SYSTEM TRANSFORMATION

Project 2.b.iii

ED Care Triage for At-Risk Populations

WHY WE CHOSE THIS PROJECT

In 2012, five of the seven counties in the Hudson Valley region were within the top 25 counties in New York with the highest number of potentially preventable Emergency Department (ED) events. Within MHVC’s network, about 81,000 (14%) of the emergency visits were preventable in one year. Approximately 25% of patients went to the ED at some point in the year, and 29% of ED users indicated that limited access to alternatives was the primary reason for their ED visit. Given these statistics, and the fact that the ED is viewed as a “one stop shop” for care, early intervention and improved access to alternative sites of care will greatly impact healthcare delivery and efficiency in the Hudson Valley.

MHVC is pursuing an integrated approach to decrease ED utilization. Through care triage, we plan to divert members to appropriate levels of alternative outpatient care sites and increase connectivity of members to outpatient providers and Community-Based Organizations (CBOs). We also intend to improve outpatient treatment and management of key diagnoses (hypertension, asthma, depression, and behavioral health in aggregate) to prevent the initial ED visit.

PROJECT GOALS

The ED Care Triage project aims to:

• Facilitate patient linkages with their Patient-Centered Medical Home (PCMH) Primary Care Provider (PCP) or assist patients in selecting a PCMH PCP
• Facilitate patient linkages with their Health Home care manager, if applicable, or identify and assist patients in enrolling in a Health Home if they are eligible but not yet participating
• Identify underlying needs driving overutilization of the ED, and connect patients to needed supports including linkages to Behavioral Health (BH) providers and CBOs

Engaging this high-risk population will enable the care team to address the social determinants of health that drive frequent use of the ED. Connecting patients with resources, supporting self-management of chronic diseases, and encouraging behavior change will ideally contribute to breaking patterns of repeated ED use for minor illnesses that could be managed by a PCP visit. Establishing strong partnerships between EDs and PCMH PCPs is essential to the success of this project. MHVC is focusing on standing ED Care Triage programs, incorporating the ED Navigator role to connect patients with avoidable/unnecessary ED visits to appropriate providers and resources in the community. We are also using a social determinants assessment tool to help hospitals identify the non-medical resources patients need to improve their health.