Hospital Proviso Preliminary Report
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Transcript of Hospital Proviso Preliminary Report
Hospital Proviso Preliminary ReportMay 30, 2014Ana Lòpez-De Fede, PhD; Kathy Mayfield-Smith, MA, MBA; Patricia Stone Motes, PhDUSC Institute for Families in SocietyDivision of Medicaid Policy Research
Hospital and Clinic Proviso Evaluation Framework
Technical Assistance Proviso Context: Healthcare Reform
Sustaining Activities
CollaborationsInterventions Targeted At: Intermediate
Outcomes• Improved care
coordination within and across providers
• Heightened patient activation and compliance
• Improved patient outcomes
• Diffusion of best practices• Patient satisfaction • Community engagement
Long-term Outcomes
• Community improvement in quality measures
• Improvement in health status
• Reduction in costs trends
• Reduction in disparities • Ongoing collaboration
to improve healthcare
Feedback on implementation and results
Public Reporting
Consumer and
Community Engagement
Quality Improvement
Payment Reform
Proviso Stakeholders
Alliance development, setting vision and strategies
Disparity Reduction
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TIMELINE
Programmatic alignment
EVALUATION COMPONENTS
It is generally accepted in action research “that researchers should not rely on any single source of data, interview, observation, or instrument.” (Mills, 2003)
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Service Patterns
Determinants of Health
Partnership Index
Case Study
Consumer
Enrollment Patterns
5,624 uninsured successfully enrolled 4,922 uninsured enrolled with a HOP with numbers ranging from 50
to 750 targets with data available from July 2012 – Dec. 2013
GENDER• 60% Female• 40% Male
RACE• 49% White• 50% African American• 1% Other Race/Ethnicity
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As of April 2014
AGE GROUPS• 10% (18–24 yrs.)• 43% (25–44 yrs.)• 34% (45-54 yrs.)• 13% (55–64 yrs.)
o 87.3% had at least one inpatient, ED, specialty, or outpatient surgery record from July 2012 – December 2013.
o 29% had at least one inpatient hospital stay• Of those with an inpatient hospital stay, 35% had a readmission
within 30 days. • 81% of inpatient admissions were associated with an ED visit.
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Enrollment Care PatternsAs of April 2014
o 96% had at least one ED visit• Of those with an ED visit,
70% had at least 3 or more ED visits.
• Approximately, 34% of the population had 7 or more ED visits.
o 51% had 2 or more chronic conditions documented.
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Enrollment Care Patterns (continued)
As of April 2014
Outreach and Reasons for Non-Enrollment (N = 4,976) As of April 2014
Medicaid Elig or Enrolled
Medicare Elig or Enrolled
Other Ins
Not HOP Catchment Area
Refused
Not Located
Invalid Address
Invalid Telephone No.
Lack of Compliance
0 5 10 15 20 25 30 35
12
4
9
3
8
19
9
30
0.3
Percent
7
25% Insured
58% Not Reached
HOP Screenings
Level 120%
Level 221%
Level 333%
Level 426%
Level 116%
Level 216%
Level 327%
Level 441%
Healthy Outcomes Plan Increases Screenings for Uninsured: PAM
Source: USC Institute for Families in Society | Division of Policy and Research on Medicaid and Medicare
• 3,549 (42%) have been screened with the PAM
• Average score = 59.5• PAM has 4 Levels with the
following scores:• Level 1: Not engaged
47 & below • Level 2: Becoming aware
47.1 - 55.1 • Level 3: Taking action
55.2 - 67.0• Level 4: Maintaining behavior
67.1 - 100• Slight shift between levels
since March to 1% more in Levels 3 & 4
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SC HOP %Distribution
National % Distribution
HOP Screenings
Healthy Outcomes Plan Increases Screenings for Uninsured: GAIN-SS
Source: USC Institute for Families in Society | Division of Medicaid Policy Research
Summary of Scores:
• 4,273 (50%) have been screened with the GAIN-SS
• Average Score = 4.1• Range of scores between 0 – 23
(Maximum possible is 23)
Scoring Distribution:Low (Zero): 1,093Moderate (1 or 2): 722High (3+): 2,458
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Low26%
Medium17%
High57%
Low13%
Medium17%
High70%
SC HOP % Distribution
National % Distribution
HOP Screenings
Domain High Risk*Feb. 2014
High Risk*Mar. 2014
High Risk*Apr. 2014
Internalizing Disorder (Sub-screen section)**(depression, anxiety, suicidal tendencies, acute/PTSD)
1,187 (60%)
1,671 (50%)
2,038(47%)
Externalizing Disorder (Sub-screen section)** (e.g., attention deficit hyperactivity, conduct disorder, aggression)
464 (22%)
622 (19%)
767(18%)
Substance Disorder (Sub-screen section)** (substance abuse/ dependence, frequency of use, effect on daily activity and degree of dependency)
205 (10%)
294 (9%)
341(8%)
Crime and Violence Disorder (Sub-screen section)**(e.g., interpersonal violence, property crime, drug-related crime)
31 (1%) 46 (1%)
56(1%)
Total GAIN-SS Scores (includes all Sub-screen sections) 1,412 (67%)
2,009 (67%)
2,458(56%)
Average GAIN-SS Score 4.9 4.4 4.1
* High Risk = 3+** People may be counted in multiple sub-screen sections
Initial Results on 4,371 People Screened with GAIN-SS
Source: USC Institute for Families in Society | Division of Policy and Research on Medicaid and Medicare
175/29/14
HOP Screenings
2012 Latest Data
Internalizing Disorder (Sub-screen section)**(depression, anxiety, suicidal tendencies, acute/PTSD)
3,149 (35%)
Externalizing Disorder (Sub-screen section)** (e.g., attention deficit hyperactivity, conduct disorder, aggression)
2,066 (23%)
Substance Disorder (Sub-screen section)** (substance abuse/ dependence, frequency of use, effect on daily activity and degree of dependency)
4,143 (46%)
Crime and Violence Disorder (Sub-screen section)**(e.g., interpersonal violence, property crime, drug-related crime)
1,070 (12%)
Total GAIN-SS Scores (includes all Sub-screen sections) 6,311 (70%)
Average GAIN-SS Score 6.02
National Average for People Screened with GAIN-SS
Source: USC Institute for Families in Society | Division of Medicaid Policy and Research
175/29/14
Linking PAM and GAIN-SS to Individual Data
for Enrolled
Linking Collaboration Index
to Case Study Interviews
Comparing Characteristics and Services use Patterns:
Enrolled Pilot versus Uninsured Total Population
Linking Implementation Process to Interviews:
Applications Criteria; Goal Attainment
NEXT STEPSCase Study Report with
Recommendations
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Ana Lòpez-DeFede, [email protected] 803-777-9124Kathy Mayfield-Smith, MA, [email protected]
Contact
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