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How care coordination, IT slashes emergency department visits

September 21st, 2011

by Joy Tapper

All too often, we see patients turn to the emergency department (ED) for medical conditions that would more appropriately be addressed through primary care services. Here in Milwaukee County, an estimated 48 percent of all ED visits are by patients without emergency needs. But the problem is certainly not localized--it's a nationwide issue that contributes significantly to the rising cost of healthcare.

For example, a 2010 study by RAND Corporation found as many as 17 percent, if not more, of all ED visits to be unnecessary, costing the United States about $4.4 billion in healthcare costs. While the RAND study points to the role retail health clinics and urgent care centers could play in reducing the ED burden, there are many patients for whom an appointment with a primary care provider would also be in order.

Resolving this misuse of the ED system requires a combination of patient education about the importance of primary care and the availability of alternatives to the ED, as well as care coordination planning and technology solutions that streamline the process and make it easier to manage. And, already we're seeing these types of programs generate success.

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Last year, the Milwaukee Health Care Partnership, through its ED Care Coordination Initiative (EDCC), launched a community-wide process to improve access to quality care and services and enhance care coordination by leveraging health information technology. Our ultimate goal: to improve overall patient wellness and outcomes and reduce the total cost of care.

In practice, the collaborative partnership between health systems, community health centers and government agencies aims to reduce avoidable ED visits, related hospitalizations, and duplicative tests and procedures for Medicaid and uninsured patients, specifically, patients with chronic conditions and pregnant women. Moreover, our goal is to connect these high-risk patients with primary care physicians in medical homes, a setting most appropriate for their health needs.

To achieve these goals, we've implemented several healthcare-related technologies, which we believe are critical to improving the process. Recognizing that connecting patients with medical homes is a key component in reducing unnecessary ED visits and ensuring appropriate follow-up care, the ability to schedule primary care appointments while the patient is still in the ED is a critical link in that process.

To address this need here in Wisconsin, we've implemented the Wisconsin Health Information Exchange (WHIE) in all area EDs to support clinical decision-making and care coordination. Additionally, we have implemented MyHealthDIRECT, a web-enabled scheduling solution, which allows ED staff to make patient appointments with primary care physicians. Available 24/7, the system lets care coordinators tap into providers' available appointment slots and even tailor appointment selection to the patient's needs and preferences. For example, a healthcare provider can be selected based on zip code, gender, specialty, and even language. The patient can walk out of the ER with an appointment in hand, having already made that important first step to follow-up care and continued wellness.

Through MyHealthDIRECT, Milwaukee EDs are currently scheduling nearly 700 appointments each month at area safety net clinics for high-risk Medicaid and uninsured patients with chronic conditions such as asthma, COPD, diabetes, hypertension, and pregnant women. Our Show rate--those patients who actually keep the appointment--is running at about 40 percent, up from just 27 percent when we began the program. And our Stick rate--patients who become established and come back for future care--is at 60 percent. As a result about 125 new patients per month are being established with a medical home.

To further improve follow-through rates, we are working to implement sending appointment reminders to patients via text to leverage the latest modes of communication patients use in their daily lives. In addition, we receive data on referral patterns to support our continuous improvement efforts for this our community-wide process.

Joy Tapper is executive director of the Milwaukee Health Care Partnership, a public/private consortium dedicated to improving healthcare for underserved populations in Milwaukee County, Wisconsin. She has worked for over 20 years in various leadership roles with the Wheaton Franciscan Healthcare System, most recently as Executive Vice President/Chief Administrative Officer from 2001-2006.

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