AcademyHealth State-University Partnership Learning Network (SUPLN) Web Conference

AcademyHealth State-University Partnership Learning Network (SUPLN) Web Conference High-Utilization Populations: Interventions to Improve Outcomes and Lower Costs April 16, 2015

Teleconference Instructions Please make sure your computer is linked to your phone: A box should appear on your screen when you log-in with dial-in instructions. OR Click on the phone symbol in the toolbar at the top of your screen. Enter your phone number and click join, the system will call you directly. OR Call in directly: Dial 1-866-244-8528 Enter the access code 602144 and press pound (#) Once you have dialed in, click on the information symbol in top right corner of the meeting room and dial the Telephone Token number into your phone. The system will link your phone with your computer. 2 2

View the Slides in Full Screen If you would like to view the slides in full screen, click the four way arrow button on the top right corner of the slides. 3 3

Download Slide Deck and Materials If you would like to download the slide deck and materials for this presentation, click the Download File(s) button in the box marked Download Slides in the lower left-hand corner. 4

Technical Assistance If you have technical questions during the event, please type them into the chat box in the lower left-hand corner of the screen. Live technical assistance is also available: Please call Adobe Connect at (800) 422-3623 5 5

To raise your hand: Discussion 1. Participants can use the hand raise button at the top of the screen to signal to the presenter that they would to speak To submit a question: 1. Click in the chat box on the left side of your screen 2. Type your question into the dialog box and click the Send button Please mute your phones if you are not speaking to reduce background noise. 6 6

AcademyHealth Staff Enrique Martinez-Vidal, Vice President State Policy and Technical Assistance Alyssa Walen, Senior Manager Stephanie Kennedy, Research Assistant 7

Current SUPLN Members California (UCSF, UCD, UCLA) Connecticut Delaware Florida Georgia Iowa Kentucky Maine Maryland Massachusetts Michigan (MSU, UM) Minnesota New Hampshire New Jersey Ohio South Carolina Wisconsin 8

Agenda Welcome and Introductions Improving Maternal and Child Birth Outcomes in Florida Elizabeth Shenkman, PhD, Institute for Child Health Policy and the Department of Health Outcomes and Policy at the University of Florida ER is for Emergencies: Emergency Department Medicaid Utilization 7 Best Practices Amanda Avalos, MPA, Washington State Health Care Authority Q+A and Discussion 9

IMPROVING MATERNAL AND CHILD BIRTH OUTCOMES IN FLORIDA Elizabeth Shenkman, PhD Institute for Child Health Policy and the Department of Health Outcomes and Policy University of Florida

Key Initiatives 11 Trending and Monitoring of Quality and Outcomes Family Data Center Mildred Maldonado-Molina, PhD (Director) OneFlorida Data Trust Betsy Shenkman, PhD and Bill Hogan (Co-Directors) Learning Collaborative Florida Perinatal Quality Collaborative Led by the Lawton and Rhea Chiles Center at the University of South Florida Infrastructure for Pragmatic Clinical Trials and Implementation Science Florida Medical School Quality Network A consortium of the nine Florida Medical Schools The OneFlorida Clinical Research Consortium

Health Status Indicators

Significant Statewide Trends Percent of Women who Entered Prenatal Care in First Trimester by Medicaid Status and Major Medicaid Subgroup in Florida Percent of Women with Inadequate Prenatal Care by Medicaid Status and Major Medicaid Subgroup in Florida

Significant Statewide Trends Percent of Deliveries to Women Who Reported Smoking during Pregnancy by Race/Ethnicity and Medicaid Status in Florida Percent of Deliveries to Women with an Obese Prepregnancy BMI by Race/Ethnicity and Medicaid Status in Florida

Significant Statewide Trends Percent of Low Birth Weight Newborns by Medicaid Status and Major Medicaid Subgroup in Florida

Significant Statewide Trends Percent of Low Birth Weight Newborns by Race/Ethnicity Medicaid Status and Major Medicaid Subgroup in Florida

More Trending Information 17 http://familydata.health.ufl.edu/data/florida-indicators-interface-2/ https://mcherdc.sites.medinfo.ufl.edu/files/2013/12/med146- Deliverable-8-15-2013.pdf

Addressing Maternal and Child Health Through Trending and Monitoring: The Family Data Center at the University of Florida 18 Funded by the Florida Agency for Health Care Administration Maternal and child health records from pregnancy through early childhood and education records from preschool through high school. Warehouse databases include birth, death, and fetal death certificates, Healthy Start prenatal risk screening and services records, postnatal infant risk screens, hospital discharge and Medicaid eligibility and claim files, student standardized test results, attendance, and behavior referrals

Trending and Monitoring: OneFlorida ~11M Patients Over 1200 Practices ~4,000 Physicians Developed Through Grants from the State of Florida and the NCATS- Funded UF Clinical and Translational Science Institute 19

Trending and Monitoring: The OneFlorida Data Trust 20 Cohort Discovery Feasibility Testing Secondary Data Analysis

Learning Collaboratives: The Florida Perinatal Quality Collaborative 21 March of Dimes Funding Quality Improvement Teams and Physician Champions Implementation Science: Example California Maternal Quality Care Collaborative Elimination of Non- Medically Indicated (Elective) Deliveries Before 39 Weeks Gestational Age toolkit.

