EDWARD THOMAS HOUSE MCO...
Transcript of EDWARD THOMAS HOUSE MCO...
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UW MEDICINE │ TITLE OR EVENT
EDWARD THOMAS HOUSE
MCO COLLABORATION
HOMELESS IN SEATTLE ED DWYER-O’CONNOR, RN
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MR. EDWARD THOMAS
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• Free-standing
• 34 beds
• Harm Reduction Program
• High medical and behavioral acuity
• Braided funding includes money from 7 hospitals, PH, HUD, local and MCOs
• IV antibiotics
• 24/7 staffing
• 473 patients in 2014
EDWARD THOMAS HOUSE
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WHO DOES RESPITE SERVE?
• Homeless men and women with complex needs:
• Acute medical issues
• IV antibiotics
• Multiple chronic conditions
• Chemical dependency and mental illness
• Must be independent in mobility (wheelchair OK)
• Behavior appropriate to the setting
• Able to serve higher acuity patients than
previous Respite site
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THE PROGRAM MODEL
5
Hospital has
eligible
homeless
adult to refer
Meets
criteria?
Bed
available?
Discharge
Welcome to
Edward
Thomas House!
The Respite Stay
- Interdisciplinary care
- Medical services
- Behavioral health services
- Social work support
- Link to regular primary care
- Housing placement
Improved
health &
housing
stability
(the goal!)
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• Risk-sharing agreement [collaboration]
• Innovative ways to provide care
• Manage the whole person
• Look for leverage points in the Triple Aim
• Reducing cost
• Improve outcomes
• Find data to support outcomes and decreased cost
APPROACH
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• MCOs could not pay for respite
• Needed to get State Health Care
Authority to release HCPCS G9006 to
allow for payment
• Presented proposal to state for
Recuperative Care to allow G9006
• Covers Coordinated care fee, home
monitoring
• We could now turn on flow of dollars
G9006
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• MCOs like numbers
• 2012 report from 69 respite patients
• Measured ED/hospital utilization 6 mo
before and 6 mo after respite; 70%
reduction in inpatient days, 57% reduction
in inpatient admissions, 10% reduction in
ED visits [of those admits reduced by half]
• 15% increase in outpatient visits
• In 2014 measured same data and found
closely supporting results
OUTCOMES
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• Get the right players to the table [MCO medical director, nurses, case managers] also Public Health, local big shots
• Provide professional written materials
• Tour the unit
• Give an overview with anecdotes
• Highlight the clinical work
• Highlight the acuity
• Highlight the utilization
• Highlight the outcomes
MEET AND GREET [HANDOUTS]
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• Tell them a story
• Answer clinical questions
• Talk about challenges but highlight
successes
• Show them the care [PICC lines,
nursing, mental health teams]
• Talk about outcomes; primary care,
housing, case management
• Schmooze
TOUR
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• United Health Care
• Molina
• Amerigroup
• CHPW [Community Health Plan of
Washington]
• Coordinated Care
THE MCOS
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• Present as amendment to core contract
• Use their format
• Allow them to massage the contract
• Focus on low cost
• Shared interests
• Sell as partnership
• No take it or leave it
• Keep a lid on the costs
CONTRACTING: SELLING THE PRODUCT
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• Keep in touch during process
• We can enhance outcomes [IV study]
• Potential as pilot program
• Highlight voluntary nature of program
• Natural cap – 34 beds
Ka-ching
MORE
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