1. Presented to Florida Hospital Association Webinar February 18, 2010 By Wally Plosky, Program Director HERAP Duval County Health Department

2. HERAP Focus  Uninsured and low income populations.  Patients without a family physician.  Patients requiring case and disease management assistance (for diabetes, cardiovascular, pulmonary and other chronic conditions).  Patients who have trouble filling prescriptions.  Zip codes with high hospital use for Ambulatory Care Sensitive conditions.

3. HERAP Components  Coordination of hospital ER and inpatient referrals.  Primary care medical homes.  Multi-disciplinary disease management services.  Free walk-in medical condition management centers (MCMCs).  Neighborhood community living rooms (CLRs).  Medication assistance program (MAP).  Expanded clinic hours – evenings and Saturdays.  Stanford Medical School’s Chronic Disease Self Management Program (CDSMP) - Living Healthy.  Regional health information exchange (JHIN).

4. HERAP Staffing  RN disease managers  Financial eligibility specialists  Clinical pharmacologists/pharmacists  Registered dietitians/certified diabetic educators  Health educators  Mental health counselors  Patient navigators

5. 2009 HERAP Accomplishments  Received 2,697 client referrals from hospitals and community partners.  Connected 70% of hospital-referred patients with medical homes in the community.  Reduced emergency room utilization of HERAP-enrolled clients by 55.4%.  Reduced hospitalization of HERAP-enrolled clients by 89.8%.  Coordinated with hospitals to recoup over $1M in billable Medicaid dollars.  Helped hospitals in accessing over $75,000 in billable Medicaid under the Medically Needy Share of Cost program.

6. 2009 HERAP Accomplishments (cont’d)  Submitted 264 medication assistance applications totaling $83,841.  Provided chronic disease management services for an average of 200 patients monthly  Conducted three 6-week Stanford Medical School Chronic Disease Self Management Programs (CDSMP), graduating 30 participants  Held 28 CLR outreach events, attended by 1007 participants, resulting in 227 HERAP enrollments  Implemented innovative technology to streamline financial eligibility for hospital-referred clients needing access to medical homes within 72 hours  Provided office space and IT support for the Duval County WE CARE program and a volunteer Project Dentists Care

7. Key HERAP Partners  Baptist Health (BMC – Baptist South)  Memorial Hospital (HCA)  St. Vincent’s Medical Center (includes St. Luke’s)  Jacksonville Health Information Network (JHIN)  DCHD Institute for Public Health Informatics and Research (IPHIR)  Agape Community Health Center Network (Co-Applicant public entity FQHC with DCHD)  WE CARE, Inc.

8. HERAP Referral Sources Hospitals/ ERs Community physicians Self referral I M Sulzbacher Community outreach Agape CHC Network HERAP DCHD programs Community partners Volunteers in Medicine We Care

9. HERAP Referrals by ZIP Codes >40 30-39 24-29 10-23 <10

10. Duval County HERAP Cost Effectiveness Review  Objectives Evaluate the impact of HERAP’s comprehensive multi-disciplinary disease management and medical home program on:  Emergency room utilization  In-patient hospital admissions/stays Evaluate the effectiveness of a health information exchange in monitoring HERAP effectiveness (Jacksonville Health Information Network – JHIN) Measure the effectiveness of a multi-hospital partnership model with individual hospital-specific program elements

11. Duval County HERAP Impact Analysis  Methods/Procedures Data set stratification  521 uninsured patients formally enrolled in HERAP’s disease management program with at least one emergency room visit or one in- patient admission  January 1, 2009 – September 30, 2009 “Before and after” utilization rate comparison  Time bounded: 180 days immediately prior to and following HERAP admission

12. Duval County Hospital Emergency Room Alternatives Program (HERAP) Impact Analysis  Emergency room visits Reduction: 55.5% Projected six month savings:  $176,490  Hospital in-patient admissions Reduction: 89.8% Projected six month savings:  $4,324,260

13. Resources Our Partner Hospitals Want for Their Discharged Patients  Assistance with non-compliant clients.  Primary care medical home.  Prescription access.  Chronic disease care and case management.  Knowledge of available community resources and how to connect clients to those resources.  Dental access.  Behavioral health and substance abuse services.

14. HERAP Contact Information Hospital Emergency Room Alternatives Program Duval County Health Department MC-92 900 University Blvd. N., Suite 202 Jacksonville, FL 32211 Tel: (904) 253-1444 Fax: (904) 745-3005 http://www.dchd.net/herap.htm Wallace B. Plosky, MBA, Program Administrator Wally_plosky@doh.state.fl.us Brenda Bernardez, MSN, Project Director Brenda_bernardez@doh.state.fl.us