was also least likely to notify PCPs of care gaps (22 percent versus 41 percent).

When asked to identify the greatest impact on overall ER efficiency, 70 percent of hospital respondents cited fast-tracking of non-urgent care, versus 33 percent of all respondents. Among the challenges of reducing avoidable ER visits, redirecting the non-urgent was considered a top obstacle for 3 percent of hospital/health system respondents, versus 18 percent of all respondents.

And 40 percent of this sector saw reductions in avoidable ER visits of between 0 to 5 percent, versus 26 percent of all respondents.

Source: 2014 Healthcare Benchmarks: Reducing Avoidable ER Visits

2014 Healthcare Benchmarks: Reducing Avoidable ER Visits delivers actionable metrics from 125 healthcare organizations on their efforts to foster appropriate use of hospital emergency departments. Enhanced with more than 50 easy-to-follow graphs and tables, this third edition of comprehensive data points presents year-over-year trends and best practices for engaging ER and hospital staff, primary care physicians, community providers and patients in reducing avoidable ED utilization.