Access, Quality and Cost in Emergency Benefits Jeffery Thompson, MD MPH Chief Medical Officer Washington State Health Care Authority September 24, 2012 The Washington State “Best Practices” Presented at WSHA Safe Table – ER is for Emergencies 9/24/12

NY State DOH, 2003 Emergency Room Utilization by Medicaid Managed Care Members: May not represent the toughest cases 49% condition several hours to one day and 51% had the problem for several days or more. 21% reported that they either spoke with or visited a health care professional about the problem 69% said their PCP told them to go to the ER. 46% stated their PCP’s office was closed 46% or that they felt too sick - 27% were in too much pain 77% reported that their health problem was either very or somewhat serious 48% reported that at the end of the ER visit they were told to go to another doctor for follow up. Presented at WSHA Safe Table – ER is for Emergencies 9/24/12

WA State Hospital Association, 2010 ER Use Conclusions People of all ages use the emergency room, but the cost of care for seniors in our emergency rooms is significantly higher All populations use the emergency room for so-called “unnecessary” care that could be better treated in a primary care setting. Patients with Medicaid insurance and without any insurance rely on the emergency room for dental care and mental health care due to lack of access to these services in the community. Emergency rooms are not busiest at night, contrary to popular belief. Deductibles do not appear to dissuade people from using the emergency room, even for “unnecessary” care. Presented at WSHA Safe Table – ER is for Emergencies 9/24/12

The Toughest Cases: We need new tools to address the difficult cases 1) A DD client living alone with alcohol issues, living alone with fear and impulse issues that drive him to the ED 2) A client with panic attacks (father and brother died young of a MI) who goes to the ED with any symptom 3) A homeless client with untreated paranoia who when she loses her voucher of housing goes to the bus for shelter and uses the ED for food 4) A client who refuses care for their schizophrenia, is homeless with multiple involuntary commitments 5) A client with drug seeking ED visits, multiple symptoms and 42 CT scans in the last year Presented at WSHA Safe Table – ER is for Emergencies 9/24/12

The Toughest Cases: We need new tools to address the difficult cases Presented at WSHA Safe Table – ER is for Emergencies 9/24/12

The Toughest Cases: We need new tools to address the difficult cases Presented at WSHA Safe Table – ER is for Emergencies 9/24/12

The Toughest Cases: We need new tools to address the difficult cases Presented at WSHA Safe Table – ER is for Emergencies 9/24/12

The Toughest Cases: Success is when we document our successes Success is when best practices are measured across the state Success is when systems of care to engage these clients where they are not necessarily where we want them to be Success is when we can pay for a limited set of non-standard benefits Success with when the EDIE system and care tools are on steroids Success is when case managers become “natural helpers” Success is when case managers have a document cost and quality ROI Presented at WSHA Safe Table – ER is for Emergencies 9/24/12

Questions? Presented at WSHA Safe Table – ER is for Emergencies 9/24/12