1. NEW DIRECTIONS AN INTENSIVE CASE MANAGEMENT PROGRAM Frequent Users of Healthcare Initiative Meeting September 2006

2. DATA COLLECTED At enrollment, 6 months, 18 months: FUI Demographics & Functional Status FUI assessment tools (Lehman Qof L, SF12, Stages of Change)

3. DATA COLLECTED (cont’d) For Prior Year, Yr. 1, Yr. 2, and Yr. 3: # of ED visits, admissions, hospital days, clinic visits Direct costs* for ED, inpatient, outpatient care # of ambulance rides Mental health contacts DADS contacts * Direct Costs = Costs for direct care only, no overhead, administrative, or indirect costs

4. DATA COLLECTED (cont’d) Staff contact log Disenrollment log

5. METHODOLOGY Compare Prior Yr. to Yr. 1, Yr. 2, & Yr. 3 Eventually compare a control group of 40 clients to the case managed group of clients

6. ANALYSIS #1 COMPARE Prior Year vs. Yr 1, Yr. 2, and Yr. 3 Percent change in visits*/admits/hospital days Number of visits/admits/hospital days Percent change in direct costs of ED/inpt./outpt. care Direct costs in dollars of ED/inpt./outpt. care * Visits = ED, Outpt, MH, DADS visits

7. ANALYSIS #2 Separate clients by those that were successful vs. unsuccessful Successful = ED visits decreased below the threshold for program (i.e. less than 8 visits / year) Unsuccessful = ED visits continue with more than 8 ED visits / year Complete analysis #1 for both groups

8. RESULTS – Hospital B 46 Clients followed for 2 years 85% Success Rate (39 out of 46 reduced ED visits to < 8) Successful Clients (39)  ED visits decreased 80% in Yr. 2  Hospital & ED Costs decreased (-$98,234) in Yr. 2  39 clients = 40% of total case load  For total case load of current program - costs would decrease by ~$245,500 for all clients

9. RESULTS – Hospital B (cont’d) Unsuccessful Clients (7)  ED visits increased in Yr. 1 by 18%, decreased only 3% in Yr.2  ED costs increased in Yr. 1 (52%) and Yr. 2 (65%)  Hospital and ED costs increased in Yr. 1 (+$39,000) and Yr. 2 (+$68,700)  In Yr. 2 outpatient costs increased more for these 7 clients than all 39 successful clients (~$57,000 vs. $23,500)

10. RESULTS Successful Clients (85%) – Hospital B Change in ED Utilization & Costs – Yr 1 & Yr 2 Changes in: 1st Yr. vs Baseline Yr. N = 39 2nd Yr. vs Baseline Yr. N = 39 % ED Visits 41 % 80 % # ED Visits130217 in ED Visits318 188318 64 % ED Costs37 %65 % Actual ED Costs $26,667$44,918 In ED Costs$103,150 $64,710$103,150 $35,720

11. RESULTS Unsuccessful Clients ( 15%) – Hospital B Change in ED Utilization & Costs – Yr 1 & Yr 2 Changes in: 1st Yr. vs Baseline Yr. N = 7 2nd Yr. vs Baseline Yr. N = 7 % ED Visits 18 % 3 % # ED Visits183 in ED Visits102 120102 99 % ED Costs52 %65 % Actual ED Costs $14,022$17,668 In ED Costs$27,196 $41,218$27,196 $44,864

12. RESULTS Successful Clients (85%) – Hospital B Change in Hosp. & Outpt. Costs --Yr 1 & Yr 2 Changes in: 1 st Yr. vs Baseline Yr. N = 39 2 nd Yr. vs Baseline Yr. N = 39 Inpatient Costs$161,545$22,447 in Inpt. Costs$185,970 $347,515$185,970 $163,523 Outpatient Costs$38,253$23,459 In Outpt. Costs $87,997 $126,250 $87,997 111,456

13. RESULTS Unsuccessful Clients (15%) – Hospital B Change in Hosp. & Outpt. Costs --Yr 1 & Yr 2 Changes in: 1 st Yr. vs Baseline Yr. N = 7 2 nd Yr. vs Baseline Yr. N = 7 Inpatient Costs$82,882$51,057 In Inpt. Costs$125,049 $207,931$125,049 $176,106 Outpatient Costs$25,825$56,951 In Outpt. Costs $37,169 $63,021 $37,169 94,120