The Milwaukee Health Care Partnership, like so many other providers, needed to reduce avoidable emergency department utilization and improve outcomes by connecting patients to medical homes or other health resources.
To meet this goal, the partnership initiated the Emergency Department Care Coordination program in 2007. The initiative seeks to help underinsured and uninsured people get access to medical, dental or behavioral health services following an emergency department visit.
The public-private consortium had no efficient way to identify available services, make appointments or effectively connect patients to follow-up services from the emergency department. Milwaukee Health Care’s emergency department staff and care managers would either have to make a series of phone calls to clinics, which was very labor intensive and time-consuming, or just distribute a list of options for the patient to seek out on their own. A natural result: many patients would not get the follow-up care they needed and would frequently return to the emergency department to seek treatment for ambulatory-sensitive conditions.
One of the key challenges was the intersystem scheduling from the various emergency departments into community clinics. Milwaukee has a number of community health centers and other safety net clinics, but they are on numerous different EHRs, which makes electronic communication difficult between referring emergency departments and receiving clinics.
What they needed was a centralized scheduling system that could bridge the gap between these systems and provide a pathway for communication so care managers in the emergency department could place patients in health homes with confirmed, scheduled appointments and simultaneously provide the receiving clinics with the necessary information to facilitate pre-visit outreach and follow-up care.
Milwaukee Health Care ultimately chose MyHealthDirect’s cloud-based digital scheduling and referral tools, which enable staff to find a clinic convenient to the patient and book an appointment that works with that person’s schedule.
There are many care coordination systems on the market. Vendors include Allscripts, b.well, Caremerge, Ensocare, Imprivata, PatientPing, pMD, Seremedi and this month Microsoft revealed plans to bring care coordination tools to market.
Meeting the challenge
The Milwaukee Health Care Partnership has deployed the system for use by care managers who work with the underinsured and uninsured patients in the emergency department to help them find a medical home or other health resource following their emergency department visit.
The technology also enables the receiving safety net clinic to have contact information of the referred patient so they can do pre-visit outreach to welcome them, encourage attendance and help with potential transportation barriers – all things that have helped improve patient engagement and show rates.
Currently, eight different emergency departments across three health systems (Ascension Wisconsin, Advocate/Aurora Health Care, and Froedtert Health) use MyHealthDirect to schedule into more than 20 safety net clinics. With the technology, patients get a menu of what clinics are available in their community and can see what appointment times are offered to select the best fit for their needs.
The consortium reduced emergency department usage for non-emergencies by 44 percent for those patients that attend their first primary care physician appointment, while connecting more than 50,000 patients with appointment bookings, with 38 percent of those being for the uninsured.
“Patients have visibility into what their options are and can select the best place and time to fit their needs,” said Greg Stadter, program director at the Milwaukee Health Care Partnership. “This significantly improves the show rate for appointments and better engages patients because they have a say in where they go for care.”
By giving patients a solid connection to a medical home, they are able to manage their chronic conditions and stay healthy, instead of having their condition worsen to the point of needing an emergency department visit, he added.
“We’ve found that in many cases the patients weren’t even aware that there was an excellent clinic right in their community and were coming to the emergency department because they just didn’t know other options were available and convenient,” he explained. “By facilitating that first visit to the clinic for them, they now are connected with a health home where they can receive primary, dental or behavioral healthcare on an ongoing basis.”
Reducing the subsequent emergency department usage by 44 percent means that patients are staying healthier, the emergency department is less crowded and can focus attention on true emergencies, and the health systems are reducing the total cost of care, as care provided in primary care clinics is much more cost-effective, he added.
As for case managers connecting more than 50,000 patients, 38 percent of those being for the uninsured, without the care coordination technology, many of these appointments would never have happened, Stadter said.
The partnership also asks clinics to track a metric called “Stick Rate,” which is patients that have two visits at the receiving clinic over a nine-month period. Stick rate is important for the partnership because it measures how many patients truly establish at the clinic as a health home, rather than coming once for episodic treatment. Having such insight helps the partnership continuously improve the program and better serve its vulnerable populations, Stadter said.
Advice for others
Milwaukee Health Care is an example of several large-scale health systems banding together to connect thousands of vulnerable patients, particularly Medicaid, uninsured and newly insured, with an ongoing medical home for the first time using digital care coordination technology. For hospital that have not yet done so, Stadter offered words of advice.
“Finding a digital solution that puts patients first in finding the care they need is the best advice I can give,” Stadter said. “Technology is opening up doors to new and more effective ways of coordinating care, but it is important to find vendors that will partner with you to work through any issues with all the clinics and stakeholders involved and develop the needed solutions to maintain a sustained and successful program.”
It is also important that the technology meets the needs of all scheduling partners, he added.
“The fact that it’s web-based means that any clinic can participate in our Emergency Department Care Coordination program regardless of their level of technical sophistication, from clinics operating with paper charts to those with an advanced EHR,” he said.
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