Project Engage Basha Silverman, Director of Prevention and Advocacy, Brandywine Counseling and Community Services Terry Horton, MD, FACP Chief, Division of Addiction Medicine Department of Medicine April 3, 2012

Patient Centered Medical Home

Substance Use and the Medically Homeless Participation assumes compliance Substance Use is often the Root Cause Health Issue If don’t address, will remain Medically Homeless with significant health issues

Delaware’s Epidemiology Estimated 2009 population of 885,000 9% of adults alcohol/drug abusing or dependent* 65,000 in need of alcohol/drug treatment** 8,216 admissions to publicly-funded SA treatment services statewide 2006*** * NSDUH data ** Wright et al *** Delaware Department of Health and Social Services, Division of Substance Abuse and Mental Health, 2007 Tx gap

Hospitals’ Inpatient Services Aggregate the Highly Disordered High rates of alcohol and substance dependency* Significant medical comorbidities Expensive revolving door higher use of ER (2.3x), inpatient care (6.7x)** Increased AMA, readmissions*** * Saitz, 2007; Bertholet, 2010 ** Stein, 1993 *** Hwang, 2003; Jankowski, 1977; Chan, 2004

An Emerging Imperative

Project Engage Targeting hospitalized substance users Bedside Peer-to-peer intervention using Motivational Interviewing Addictions Community Social Worker Assistance with barriers to transition to care Help with integration into the hospital milieu

Project Engage Initial Pilot at Wilmington Hospital 2008 Roll out to Christiana Hospital Dec additional Patient Engagement Specialists Social Worker Rigorous Program Evaluation (May,2012) Partnership with U. Pennsylvania, TRI, and State Medicaid Office Demographics, Engagement parameter and health economics

Gender 667 Patients seen 9/1/08 -3/30/12

Project Engage - Gender Race 667 Patients seen 9/1/08 -3/30/12

Age

Drug of Choice

Patient Experience

Health Insurance

Outcomes Data Review N = 423 (9/1/ /10/10) 41% successfully admitted into 33 drug/alcohol treatment programs Overall 667 seen- (9/1/08 -3/30/12) Overall 36% successfully engaged into care/drug treatment

DPCI/Aetna Data Claims from June 1, November 30, months before and after claims review, n = 18 MetricPrePostFinding Medical inpatient admits12833% decrease $35,938 ER visits543338% decrease $4,248 BH/SA inpatient admits71043% increase ($1,579) BH/SA outpatient visits121633% increase ($847) PCP office visits275188% increase ($1,281) Total Savings = $36,479 Modified from Wright, Delaware Physicians Care Inc, 2010

DPCI/Aetna Data Claims from January 1, December 30, months before and after claims review, n = 25 MetricPrePostFinding Medical inpatient admits17758% decrease : $68,422 saved ER visits % decrease : $3,308 saved Total Savings = $71,730 Modified from Wright, Delaware Physicians Care Inc, 2010 Claims from January 1, December 30, months before and after claims review, n = 30 MetricPrePostFinding Medical inpatient admits422248% decrease : $184,236 saved ER visits % decrease : $8,690 saved Total Savings = $192,926

Cost Savings From A Few Can Support Many

Next Steps Rigorous Program Evaluation to begin May 1 in partnership with Treatment Research Institute, University of Pennsylvania and Christiana Care Center for Outcomes Research and Office of Medicaid Sustainability is the key State-wide roll out?

For Consideration There is value in identifying and engaging disenfranchised populations Need to find doors for their inclusion into the medical home Rigorous program evaluation likely to reveal potential for significant savings

Project Engage Basha Silverman, Director of Prevention and Advocacy, Brandywine Counseling and Community Services Terry Horton, MD, FACP Chief, Division of Addiction Medicine Department of Medicine