1. Rural Health Network Development Grantee Meeting August 2, 2010 Diane M. Hughes, MBA Executive Director

2. Mission Statement Access Health Adams County (AHAC) develops, supports, and coordinates programs to provide appropriate access to healthcare for individuals whose access to services are limited due to insurance status and other factors including health conditions, health literacy, and social issues.

3. Three Main Components Community Service Link Physician Led Access Network Care Management

4. Community Service Link (CSL)

5. CSL Statistics 27 Participating Agencies 1,477 unduplicated Adams County residents Quarterly provider audit Ongoing user training 159 Users Quarterly User Group Meetings 35 referrals came to AHAC from Oct - May

6. Medicaider statistics Medicaider screens Adams County residents for eligibility into all state and federal programs.  992 Medicaider screenings  238 clients screened eligible for programs  Avg. interview time: 2.17 minutes  80 users community-wide

7. Community Service Link (CSL) What makes the linking system and Medicaider valuable?

8. Community Service Link (CSL) How could this software pay for itself?

9. Community Service Link (CSL) What is AHAC doing to make system Sustainable and valuable? Require Participation Agreements Quarterly User Group Meetings Training Sessions Weekly emails to update users Participation Certificates Executive user group meeting planned for the Fall 2010

10. Physician Led Access Network (PLAN)

11. Blessing Hospital Clinical Radiologists SIU Quincy Family Practice Center Quincy Medical Group Blessing Physician Services Dr. Ronald Wheeler Dr. Duane Hanzel Dr. James Hayashi Community Outreach Clinic

12. Sliding Fee Scale FEE CODEBCDE Patient pays:10%25%50%75% Family size:0-125% of HHSPG 126-150% of HHSPG 151-175% of HHSPG 176-200% of HHSPG 1$13,537$16,245$18,953$21,660 2$18,212$21,855$25,498$29,140 3$22,887$27,465$32,043$36,620 4$27,562$33,075$38,588$44,100

13. PLAN statistics Over 700 Adams County residents 79 clients on waiting list Value of $1.6 million has been donated in healthcare from May 2008 to April 2010 62% of patients have had a medical physical in the past two years 23 new providers in 2010 Provider Satisfaction had a score of 93% in 2009 100% of AHAC patients have a primary care home

14. PLAN Value and Sustainability How do we continue participation? Care Management Patient accountability Cost savings (ROI) Referral source for network members Assessing satisfaction Systematic volunteer opportunity for physicians/providers  Equitable distribution  Ensuring patient eligibility

15. Care Management

16. Who receives care management? All clients enrolled in the Physician Led Access Network

17. Activities of Care Management Client advocacy Connecting clients to community resources Coordination of healthcare services in PLAN Follow-up after medical appointments Assistance with applications such as MedAssist, Community Outreach Clinic, charity applications

18. Activities of Care Management, cont. Facilitate Referrals to CareLink for nursing care management Provide or connect clients with appropriate disease education Managing client healthcare appointments and ensuring eligibility to physician offices Provide healthcare appointment reminders

19. Evaluation of the Program

20. What are we tracking to demonstrate value? Medical appointment attendance rates Charity care for local hospital to maintain tax- exempt status Reduction in the cost of care per member per month Reduction in Emergency Room and Inpatient Utilization Appropriate utilization of healthcare system for treatment of ambulatory sensitive conditions

21. Medical Appointments February 2010 – April 2010 523 physician appointments 3% 16% 81%

22. Blessing Hospital Financial Assistance Applications 2008$83,570.26 2009$817,580.53 2010$1,503,734.93

23. Value of Donated Care 1 st Quarter$9,556.01 2 nd Quarter$31,348.25 3 rd Quarter$80,721.68 4 th Quarter$206,005.86 5 th Quarter$257,334.97 6 th Quarter$260,823.03 7 th Quarter$286,025.08 8 th Quarter$412,462.14

24. Results of program $530.89 $267.49

25. Emergency Room/Inpatient Utilization Hospital service data collected on AHAC enrollees Group 1  May 1, 2008 – Nov 30, 2008  41 unduplicated individuals

26. ER Utilization – Group 1 ER encounters 6-months prior to AHAC Dollars in Charges ER encounters 6- month POST AHAC Dollars in Charges 23$45,85517$19,078 26% reduction58% savings

27. Inpatient Hospitalizations – Group 1 Inpatient stays 6-months prior to AHAC Dollars in Charges Inpatient stays 6-month POST AHAC Dollars in Charges 9$141,3436$154,557 33% reduction9% increase

28. Emergency Room/Inpatient Utilization Group 2  Dec 1, 2008 – April 30, 2009 (exclusive of Group 1 clients)  114 unduplicated clients

29. ER Utilization – Group 2 ER encounters 6-months prior to AHAC Dollars in Charges ER encounters 6- month POST AHAC Dollars in Charges 104$139,00751$73,237 51% reduction47% savings

30. Inpatient Hospitalizations – Group 2 Inpatient stays 6-months prior to AHAC Dollars in Charges Inpatient stays 6-month POST AHAC Dollars in Charges 20$600,60614$276,413 30% reduction54% savings

31. Ambulatory Sensitive Care Conditions Treated at the Hospital 2005 problematic conditions 1. Congestive Heart Failure 2. Bacterial Pneumonia 3. Urinary Infection 4. Dehydration 5. Diabetes 6. Chronic Obstructive Pulmonary Disorder 7. Hypertension

32. Group 1 254 individual hospital charges representing ER, inpatient, and outpatient charges 14% or 36 charges represented one of the seven ambulatory sensitive care conditions 6 charges associated with ER encounters and inpatient hospitalizations Remaining 83% or 30 charges associated with outpatient service utilization

33. Group 2 630 individual hospital charges representing ER, inpatient, and outpatient charges 9% or 56 hospital charges represented one of the seven ambulatory sensitive care conditions Of interest, 4 of 56 were associated with ER encounters PRIOR to the AHAC enrollment NONE were associated with ER and Inpatient hospitalization after enrollment 93% of those ambulatory sensitive diagnosis codes were associated with outpatient hospital charges

34. Healthcare Reform: Where does AHAC fit in? Strong network has been developed AHAC is known to tailor to its clients needs Care coordination Disease Management

35. Future Funding Community Meeting “Celebration” May 18, 2010 Public Relations  Patient highlighted in news  Newspaper articles  Radio interviews  TV interviews Notice of intent to grant from local health system Diverse funding

36. Resources www.CHSDonline.com Georgia Health Policy Center Sustainability Formative Assessment Tool