1. Senior Centered Care Programming for Older Adults Excellus August 13, 2009

2. Adult Volume (Seniors = 65+) 540 520 505 580.3 254 304 354 404 454 504 554 604 654 704 Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Senior Volume 65+ UCL +2 Sigma +1 Sigma Average -1 Sigma -2 SigmaLCL Mean Volume Age 19-64 (Excluding Maternal/Child)

3. Adult Average Daily Census

5. Senior Services Programming and Integration Complication Prevention Maintaining Function Care Transitions To assess and improve the interdisciplinary, comprehensive processes of care for seniors using the Crouse Hospital care network, paying particular attention to geriatric syndromes and other issues unique to seniors accessing healthcare.

6. Care Transitions  Goal – Improve the patient’s ability to self manage chronic conditions  Global Outcomes  Reduce readmissions  Enhance patient satisfaction/loyalty  Ready Crouse for healthcare reform  Eric Coleman, MD University of Colorado

7. Why do patients return to the hospital?  Medication issues  Medication record & discrepancy analysis  Lack of timely follow up with MD/NP  Follow up appointment  Lack of knowledge/mgt of chronic conditions  Red flags & personal health record

8. Care Transitions Process  Community-dwelling patients with congestive heart failure / atrial fibrillation  Patient visited early in hospital admission  Home visit within 72 hours  Phone calls on days 2, 7, 14, and 30

9. Reduce the 30 day readmission rate of CHF patients in the program to below 9.71% (the hospital mean)

12. Resource Utilization  285 encounters  Average # admits = 2.85  Total cost = $1,958,197 100 CHF/Afib patients examined 1/2007 – 9/2008 All inpatient and outpatient visits related to CHF or Afib

13. Financial Impact (1/2007 – 9/2008) 100 patients studied Patients stayed out of hospital 70 Patients with subsequent admissions 30 *Admissions any time in study period ED & inpatient visits

14. Patients with Multiple Visits Before Intervention 45 patients Patients stayed out of hospital 26 Patients having subsequent admissions 19 *Admissions any time 1/2007 – 9/2008 ED & inpatient visits

15. Patients with Multiple Visits Before Intervention 19 Patients w Subsequent Admissions BeforeAfter Avg # visits = 3.4Avg # visits = 1.7 ALOS = 4.8ALOS = 3.9 *Admissions any time 1/2007 – 9/2008 ED & inpatient visits

16. Days to Readmission 26 Patients with Multiple Admissions before CT Intervention & no readmits after intervention Avg. days to rehospitalization before intervention = 86 Avg. days out of hospital after intervention = 175

17. Patients Enrolled During First CHF Admission 55 Patients Patients stayed out of hospital 44 Subsequent admissions 11 *Admissions any time 1/2007 – 9/2008 ED & inpatient visits

18. Patients Enrolled During First CHF Admission N= 55 / 11 with Subsequent Admissions* BeforeAfter Avg # visits = 1.0Avg # visits = 1.5 ALOS = 6.0ALOS = 4.2 *Admissions any time 1/2007 – 9/2008 ED & inpatient visits

19. Sharing Our Success University of Rochester Bassett Thompson Health Healthcare Advisory Board Cardiovascular Roundtable Health Quest, Poughkeepsie, NY Glens Falls Hospital Bronson Hospital, Kalamazoo, MI Christiana Care Ocean Medical Center, NJ Wheaton Franciscan Healthcare Alegent Health/Immanuel Health Systems OSF Franciscan Morton Plant Mease Health Care St. Francis Hospital, Tulsa, OK

20. Sharing Our Success American Hospital Association Wall Street Journal HANYS Annual meeting Dept of Health -- Patient Centered Care Northeast Home Care Nurses Association American Heart Association Regional meeting IPRO Teleconference HC Pro Teleconference

21. What’s Next?  Complex elders with multiple comorbidities  Transitional Care – Mary Naylor, PhD, RN University of Pennsylvania  COPD, frequent ED visitors, diabetes – good possible populations