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Transcript of St. Johns River Rural Health Network Serving: Baker Bradford Clay Nassau Union Serving:...
St. Johns RiverSt. Johns RiverRural Health NetworkRural Health Network
St. Johns RiverSt. Johns RiverRural Health NetworkRural Health Network
Serving:Serving:
Baker Baker Bradford Bradford Clay Clay Nassau Nassau Union Union Serving:Serving:
Baker Baker Bradford Bradford Clay Clay Nassau Nassau Union Union
Comprehensive Diabetes Managementand Education Program
Comprehensive Diabetes Managementand Education Program
St Johns River Rural Health Network, Inc.
Brief Background onBrief Background onRural Health NetworksRural Health Networks
(RHN’s) In Florida (RHN’s) In Florida
Brief Background onBrief Background onRural Health NetworksRural Health Networks
(RHN’s) In Florida (RHN’s) In Florida
• 9 Rural Health Networks in Florida 28/33 rural counties and parts of 13 non-rural counties
• Established by State Statute 381.0406 in 1993
• Intended to address 3 fundamental problems: Inadequate Funding for healthcare in rural areas Recruitment and retention of health professionals Migration of patients from rural to urban providers
• Core function to integrate public and private health resources; and to emphasize cooperation over competition.
St Johns River Rural Health Network, Inc.
Overall GoalOverall Goalof RHN’sof RHN’s
Overall GoalOverall Goalof RHN’sof RHN’s
“The ultimate goal of rural health networks shall be to ensure that quality health care is available and efficiently
delivered to all persons in rural areas.”
St Johns River Rural Health Network, Inc.
St Johns RiverSt Johns RiverRural Health NetworkRural Health Network
St Johns RiverSt Johns RiverRural Health NetworkRural Health Network
Incorporated in 1994; Certified by the AHCA in 1995
Baker, Clay, Flagler, Nassau, Putnam, St. Johns, and Volusia (also services in Union, Bradford)
Active membership: CHD’s, AHEC, medical providers, rural hospitals, FQHC’s, RHC’s, behavioral health providers, Universities, others…
Health Planning Council of Northeast Florida provides staff support and administrative services under contract from FDOH, Office of Rural Health
St Johns River Rural Health Network, Inc.
Mission of SJRRHNMission of SJRRHNMission of SJRRHNMission of SJRRHN
To recognize, encourage, and support partnerships that improve the health of rural communities in Baker, Clay, Flagler, Nassau
St. Johns, Putnam, and Volusia Counties.
St Johns River Rural Health Network, Inc.
Strategic PrioritiesStrategic Prioritiesfor 2009 - 2012for 2009 - 2012
Strategic PrioritiesStrategic Prioritiesfor 2009 - 2012for 2009 - 2012
Develop the SJRRHN into a relevant leader and primary information source for Health Information Technology or Informatics among rural healthcare providers.
Enhance and expand the RHN’s existing Chronic Disease Management and Education program (LIP Program), and related Care Coordination activities.
Become a prime resource among rural health providers for information and technical support related to rural healthcare funding, reimbursement issues, and overall Sustainability.
Coordinate a mechanism to foster and facilitate comprehensive real-time health status, healthcare services/resources, and outcomes information sharing among rural providers in Northeast Florida.
St Johns River Rural Health Network, Inc.
Regional AssessmentRegional AssessmentRegional AssessmentRegional Assessment
MUA/MUP’s and HPSA’s in Rural NEFLAll of Baker, Bradford and Union
Low-Income groups in Clay, Nassau
Socio-Economically Disadvantaged
Per capita income as much as 55% below avg. for FL
Population below FPL as high as 23.6% (Union)
Higher rates of Medicaid enrollment and un-insured
Health Indicators
Leading Mortality: Cancer, Heart Disease/CVD, Respiratory Disease, Injuries, Diabetes
High/Very High rates of overweight and obesity (BRFSS)
Very high rates of hospitalization and lower-limb amputations (Hosp. utilization data)
St Johns River Rural Health Network, Inc.
