MEDFORD, Ore. — High-frequency use of emergency departments represents the fourth largest category of financial waste nationwide, according to a report from the New England Healthcare Institute in 2007.
For Mercy Flight, that represents an opportunity to reduce waste, and along the way provide improved care for patients. It’s a health care gap right here in Jackson County they knew they could help address, beyond the ground ambulance services and emergency flights they are best known for.
For Jackson Care Connect, one of the Coordinated Care Organizations providing care for Oregon Health Plan (Medicaid) members in Jackson County, that is also a big challenge. Patients who overuse local emergency departments account for just 1 percent of members, but about 50 percent of health care costs.
About four years ago, Mercy Flights’ Chief Operations Officer Tim James, Communications Manager Leslie Terrell and Chief Executive Officer Doug Stewart began researching how other communities across the country and internationally were addressing this problem.
To create a program tailored for the specific needs of this community, they talked with local hospitals, and began explaining their idea to health care providers and care coordinators.
“I think we knew where we wanted to head. It was just telling our story in an understandable way,” says James.
In 2015, a grant opportunity from Jackson Care Connect provided an opening. Mercy Flights partnered with Providence Medford Medical Center to apply for a Health Innovation Grant, and Jackson Care Connect awarded $220,485 for the Emergency Department Avoidance Project. The aims of the project, which started in 2016, were to reduce emergency department visits by habitual users, support patients in understanding their health issues, help eliminate barriers to health care and reduce patients’ dependence on emergency departments.
For the first year, Providence staff identified patients who had used the emergency department at least 4 times in the previous 90 days. In 2016, 62 patients who had a combined total of 571 emergency room visits over the previous year were enrolled.
Upon agreeing to participate in the program, a patient is enrolled for two months. Mercy Flights paramedics visit the patients once a week and perform a home safety check, make sure they have the prescriptions they need and help them with their insurance. Mercy Flights also helps the patient connect with a primary care provider and find transportation to appointments, if necessary.
To serve these needs, Mercy Flights provided their paramedics additional training in chronic disease intervention, nutrition and patient communication, and clinical rotations in emergency medicine and behavioral health.
At the end of the first year, the results of the Emergency Department Avoidance Project were encouraging. Of the 62 patients enrolled in 2016, there was an overall 56 percent reduction in overall visits to the emergency department, surpassing Mercy Flights’ goal of reducing visits by half. This reduced Emergency Department costs by an estimated $448,100 (based on an average charge of $1300). Additional estimated savings in emergency transport over the same period totaled $289,200.
An additional 22 patients started but did not complete the program. But even with abbreviated contact with Mercy Flights staff, this group also had a significant reduction in overall emergency department visits.
The Emergency Department Avoidance Program continues in 2017, and Mercy Flights and Jackson Care Connect services have also expanded to a new program called Transitions of Care. Jackson Care Connect awarded a total of $170,898 for 2017 for both programs. The Transitions of Care program is exclusive to Jackson Care Connect members who have been admitted to the hospital, and have a moderate risk for readmission based on age, medical condition and social determinants.
Mercy Flights staff does their best to make contact with the patient at the hospital. “If we can do a face-to-face meeting, the enrollment percentages are much higher,” Terrell says.
Paramedics then work with the patient in the Transitions program over 30 days, making sure they have a follow-up visit with a primary care provider, understand how to use their medications, and have no barriers to safety or care.
It’s too early for concrete numbers on the new Transitions program, but Mercy Flights’ staff says the response has been positive overall.
Ginger Scott, transformation specialist at Jackson Care Connect, praises the work being done by Mercy Flights. She says, “It really meets the triple aim of improving the health of population we serve, improving the experience of patients and reducing costs.”
Looking forward, the Mercy Flights crew hopes to conscientiously build on the programs, and continue to identify ways to improve the health of the community and community members, while still reducing the per capita cost of health care.
For information about Jackson Care Connect, contact Jeanie Lunsford, 503-416-3626, [email protected].
For information about this story, contact Sara King Cole, Communications Consultant, 541-601-9011, [email protected].
About Jackson Care Connect
Jackson Care Connect serves the people of Jackson County as an Oregon Health Plan (Medicaid) Coordinated Care Organization. We bring physical, behavioral and oral health care together, to make it easier for members to get the care they need. Our mission is to help members of our community prevent illness and respond effectively to health issues. We partner with other organizations to explore innovative projects that promote a healthy Jackson County. To connect members with appropriate whole person care, we work closely with clinical and community organizations.
