Project Spotlight ED Care Triage (2biii) Sherry Buglione MS, RN Director of Integrated Care & Strategy Deployment Oneida Healthcare May 26, 2016

ED Care Triage Project (2biii) The Goal: Identify individuals with an ambulatory sensitive condition (ASC) or potentially preventable visit (PPV) and connect them to a Primary Care Provider. CNYCC defined criteria for the target population: Each ED’s own clinical determination of an ambulatory sensitive condition OR Have an Emergency Severity Index level 3, 4, or 5 (entity must provide protocol for classification of an ESI 3) Oneida 2015 ED Data Analysis 32% of ED visits were Non-Urgent (triage level 4 & 5) 57% of non-urgent visitors had medicaid 30% did not have a PCP, or didn’t know who their PCP was 69% of Patients with >5 visits over 10 months were Medicaid

Oneida Healthcare Target Population Patients who do not have a Primary Care Physician or do not know who their PCP is 6 or more ED visits over the previous 12 months. Patients who are non-urgent ESI 4s & 5s. ESI 3’s who in the providers clinical judgment deem appropriate

Beginning of the Patient Navigation Program Presented ED Navigator position and 2015 data to Senior Leadership November 2015 Began bi-weekly meetings with CNO, ED Nurse Manager, Practice Manager, Care Coordinator at Practices, and Care Transition staff to discuss ED utilization Developed interim program with Care Transitions Team for patients with no PCP Attempted to reach patient after ED discharge: largely unsuccessful Linda ~ she would need to secure appointments for 215 patients next year to pay for her salary. Triggers built into Meditech Alert on status board when patient presented to the ED with: no PCP, ESI of 4 or 5 or 6 or more visits in past12 months Patient Navigator hired Met with St. Joe’s Patient Navigator January 2016 Visited all area PCP offices and ED physician & staff meetings Explained her role, the program, and made contacts with scheduling personnel at each office Patient Navigator begins in Emergency Department February 2016 Patient Navigators

Patient Navigation Process Proactively identify the patient through ED Alerts or discussion with clinical team. Navigator hours M-F 9a-5p Report runs @ 10am daily of patients who qualify for navigation after 5pm Navigator attempts to contact them the following day After medical screening (determines non-urgent visit) Patient Navigation begins Meet with patient in ED room to introduce self and the program Verify demographic information Obtain desire & preferences for PCP Identify barriers to access primary care Offer to obtain follow-up appointment with PCP Review proper utilization of ED & benefits of PCP with patient If uninsured, refer to in-house Application Counselor Refer to community services as needed Refer to Health Home or notify Health Home Care Manager if enrolled

Patient Navigation Process Scheduling of appointment: Contact Practice Care Coordinator or PCP office to schedule appt. while patient in the ED If scheduled; appointment card given to patient, with directions & phone number Cannot schedule while in the ED (after hours or left ED) Patient notified within 2 days Inform ED provider of F/U appointment to include in his Plan of Care Documentation of all interactions and data fields in Meditech For DSRIP reporting, performance improvement & quality measures All ED patients receive follow-up phone call via Cipher Health within 72 hours of visit Future plans: Identify Health Home patients in Meditech Potential to perform PAM screenings Open scheduling in our practices

Success to Date Challenges Linda has Navigated 234 patients 173 Medicaid, 61 other 37 appointments beyond 30 day requirement 24 Medicaid, 13 other Appointments with specialists (Ortho, Dental, Women's Health, ENT) Challenges Saturation at Primary Care Practice, increased days to appointment No- Show rate Drug seeking patients Navigator Coverage Transmitting ED record to PCP Monitoring improvement After hour PCP answering machine (“call back in am”)

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