Program AreaProgram AreaProgram AreaProgram Area
• 2,371 sq. miles
• 320,000 (est.) population
Target population
• Un-insured Adult (Ages 18-64)
• Low-income (≤150% FPL)
• Resident of Baker, Bradford, Clay, Nassau, or Union
• Clinical diagnoses of Diabetes
St Johns River Rural Health Network, Inc.
Program PartnersProgram PartnersProgram PartnersProgram Partners
5 County Health Departments (Baker, Bradford, Clay, Nassau, Union)
St. Johns River Rural Health Network, Inc.
Independent Eye and Foot specialists in each county
Nassau County Government (provides local match $$)
Winn-Dixie Pharmacies (and others)
Florida Academy of Family Physicians (DMCP)
Hospitals (referrals)
St Johns River Rural Health Network, Inc.
Program ComponentsProgram ComponentsProgram ComponentsProgram Components
Primary Care and Medical Home
• Labs
• Immunizations
Disease-specific Specialty Services
Prescription Medications and Supplies
Care Coordination
Individual Disease Self-Management Education and Support
Group Level Education using Accredited Programs
FAFP Diabetes Master Clinician Program and EPR
Ongoing Community Support Groups
St Johns River Rural Health Network, Inc.
Primary Care Services Primary Care Services andand Medical Home Medical Home
Primary Care Services Primary Care Services andand Medical Home Medical Home
Enrollment: • 100% of clients are screened for eligibility for Medicaid and Drug Assistance Programs.
• 100% of enrolled clients given a medical home.
Extended clinic hours in most locations
24Hr on-call service for urgent needs
Access to nutrition and other education programs
• All diabetes-related medications and supplies, plus others
Baker 40Bradford 40Clay 80Nassau 60Union 40TOTAL 260
Estimated savings to area hospitals due to reduced Emergency Room utilization and reduced Admissions/Re-Admissions is over $344,500.
OUTCOME: Self-reported ER utilization reduced by ≥50%.
St Johns River Rural Health Network, Inc.
Care Coordination and Care Coordination and Specialty ServicesSpecialty Services
Care Coordination and Care Coordination and Specialty ServicesSpecialty Services
• Referral and linkage to specialty services and other community-based resources:
Vision/Eye Care
Podiatry
Education and Support
Social Services
• Applications for drug assistance programs Receipt, distribution, tracking, and follow-up
• Follow-up to ensure services are received
St Johns River Rural Health Network, Inc.
Disease ManagementDisease Managementand Educationand Education
Disease ManagementDisease Managementand Educationand Education
• 2 FTE Disease Managers/Health Educators
– Outcome-based Disease Self-Management Education
– Community Outreach and Home Visits
– Individual and Community-based Group Education
– Ongoing Support Groups
• FAFP Diabetes Master Clinician Program
– Diabetes Registry
– Group Visits
St Johns River Rural Health Network, Inc.
Accredited and ProvenAccredited and ProvenEducation ProgramsEducation Programs
Accredited and ProvenAccredited and ProvenEducation ProgramsEducation Programs
Diabetes Conversation Maps:• Developed jointly by ADA and Merck
• 5 Total Maps (Conversations)
• 1-2 Hours each
“Take Charge of your Diabetes”
• CDC Program
• 12 Sessions (1-2 per week)
• 1.5-2 Hours each
St Johns River Rural Health Network, Inc.
FAFP Diabetes Master FAFP Diabetes Master Clinician ProgramClinician Program
FAFP Diabetes Master FAFP Diabetes Master Clinician ProgramClinician Program
• As developed by Dr. Edward Shahady, MD and FAFP in 2003
• Currently more than 80 practices participating (17,000+ patients)
• Internet based “relational” database (HIPPA Compliant)
• Based on American Diabetes Association recommended goals:– HbA1c ≤ 7%
– LDL’s ≤ 100
– BP ≤ 130/80
• Individual Client Report Cards and Aggregate Provider/Clinic Reports
• Projected cost-saving up to $1,122 per client/year (Totaling at least $291,720/yr in overall savings for all clients enrolled.)
