A cross-system collaborative approach to serving frequent users of emergency health services Frequent Users Systems Engagement (FUSE) Initiative of Washtenaw County

FUSE Program Goals and Elements Use a data-driven, quantitative method to identify the vulnerable high-cost, high-need, homeless population of emergency health services frequent utilizers, and: Serve, through case management and housing, 100 individuals within two years Create cross-system partnerships to improve health care delivery for patients with complex medical and psycho-social needs Improve health outcomes for frequent users Reduce health care costs associated with frequent users for public and private health insurance plans, hospitals and ambulance agencies

Funding Current: SIF Medicaid MSHDA ESG CoFu RAAH SJMHS PA2 Future: Supportive Housing Benefit HUD PSH Bonus Insurance Companies / Managed Care Organizations

FUSE Partners Lead Agency Avalon Housing Housing Ann Arbor Housing Commission Shelter Association of Washtenaw Co. Michigan Ability Partners Washtenaw Housing Alliance Hospitals University of Michigan Hospital St. Joseph Mercy Hospital Huron Valley Ambulance Integrated Health Packard Health Washtenaw Health Plan Community Support and Treatment Services Washtenaw Community Health Organization Home of New Vision Dawn Farm Evaluation New York University

Target Population Homeless or in persistent housing crisis Have a chronic behavioral health condition and/or one or more chronic physical health condition Very low income and High utilizer of crisis health services Defined as 8+ ED visits, OR 3+ ED visits with 1 inpatient stay

What is this costing us? For each of the top one hundred matched utilizers: Average annual hospital charges were $178,500 and median annual hospital charges were $99,500, in the year prior to intervention. Poor health outcomes. Tremendous strain on city and county infrastructure and services.

Current enrollment and housing status 93 people housed; 101 enrolled. 11 exits: 3 long-term incarceration, 1 State hospital, 7 deaths 89% housing retention rate

Outreach and Recruitment Strategy Primary outreach sites Hospitals ER coordination and “real-time” referrals Ambulance FUSE Outreach Coordinator housed with the PATH Team Shelter, jails, detox facilities, motels, streets and campsites

Securing Permanent Supportive Housing Scattered-site mixed housing model Avalon Housing 28 PSH units Ann Arbor Housing Commission 25 Housing Choice Vouchers 15 Public housing units 5 SRO units Private Landords 26 scattered-site units in Ann Arbor and Ypsilanti PSH Bonus - 44 subsidies Miller Manor

Health Care Prevalence (N=96) 75 Reported/Recorded a chronic physical health condition 11 Diabetes, all types 22 Hypertension 8 Hepatitis, all types 3 HIV/AIDS 3 Chronic Pain disorder 5 Seizure disorder 11 COPD & Asthma

Mental Health Prevalence (N=96) 69 Reported/Recorded Primary Axis 1 Mental Health Diagnosis 29 Depression 10 Bipolar disorder 6 Schizophrenia 8 PTSD 5 Psychotic NOS 10 Mood NOS 1 SUD induced mood disorder

SUD Prevalence (N=96) 78 Reported/Recorded Substance Use/Misuse/Dependence (Primary Drug of Choice) 50 Alcohol 10 Opiates 7 crack cocaine 3 Amphetamines 8 Marijuana

ED Utilization Outcomes Pre-intervention: 9.6 ED Visits 4.6 Inpatient stays One year post-intervention 4.8 ED Visits 1.25 Inpatient stays Remember, this carried an average cost of $178,500, in the year prior to intervention. This has an extrapolated average annual cost of $80,000.

Laurie Ingram Director, Compliance and Evaluation Aubrey Patino Clinical Director ext.224 Jason Prince Associate Clinical Director