John W. Robinson, MD, SM VP Medical Affairs & Chief Medical Officer Molina Healthcare of Washington, Inc. Reducing Preventable ER Visits April 19, 2011
Dec 18, 2015
John W. Robinson, MD, SMVP Medical Affairs & Chief Medical OfficerMolina Healthcare of Washington, Inc.
Reducing Preventable ER Visits
April 19, 2011
Creating Community Partnerships and Data Planning between Hospitals and Health Plans
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Molina Healthcare of WA (MHW), a managed care health plan, provides a wide range of quality health care services to families and individuals who qualify for government-sponsored programs, including Healthy Options, the Children's Health Insurance Program (CHIP), Basic Health+, Basic Health, WMIP and Medicare. Over 350,000 members are covered in Washington. MHW also operates two primary care clinics in Snohomish County.
The Problem
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Molina members go to the ER over 15,000 times each month.
Based on the NY Algorithm calculations, 55% of these ER visits are preventable.
Medical Management Initiatives
Reduce ER UtilizationFull Range of initiatives
Low
High
# of
Mem
bers
High
Low
ED Use
Medical Management Initiatives
The Top of the Pyramid
Molina Healthcare of Washington wants to partner with hospitals serving Molina Healthcare members to receive daily census and ER information in a secure electronic format (“eCensus” data).
eCensus data is used to: • Improve turn-around time and accuracy of admission
notification •Ease the administrative burden on facility staff by eliminating time spent printing and faxing daily census•Quickly identify Molina Healthcare members with potentially avoidable emergency department visits who might benefit from Molina Healthcare education and outreach efforts
Started in CY2010
eCensus Background
• HOLY FAMILY HOSPITAL• KADLEC MEDICAL CENTER• KENNEWICK GENERAL HOSPITAL• MOUNT CARMEL HOSPITAL• PROV EVERETT MED CTR• PROVIDENCE CENTRALIA HOSPITAL• PROVIDENCE ST PETER HOSPITAL• SACRED HEART MEDICAL CENTER• SEATTLE CHILDRENS HOSPITAL• ST JOSEPH HOSPITAL OF CHEWELAH• VALLEY MEDICAL CENTER HOSPITAL
Current Hospitals Live on eCensus
eCensus Flow Chart
Pilot: eCensus data from 10 Hospitals
Data fields transmitted to Molina daily:1. Patient name2. DOB3. Policy number4. Admission date5. Discharge date (for I/P)6. Status (active, discharged or blank)7. Patient type (EMR, I/P, or OBO)8. Admission Diagnosis9. Unit10. Patient phone11. Adm Source (floor in hospital)12. Adm physician
RESULTS
Sample Data: January 2011
# of ER visits in eCensus data: 1673
# of f/u phone calls completed to those members: 716
# of members with scheduled f/u: 360
# of members assigned to CM/DM: 85
# of members contacted who refused assessment: 4
Questions and Comments
Presenter Contact Information
John W. Robinson, MD, SM
VP of Medical Affairs & Chief Medical Officer
Molina Healthcare of WA
Ph: 425-424-7124