St Johns River Rural Health Network, Inc.
Background on Estimated Background on Estimated Annual Cost Savings* Annual Cost Savings*
Background on Estimated Background on Estimated Annual Cost Savings* Annual Cost Savings*
• Hb A1C: Good control (<7%) = $279
• Blood pressure: <130/80 = $464
• LDL: Reduced to <100mg/dl = $369
• Total: All 3 targets met = $1,112
* Towers Perrin 2005 actuarial analysis conducted for ADA/NCQA for Diabetes Physician Recognition Program
St Johns River Rural Health Network, Inc.
Patient Report CardsPatient Report CardsPatient Report CardsPatient Report Cards
St Johns River Rural Health Network, Inc.
Provider ReportsProvider ReportsProvider ReportsProvider Reports
St Johns River Rural Health Network, Inc.
Population Population Management ToolsManagement Tools
Population Population Management ToolsManagement Tools
St Johns River Rural Health Network, Inc.
Services ProvidedServices Providedin FY 2008 - 2009in FY 2008 - 2009Services ProvidedServices Providedin FY 2008 - 2009in FY 2008 - 2009
• 3,475+ Primary Care visits
• 473+ Specialist visits (foot and eye)
• 3,288+ Prescriptions filled
• 1,905 Labs performed
• 2,504 Disease Management encounters
• 1,180 Care Coordination activities
St Johns River Rural Health Network, Inc.
Primary Care43%
Pharmaceuticals31%
Disease Management
17%
Vision/Eye Care6%
Podiatry3%
Program ExpendituresProgram ExpendituresProgram ExpendituresProgram Expenditures
More than $2.3M in services provided in FY08-09
St Johns River Rural Health Network, Inc.
Sample OutcomesSample OutcomesSample OutcomesSample Outcomes
Eye Exam 48% 70%
Foot Exam 48% 70%
% thr ough 11/ 6/ 07
% thr ough 1/ 5/ 09
Annual Exams
Average Percent of Diabetics achieving all 3 goals:
United States 7%
SJRRHN Clients 15%
St Johns River Rural Health Network, Inc.
Estimated Hospital Costs Estimated Hospital Costs from Diabetesfrom Diabetes
Estimated Hospital Costs Estimated Hospital Costs from Diabetesfrom Diabetes
Data source for all figures: AHCA hospital utilization monthly data submissions
Pt. County of Residence Average Charges # of OP visits Sum of ChargesCalculated #
Admitted from ERTotal
ER Encounters
% of ER Visits resulting in Admission
Baker 2,899$ 63 182,610$ 23 86 27%Bradford 2,183$ 25 54,566$ 21 46 46%Clay 3,791$ 137 519,421$ 163 300 54%Nassau 2,753$ 82 225,746$ 69 151 46%Union 1,938$ 15 29,066$ 8 23 35%Totals 3,141$ 322 1,011,409$ 284 606 47%
Emergency Department Outpatient visits
Based on ICD-9 code 250.xx (diabetes, unspecified)Adults ages 18-64, regardless of insurance status
Pt. County of Residence Average Charges # of Admissions % Admitted from ERCalculated #
Admitted from ERAverage LOS* Sum of Charges
Baker 48,815$ 34 67.6% 23 8.44 1,659,725$ Bradford 18,265$ 23 91.3% 21 4.61 420,102$ Clay 37,264$ 191 85.3% 163 4.85 7,117,427$ Nassau 27,911$ 86 80.2% 69 4.98 2,400,328$ Union 34,743$ 18 44.4% 8 4.78 625,375$ Totals 34,724$ 352 80.7% 284 5.21 12,222,957$ * The average Length of Stay (LOS), in days, for diabetic patients is approximately 75% longer than for the total population among this age group. This equals approximately 1 additional day per diabetic patient admission when compared to other illnesses/conditions.
Based on ICD-9 code 250.xx (diabetes, unspecified)
Hospital In-Patient/Admissions
Adults ages 18-64, regardless of insurance status
St Johns River Rural Health Network, Inc.
