South Carolina Hospital Association October 4, 2012

Data is not the answer: it just points you in a direction… DATA = Information + Experience = Knowledge … Wisdom…. GOOD DECISION MAKING

 Build your Community Health Plan  Implement your Community Health Plan  Measure the impact of your Community Health Plan

It all begins with … Asking lots of questions, Asking the right questions, and Knowing when to stop and when NOT to stop….

 10%: No Teeth  8%: No prenatal care  17.2% live in poverty  25% Smoke  African Americans: Death from heart disease 2X greater; Diabetes, 3X greater  49% ER visits – non-emergent  65% overweight or obese  Highest teen pregnancy rate in SC  High infant mortality rate  15% readmissions

BUT… Data can be your best ally worst enemy or your worst enemy

Example  Spartanburg Regional: 15% Readmission Rate

 Solutions:  Internal Hospital Focus:  Better manage the patient while in the hospital  Improve Discharge Planning efforts  Send the patient home with medicationsOR…..

 Identify global solutions:  External focus! Upstate Care Transitions Coalition 4 Hospitals 3 Counties 20 Community Partners

Example:  49% ER visits: Non-emergent Care  ER at capacity

 Solutions:  Discourage non-emergent use:  Copays  Discourage ER for follow-up visit  Require payment up front  Expand the EROR…..

Before finding solutions….  Determine the Cause  Capacity Issues (Safety Net providers full)  Lack of primary care and specialty care  Address the Causes  Develop solutions to expand capacity outside the ER

A shocking statistic can motivate a community to change  It all begins with awareness.  Awareness leads to emotion/anger/frustration/disgr ace, etc…  Emotion leads to commitment.  Commitment leads to CHANGE.

 10 % citizens have no teeth  Highest teen pregnancy rate in the state  Children in communities that have a Smokefree Ordinance are 44% less likely to ever start smoking

 Improving Outcomes  Reducing Costs  Birth Matters  AccessHealth Spartanburg  Welvista

BirthMatters Participants and Outcomes Spartanburg County BirthMatters (mothers age 20 and under) Racial/Ethnic Composition 85% African American, 8% Caucasian, 7% Latino Low Birth Weight Births 2% (compared to 10.1% in Spartanburg County) Mothers Breastfeeding at Birth 93% (compared to 61.2% in Spartanburg County)

 Over 2000 clients enrolled  750 Cases closed  175 graduates  48% reduction IP admissions  57% reduction IP charges  32% reduction ER visits  35% reduction ER charges 13 to 1 return on investment!! 13 to 1 return on investment!!

 Hospital Investment:  $185,000  Return:  $5.7 million free meds  50.6% reduction in ER charges  25.3% reduction ER visits  63.6% reduction IP charges  45% reduction IP admissions $1.7 million savings/year!! $1.7 million savings/year!!

 Hospital  Finance  Quality  Information Services  Community  DHEC  Local universities  Council of Governments  County government  State  DHEC  ORS  State universities

Renee Romberger, FACHE VP, Community Health Policy & Strategy Spartanburg Regional Healthcare System