John W. Robinson, MD, SMVP Medical Affairs & Chief Medical OfficerMolina Healthcare of Washington, Inc.

Reducing Preventable ER Visits

April 19, 2011

Creating Community Partnerships and Data Planning between Hospitals and Health Plans

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Molina Healthcare of WA (MHW), a managed care health plan, provides a wide range of quality health care services to families and individuals who qualify for government-sponsored programs, including Healthy Options, the Children's Health Insurance Program (CHIP), Basic Health+, Basic Health, WMIP and Medicare. Over 350,000 members are covered in Washington. MHW also operates two primary care clinics in Snohomish County.

The Problem

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Molina members go to the ER over 15,000 times each month.

Based on the NY Algorithm calculations, 55% of these ER visits are preventable.

Medical Management Initiatives

Reduce ER UtilizationFull Range of initiatives

Low

High

# of

Mem

bers

High

Low

ED Use

Medical Management Initiatives

The Top of the Pyramid

Molina Healthcare of Washington wants to partner with hospitals serving Molina Healthcare members to receive daily census and ER information in a secure electronic format (“eCensus” data).

eCensus data is used to: • Improve turn-around time and accuracy of admission

notification •Ease the administrative burden on facility staff by eliminating time spent printing and faxing daily census•Quickly identify Molina Healthcare members with potentially avoidable emergency department visits who might benefit from Molina Healthcare education and outreach efforts

Started in CY2010

eCensus Background

• HOLY FAMILY HOSPITAL• KADLEC MEDICAL CENTER• KENNEWICK GENERAL HOSPITAL• MOUNT CARMEL HOSPITAL• PROV EVERETT MED CTR• PROVIDENCE CENTRALIA HOSPITAL• PROVIDENCE ST PETER HOSPITAL• SACRED HEART MEDICAL CENTER• SEATTLE CHILDRENS HOSPITAL• ST JOSEPH HOSPITAL OF CHEWELAH• VALLEY MEDICAL CENTER HOSPITAL

Current Hospitals Live on eCensus

eCensus Flow Chart

Pilot: eCensus data from 10 Hospitals

Data fields transmitted to Molina daily:1. Patient name2. DOB3. Policy number4. Admission date5. Discharge date (for I/P)6. Status (active, discharged or blank)7. Patient type (EMR, I/P, or OBO)8. Admission Diagnosis9. Unit10. Patient phone11. Adm Source (floor in hospital)12. Adm physician

RESULTS

Sample Data: January 2011

# of ER visits in eCensus data: 1673

# of f/u phone calls completed to those members: 716

# of members with scheduled f/u: 360

# of members assigned to CM/DM: 85

# of members contacted who refused assessment: 4

Questions and Comments

Presenter Contact Information

John W. Robinson, MD, SM

VP of Medical Affairs & Chief Medical Officer

Molina Healthcare of WA

Ph: 425-424-7124

John.robinson@molinahealthcare.com