ED Care Triage Actively Engaged Patient Modifications PIC Discussion July 19th , 2016

ED Care Triage Reporting Requirement DOH “Actively Engaged” Definition: “The number of participating patients presenting to the ED, who after medical screening examination were successfully redirected to a PCP as demonstrated by a scheduled appointment.” DOH Clarifying Information: “The term successfully redirected means that the patient had and was made aware of an appointment with a PCP within 30 days after ED presentation and medical screening. It is expected that the redirection could occur within or en route to the ED.” CNYCC Additional Reporting Requirement: While subject to change, CNYCC is currently interpreting the expectation that “redirection could occur within or en route to the ED” to be satisfied if the patient has a scheduled appointment and is notified of that appointment within 2 calendar days of the date of discharge from the Emergency Department.

Partner Discussion and Feedback Trial of 2 Calendar Day Notification DY1 Q4: Low Actively Engaged Patient numbers Temporary removal of 2-day stipulation DY2 Q1 Targets (as of 7/18) Organizations Participating in ED Care Triage with submitted Actively Engaged Patient Counts Auburn Community Hospital (40) Lewis County General Hospital (136) MVHS (16) Oneida Healthcare (123) Oswego Hospital (301) Rome Memorial Hospital ( ~600 ) St. Joseph’s Hospital Health Center (213) Upstate University Hospital (67) Q DUE Target Actual Gap to Goal DY2 Q1 1600 1496 (104)

DOH Change in Actively Engaged Definition DOH “Actively Engaged” Definition: “The number of participating patients presenting to the ED, who after medical screening examination were successfully redirected to a PCP or Health Home care manager as demonstrated by a scheduled appointment.” DOH Clarifying Information: “The term successfully redirected means that the patient had or was made aware of an appointment with a PCP or Health Home care manager within 30 days after ED presentation and medical screening. Health Home care manager will only serve an option for those patients enrolled in a Health Home at time of presentation to the ED. A redirection could occur within or en route to the ED.”

Impacts on ED Care Triage Had or made aware of an appointment with a PCP or Health Home Care Manager within 30 days (if currently established with a Health Home Care Manager) Instead of only connecting a patient to a/their PCP, now a patient can be directed to their Health Home Care Manager Responsibility for notification & scheduling of appointment can be shifted to an entity other than the ED Timeframe to make an individual aware of their appointment. Reporting back to CNYCC if an entity other than the ED is making an appointment with the patient.

Decisions to Be Made Who is responsible for scheduling and notifying individual of their appointment? Does responsibility completely lie with Emergency Departments? Are partners willing and able to have a shared responsibility in this project? For example: have Health Homes/PCP’s take the lead on scheduling and notifying patients What is in the best interest of the patient? Could be different for each patient Timeframe for notification/reach out to patient Does the current 2 business day notification make sense? Health Homes current policy: 24 hours or next business day Primary Care Provider: Based on follow-up notes in discharge summary NYS DOH Requirement: within 1 week

Decisions to Be Made Reporting Information to CNYCC Which entity is taking ownership of project activities to report back to CNYCC? Are partners willing and able to have a shared responsibility in this project? For example: ED’s would provide a list of navigated to CNYCC. CNYCC will work with Health Homes/PCP’s for the additional information to conclude a successful Actively Engaged Patient. Payment Policy Implications