Emergency Department (ED) Navigation Presentation Project HOME Network Helpful Opportunities for Medical Care Enhancement Emergency Department (ED) Navigation Presentation Community Health Worker Conference Louisville, KY 9/28/2016 John Isfort, Director Project HOME Network Marcum & Wallace Memorial Hospital 60 Mercy Ct Irvine, KY 40336

Describe the Project HOME Network Describe the ED Navigation Program Helpful Opportunities for Medical Care Enhancement Describe the Project HOME Network Describe the ED Navigation Program Define the Criteria for ED Navigation List the benefits of an ED Navigator (CHW) Describe other benefits of a CHW in the Emergency Department

ORHP Network Planning Grant 2009 Project HOME Network Helpful Opportunities for Medical Care Enhancement ORHP Network Planning Grant 2009 ORHP Rural Healthcare Outreach Grant 2012 $450,000 (3 Years/ 2012-2015) Based on Collaboration with CAH & FQHC’s Focused on Uninsured Overutilization of ED for Primary Care Transportation Specialty Care Lung Cancer Screening

Project HOME Network Helpful Opportunities for Medical Care Enhancement Lexington Campbell Estill & Lee Counties Project HOME Network Boone Kenton Gallatin Bracken Carroll Pendleton Trimble Grant Mason Owen Robertson Greenup Henry Harrison Lewis Oldham Fleming Nicholas Carter Boyd Jefferson Franklin Scott Shelby Bourbon Rowan Bath Elliott Spencer Woodford Fayette Lawrence Montgomery Meade Bullitt Anderson Clark Hancock Menifee Jessamine Morgan Mercer Powell Johnson Henderson Daviess Breckinridge Nelson Washington Madison Wolfe Martin Estill Magoffin Hardin Union Garrard Lee Floyd Webster Mclean Larue Marion Grayson Lincoln Breathitt Ohio Jackson Owsley Pike Crittenden Rockcastle Hopkins Hart Casey Knott Livingston Muhlenberg Butler Edmonson Green Perry Caldwell Adair Laurel Clay Ballard Pulaski Leslie Letcher McCracken Lyon Metcalfe Warren Barren Russell Carlisle Marshall Christian Todd Logan Knox Trigg Cumberland Harlan Graves Simpson Allen Wayne Hickman Monroe Clinton Mccreary Whitley Bell Calloway Fulton

Marcum & Wallace Hospital Westcare Project HOME Network Helpful Opportunities for Medical Care Enhancement 16 Agencies in Network Marcum & Wallace Hospital White House Clinics Juniper Healthcare, Inc Foothills Mobile Clinic Mercy Health Clinics US Acute Care Solutions Kentucky Homeplace Estill Medical Clinic, PSC Westcare Estill Development Alliance Lee Health Department Estill Health Department KRCC Bluegrass.org Hospice Care Plus Estill County EMS

Emergency Department Health Care Navigation Project HOME Network Helpful Opportunities for Medical Care Enhancement Emergency Department Health Care Navigation

Health Care Navigator (HCN) for the ED Lay Worker Project HOME Network Helpful Opportunities for Medical Care Enhancement Health Care Navigator (HCN) for the ED Lay Worker Trained by Kentucky Homeplace Database Provided by Kentucky Homeplace Liaison to Network Clinical Partners Works with Medicaid MCO’s 40 hour week (Peak Hours) Onsite in ED Jim Thacker

Criteria for Navigation (2011/2012) Uninsured Project HOME Network Helpful Opportunities for Medical Care Enhancement Criteria for Navigation (2011/2012) Uninsured 6 or more ED visits in previous 12 months No Primary Care Provider Resident of Project HOME Network Counties

Cost Comparison for Navigated Patients (2013-14) 96 Patients Project HOME Network Project HOME Network Helpful Opportunities for Medical Care Enhancement Cost Comparison for Navigated Patients (2013-14) 96 Patients 821 ED Visits $2,660 Average ED cost per patient ($311 per visit) $255,361 Total cost for ED visit $134.50 Average cost of Clinic Visit $110,424 Total Cost of ED visits if in Clinic 187 ED visits after Navigation 77% decrease in ED Visits after HCN contact

ACA Enrollment Project HOME Network Helpful Opportunities for Medical Care Enhancement ACA Enrollment

ACA Supplemental Funding $25,000 x 2 Open Enrollment Project HOME Network Project HOME Network Helpful Opportunities for Medical Care Enhancement ACA Supplemental Funding $25,000 x 2 Open Enrollment Health Care Navigator Target 600 Enrolled 647

Community Lung Cancer CT Screening Program Project HOME Network Helpful Opportunities for Medical Care Enhancement Community Lung Cancer CT Screening Program

Lung Cancer CT Scan Screening Program Project HOME Network Project HOME Network Helpful Opportunities for Medical Care Enhancement Lung Cancer CT Scan Screening Program Partnership with University of Kentucky Markey Cancer Center 40 Patients to be Screened (Uninsured) Community Program (Screened Locally) Treatment and Follow-up Provided by UK Multi Disciplinary Team Shared Decision Making (SDM) by CHW

Lung Cancer CT Scan Screening Program 42 - Patients screened Project HOME Network Helpful Opportunities for Medical Care Enhancement Lung Cancer CT Scan Screening Program 42 - Patients screened 2 – Positive 4 – Suspicious 36 - Negative

Summary of Accomplishments Project HOME Network Helpful Opportunities for Medical Care Enhancement April 2016 Summary of Accomplishments 2079 patient encounters in all programs (40 months) 60% reduction in ED visits after contact with HCN ACA enrollment penetrated 10% of local uninsured market CT Lung Screening detected 2 early cancer ED Navigator provided significant ROI

ACA Insurance Program I&II Project HOME Network Helpful Opportunities for Medical Care Enhancement 4/19/2016 Project HOME Network ED Navigation Program Target 184 Navigated 187 Percent Navigated 100% CT Screening Program Target 40 SDM 42 Scanned Percent Scanned 100% ACA Insurance Program I&II Target 600 Contacted 1114 Enrolled 647 Percent Enrolled 100%

Thank You Questions Project HOME Network Helpful Opportunities for Medical Care Enhancement Thank You Questions

John Isfort jisfort@mercy.com 859-625-8104 Project HOME Network Helpful Opportunities for Medical Care Enhancement John Isfort jisfort@mercy.com 859-625-8104