LIP Program - Estimated LIP Program - Estimated Hospital Cost SavingsHospital Cost Savings
LIP Program - Estimated LIP Program - Estimated Hospital Cost SavingsHospital Cost Savings
Client self-reported ER utilizatation:
ER Utilization %Calc. # of ER visits
(Assumes 1 visit/cl/yr)
Calc. ER CostCalc. # of
AdmissionsCalculated
In-patient costsTotal
Hospital Costs
Baseline 11.5% 31.4 $ 98,611.70 14.7 $ 510,900.06 609,511.75$
Current (calculated) 5% 13.7 $ 42,874.65 6.4 $ 222,130.46 $ 265,005.11
Difference (SAVINGS) 6.5% 17.7 $ 55,737.05 8.3 $ 288,769.60 $ 344,506.64
At least 11.5% of enrolled clients indicated visiting an Emergency Room in relation to their diabetes during the 2 year period before they were enrolled in the LIP disease management program in 2006.
Within 24 months of program activity, the percentage of enrolled clients who reported visiting an emergency room within the previous 2 years had declined to 5%.
This represents a 56.5% reduction in self-reported ER utlization within 2 years.
Calculated Cost Savings (based on 273 unduplicated clients served) :
Estimated direct savings to area hospitals. Does not include primary care cost savings such as reduced need for prescription medications and fewer needed follow-ups achieved through effective disease management.
St Johns River Rural Health Network, Inc.
Return on InvestmentReturn on InvestmentReturn on InvestmentReturn on Investment
Total Program Funding: 650,000$
Cost-Limit Estimate of Services Provided: 2,315,000$
Estimated Savings to area Hospitals: 344,500$
Sub-Total 2,659,500$ 4.09
*Potential Primary Care Savings (goals met): 39,551$
TOTAL POTENTIAL RETURN ON INVESTMENT: 2,699,051$ 4.15
ROI only Match dollars 289,900.00$ 9.31
St Johns River Rural Health Network, Inc.
Success StoriesSuccess StoriesSuccess StoriesSuccess Stories
“John” enrolled July, 2008– Type II Diabetes– Stroke in May, 2008
• Weight at enrollment: 309.6lbs
• Cholesterol: 210
• Triglycerides: 309
• HbA1c: 7.9
St Johns River Rural Health Network, Inc.
Success StoriesSuccess StoriesSuccess StoriesSuccess Stories
• HbA1c reduced to 5.3 within 5 months
• John lost more than 35 lbs in 7 first months
• Learned to inject his own insulin
• Now attends all appts. and classes
• Reports feeling much more energized and is able to get around much easier!
• Total weight loss as of 6/09: 88 lbs.
• Last HbA1c: 5.1
St Johns River Rural Health Network, Inc.
Success StoriesSuccess StoriesSuccess StoriesSuccess Stories
“Mary” enrolled in July, 2007
Weight: 373 lbs
Highest HbA1c: 8.1
No daily blood glucose checks
Repeatedly no-showed for appointments
St Johns River Rural Health Network, Inc.
Success StoriesSuccess StoriesSuccess StoriesSuccess Stories
Mary in July, 2009 (2 years later)…• Testing blood glucose several times daily
• Attends all regular medical appointments
• Regularly attends education classes
• Improved diet/nutrition
• Began exercise – thanks to a new dog!
• Improved confidence
• Total weight loss: 103 lbs!!
St Johns River Rural Health Network, Inc.
Program EnhancementsProgram EnhancementsProgram EnhancementsProgram Enhancements
Behavior Change assessment and evaluation Based on proven Readiness to Change theory
Baseline assessment at enrollment
Periodic 6 month re-evaluations
Longitudinal monitoring of individual clients to better target intervention and education strategies
St Johns River Rural Health Network, Inc.
Contact InformationContact InformationContact InformationContact Information
St. Johns River Rural Health Network, Inc.Nikole Helvey, MS HSA, Program Director
(904) 723-2162 Ext. 109
Health Planning Council of Northeast Florida, Inc.Dawn Emerick, Ed.D., MPA, Executive Director
(904) 723-2162 Ext. 110