Tuesday, October 4, 2016

Population health transforms ED mission

CoxHealth EDs help patients access the right level of care to reduce overcrowding and improve health.

The model of care at CoxHealth’s emergency departments is evolving, with the goal of helping patients get the best care in the most appropriate setting.

Nationally, emergency departments are plagued with overcrowding. Several factors are driving the increase, but a trend has emerged in the past decade that presents a new challenge for ERs: More patients are turning to emergency rooms for treatment of chronic health conditions.

Reducing inappropriate ED utilization is the million dollar question facing Emergency De

partments. Recently, we realized we needed to change our model to one that will lead to better overall health of our communities.

In the emergency department, we are episodic care experts. If you have an acute exacerbation of an illness or an acute emergency, that’s what we do best. Likewise, the care of chronic conditions is best delivered in a primary care setting, or perhaps, even in the patient’s home.

The American College of Emergency Physicians and Emergency Nurses Association have partnered with the Centers for Medicare and Medicaid Services (CMS) to get involved in population health – managing the health of every individual in the population. That can be as simple as updating immunizations to more complex issues of trying to get patients into the right and most efficient level of care.

Patients come to the ED for treatment of their chronic conditions such as diabetes, congestive heart failure or COPD, for any number of reasons, including not being able to get into primary care or not having access to the resources available.

Patients try to deal with their illness at home – they might get progressively sicker until their illness becomes an emergency and we address that need in the ER. But what happens when they leave the ER? How do we ensure that patients in high-risk populations transition to the right level of care for the ongoing treatment of their chronic disease?

Generally, if patients are not seen within 3-5 days after discharge from the ER or hospital, they are at risk for readmission. Hospitals are evaluated by CMS on 30-day readmission rates and ERs are measured on 72-hour patient returns. Any effort we can make for better care management after discharge will be better for our patients – and for our bottom lines.

CoxHealth has been a leader in getting patients into the best level of care. In Springfield, moving our urgent cares to the Cox South campus allows for lower acuity patients to have access to quicker, less expensive care. Also, the development of specialized trauma and disease-specific clinics allows for trauma patients and those with high-risk chronic illnesses to be seen within 3-5 days after discharge from the ED or the hospital if they aren’t able to get in to see their primary care provider.

Now, new processes and new external partnerships are helping us expand our population health efforts even further.

First, we identified gaps in service to our patient populations, such as dental care for those who come to the ED with tooth pain and have no insurance; outpatient management of mental health conditions for people who are stabilized in the ED but don’t have a mental health provider for follow up; and social health support for patients who are well physically but lack social support.

We developed a multidisciplinary team across the region involving internal and external partners. We identified and worked to close the gaps either within CoxHealth or by partnering with other agencies in the community such as Jordan Valley and Burrell Behavioral Health.

Jointly, we have worked to obtain grant funding that ultimately will reduce overall cost and reduce state and federal Medicaid spending while improving the health of our region.

You will be hearing more about some of those partnerships here in Connection in the coming months. Population Health coverage will also include efforts in Branson and Monett and through the work of the new Population Health team.

Thinking about serving our patients in different ways is exciting. Making a difference in the community – that’s what I love doing and I’m glad we work in an organization that allows us to reach out of our areas of expertise to find new ways to be the best for those who need us