1 SPRING 2014 REDUCTION OF EMERGENCY DEPARTMENT ADMISSIONS UNDER THE MAINECARE MANAGEMENT COLLABORATIVE

ROADMAP 2 The Approach How it Works Results Next Steps Goals and Barriers

ROADMAP 3 The Approach How it Works Results Next Steps Goals and Barriers

THE APPROACH 4 Hospitals Primary Care Emergency Personnel Community Care Behavioral Health State Agencies

ROADMAP 5 The Approach How it Works Results Next Steps Goals and Barriers

GOALS 6 Before After Care Mgmt

BARRIERS 7 Can’t contact Homelessness Substance Abuse Behavioral Health Blackballed Voluntary GOALGOAL

ROADMAP 8 The Approach How it Works Results Next Steps Goals and Barriers

9 Schedule Appointment Arrange Ride Schedule Appointment Arrange Ride Send Letter Close Case, Inform Hospital Establish PCP Identify Member Check Eligibility Verify PCP No Pull Patient Data Send Letter No Contact Member No Review Case Yes Contact Providers Contact Member No Discuss ED Usage Identify Barriers Discuss ED Usage Identify Barriers INITIAL PROCESS Yes

VARIATIONS 10 Identify Member Review Case Yes Presents in ED w/Anxiety Dental Pain, Infection Report to Providers Contact BH Providers Offer to Coodinate Care Partner w/Community Outreach to Home Partner w/Hospitals on placement Coordinate w/local Dentist Partner w/Hospital and Dental community for referral and treatment plan Arrange Transport Report to Providers Behavioral HealthDental Health Partner for Affordability

11 Meet w/Hospital and PCP office Care Managers No FOLLOW-UP PROCESS Discuss Findings, set goals Close case and monitor use ED visit in past 4 months Notify All Providers Formulate Next Steps Troubleshoot w/Providers No Community Meeting Yes Contine to Manage

ROADMAP 12 The Approach How it Works Results Next Steps Goals and Barriers

LOWER TOTAL COSTS 13 December 2011 Tracking Begins December 2011 Tracking Begins *Data courtesy of Wendy Waltz, MaineCare November 2012 – May 2014 Intervention Interval November 2012 – May 2014 Intervention Interval

FEWER ED VISITS 14 *Data courtesy of Wendy Waltz, MaineCare December 2011 Tracking Begins December 2011 Tracking Begins November 2012 – May 2014 Intervention Interval November 2012 – May 2014 Intervention Interval

BETTER OUTCOMES 15 Robert Wood Johnson Foundation: Caring for Health Care’s Costliest Patients 15 Before After Care Mgmt  Mobility problems  Weight problems  Hearing-loss  No support  Frequent ED trips  Hospitalization  Missed appointments  Mobility problems  Weight problems  Hearing-loss  No support  Frequent ED trips  Hospitalization  Missed appointments KVCCT  Walking program  Meals on Wheels  Free hearing aids  Arrange transport KVCCT  Walking program  Meals on Wheels  Free hearing aids  Arrange transport

ROADMAP 16 The Approach How it Works Results Next Steps Goals and Barriers

NEXT STEPS Pilot an Admission/Readmission initiative with 2 pilot hospitals Partner with APS to identify members in need of services Enhance and improve reporting to hospitals Increase in-home member contact Partner with Community Care Teams and Partner in Wellness Implement the MaineCare member lock-in program 17

QUESTIONS 18