1. Project Engage Basha Silverman, Director of Prevention and Advocacy, Brandywine Counseling and Community Services Terry Horton, MD, FACP Chief, Division of Addiction Medicine Department of Medicine April 3, 2012

2. Patient Centered Medical Home

3. Substance Use and the Medically Homeless Participation assumes compliance Substance Use is often the Root Cause Health Issue If don’t address, will remain Medically Homeless with significant health issues

4. Delaware’s Epidemiology Estimated 2009 population of 885,000 9% of adults alcohol/drug abusing or dependent* 65,000 in need of alcohol/drug treatment** 8,216 admissions to publicly-funded SA treatment services statewide 2006*** * 2004-2005 NSDUH data ** Wright et al. 2007 *** Delaware Department of Health and Social Services, Division of Substance Abuse and Mental Health, 2007 Tx gap

5. Hospitals’ Inpatient Services Aggregate the Highly Disordered High rates of alcohol and substance dependency* Significant medical comorbidities Expensive revolving door higher use of ER (2.3x), inpatient care (6.7x)** Increased AMA, readmissions*** * Saitz, 2007; Bertholet, 2010 ** Stein, 1993 *** Hwang, 2003; Jankowski, 1977; Chan, 2004

6. An Emerging Imperative

7. Project Engage Targeting hospitalized substance users Bedside Peer-to-peer intervention using Motivational Interviewing Addictions Community Social Worker Assistance with barriers to transition to care Help with integration into the hospital milieu

8. Project Engage Initial Pilot at Wilmington Hospital 2008 Roll out to Christiana Hospital Dec. 2012 2 additional Patient Engagement Specialists Social Worker Rigorous Program Evaluation (May,2012) Partnership with U. Pennsylvania, TRI, and State Medicaid Office Demographics, Engagement parameter and health economics

9. Gender 667 Patients seen 9/1/08 -3/30/12

10. Project Engage - Gender Race 667 Patients seen 9/1/08 -3/30/12

11. Age

12. Drug of Choice

13. Patient Experience

14. Health Insurance

15. Outcomes Data Review N = 423 (9/1/08 - 12/10/10) 41% successfully admitted into 33 drug/alcohol treatment programs Overall 667 seen- (9/1/08 -3/30/12) Overall 36% successfully engaged into care/drug treatment

16. DPCI/Aetna Data Claims from June 1, 2009 - November 30, 2009 3 months before and after claims review, n = 18 MetricPrePostFinding Medical inpatient admits12833% decrease $35,938 ER visits543338% decrease $4,248 BH/SA inpatient admits71043% increase ($1,579) BH/SA outpatient visits121633% increase ($847) PCP office visits275188% increase ($1,281) Total Savings = $36,479 Modified from Wright, Delaware Physicians Care Inc, 2010

17. DPCI/Aetna Data Claims from January 1, 2010 - December 30, 2010 6 months before and after claims review, n = 25 MetricPrePostFinding Medical inpatient admits17758% decrease : $68,422 saved ER visits13311612.7% decrease : $3,308 saved Total Savings = $71,730 Modified from Wright, Delaware Physicians Care Inc, 2010 Claims from January 1, 2011 - December 30, 2011 6 months before and after claims review, n = 30 MetricPrePostFinding Medical inpatient admits422248% decrease : $184,236 saved ER visits1531511% decrease : $8,690 saved Total Savings = $192,926

18. Cost Savings From A Few Can Support Many

19. Next Steps Rigorous Program Evaluation to begin May 1 in partnership with Treatment Research Institute, University of Pennsylvania and Christiana Care Center for Outcomes Research and Office of Medicaid Sustainability is the key State-wide roll out?

20. For Consideration There is value in identifying and engaging disenfranchised populations Need to find doors for their inclusion into the medical home Rigorous program evaluation likely to reveal potential for significant savings

21. Project Engage Basha Silverman, Director of Prevention and Advocacy, Brandywine Counseling and Community Services bsilverman@brandywinecounseling.org Terry Horton, MD, FACP Chief, Division of Addiction Medicine Department of Medicine thorton@christianacare.org