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Learning Collaboratives: The Florida Perinatal Quality Collaborative 23 Current Projects Obstetrical hemorrhage The Golden Hour: Delivery Room Management Expansion of Early Elective Deliveries Development of Quality Indicators Learn More http://health.usf.edu/publichealth/chiles/fpqc/about.ht m

Infrastructure Development 24 o Florida Medical Schools Quality Network (FMSQN) Ensures continued involvement of medical schools and graduate medical education programs to improve clinical outcomes of managed care plans Established in Statute Provides for development of implementation science projects Initial Project: Oral Health Screening in Pediatric Primary Care University of Florida, Florida State University, University of Miami

Infrastructure Development: OneFlorida 25 o o o o An infrastructure for pragmatic clinical trials and implementation science studies Clinician champions Clinical practice facilitators Current Maternal Child Health Study o Maternal Depression Screening

26 Thank You

Amanda Avalos, MPA Washington State Health Care Authority Emergency Department Medicaid Utilization 7 Best Practices 27

Timeline July 2011, legislature passed a 3 annual ER visit limit for Medicaid clients November 2011, Superior Court Judge halted implementation April 2012, legislature required WA hospitals to implement 7 best practices July 2012, 7 best practices (ER is for Emergencies) began Third Engrossed Substitute House Bill 2127: Washington hospitals were required to implement 7 best practices aimed at reducing unnecessary emergency department use by Medicaid clients

Partnership Collaboration Washington State Medical Association Washington State Hospital Association Washington State Health Care Authority Washington Chapter of the American College of Emergency Physicians Medicaid Health Plans Washington Collective Fire Chiefs Medical East Technologies Pierce Fire EDIE and Rescue

Seven Best Practices 1) Electronic Health Information Goal: Exchange patient information among Emergency Departments Identify frequent ER visitors Improve care coordination All hospitals can access treatment plans Hospitals are using the EDIE system 30

Seven Best Practices 2) Patient Education Goal: Help patients understand and use appropriate sources of care Active distribution of educational materials by hospitals Discharge instructions 31

Seven Best Practices 3) Patients Requiring Coordination (PRC) Goal: Ensure hospitals know when they are treating a PRC patient and assist accordingly PRC clients = frequent ER users, often narcotic seekers Hospitals identify patients on arrival Develop and coordinate case management programs 32

Seven Best Practices 4) PRC Client Care Plans Goal: Assist PRC clients with their care plans Contact the primary care provider when PRC client visits the ER Efforts to make an appointment with the primary care provider within 72 hours when appropriate Relay barriers to care to Health Care Authority 33

Seven Best Practices 5) Adhere to Opioid Guidelines Goal: Reduce drug-seeking and inappropriate drug-dispensing Prohibiting long-acting opioids and discourage injections Screening patients for substance abuse Referring patients suspected of Rx abuse to treatment 34

Seven Best Practices 6) Prescription Monitoring Program Goal: Ensure coordination of prescription drug prescribing practices Enroll ER providers in Prescription Monitoring Program (PMP): electronic online database with data on patients prescribed controlled substances Target enrollment for ER providers : 90% 35

Seven Best Practices G) Feedback Reports Goal: Hospitals review their Medicaid data, ensure interventions are working Monthly reports provided from Health Care Authority to hospitals Includes both utilization and prescription drug data 36

Keys to Success Strong partnerships Standard policies in every hospital; No patient shopping for a different physician Safe Table Learning Collaborative to share best practices Measurable, with achievable benchmark Friendly competition towards a shared goal

Results Rate of ER visits declined by 9.9% Rate of visits resulting in a scheduled drug prescription down by 24% 38

Rate of visits with low acuity diagnosis down by 14%. Results Rate of frequent clients* decreased by 10.7% *5 visits or more in 12 months Rate of ER visits declined by 9.9% Rate of visits resulting in a scheduled drug prescription down by 24% 39

Post- Medicaid expansion 40

98 of 98 hospitals participating in ER is for Emergencies Electronic care plans shared for >33,500 clients- not just Medicaid Care managers arranging follow up in most facilities Instant notification to PCPs 41

Where We Are Today Moving Forward Too many systems! Integrate info into EHRs across the care continuum Prescription Drug Monitoring Program enhancements Broaden the collaboration: Primary care, Payers, behavioral health, fire/ambulance Medicaid Expansion: Adapt to changing landscape 42

Questions? Contact: Amanda Avalos WA Health Care Authority 360.725.3707 amanda.avalos@hca.wa.gov Resources: http://www.hca.wa.gov/medicaid/prr/pages/criteria.aspx http://www.agencymeddirectors.wa.gov/opioiddosing.asp http://www.wsha.org/eremergencies.cfm http://wsma.org/wcm/for_patients/know_your_choices/er_is_for_emergencies_for_physicians/wc m/patients/know_your_choices/er_is_for_emergencies_for_physicians.aspx 43

Questions?

Thank You! Please fill out the evaluation questions on screen Additional Questions? Contact: Stephanie Kennedy (Stephanie.Kennedy@AcademyHealth.org) Alyssa Walen (Alyssa.Walen@AcademyHealth.org) 45