Cares



|ED Care Triage (2biii ) Meeting Notes – 7/19/16 |

|Attendees | |

| |Kari Burke, Barbara Drapola, Thomas Filiak, Joel Frank, Nicholas Hanno, Denise Hummer, Stacey Keefe, Frank Lackey, Kim |

| |McNamara, Poonam Patel, Lisa Volo, Sherry Willis, Kim Witchley |

| | |

| |CNYCC: Kate Weidman, Lauren Wetterhahn, Michele Treinin, Shana Rowan |

| |Welcome! |

| | |

| |Updated Actively Engaged Patient Modifications |

| | |

| |Slide: ED Care Triage Reporting Requirement |

| |30-day window concerns |

| | |

| |Slide: Partner Discussion and Feedback |

| |Trial of 2-day notification (DY1Q4) |

|Discussion |Resulted in low engaged numbers, so temporarily removed the 2-day stipulation. |

| |DY1Q4 targets- target: 1600, Estimated actual: 1480, gap to goal: 120 |

| |(awaiting final rosters for partner organizations) |

| | |

| |Slide: DOH Change in Actively Engaged Definition |

| |DOH Actively Engaged Definition |

| |DOH Clarifying Information |

| | |

| |We are still waiting on clarifying information from the state, we are interpreting the requirements as keeping the 30-day |

| |appointment and notification requirements. When we receive clarifying guidance, we will inform partners. We are doing so in |

| |attempt to make as few changes as possible on the partner end. |

| | |

| |Attendees asked for a discussion around the current 2-day patient notification stipulation, as it adds in a new dynamic of |

| |Health Homes which operate under different guidelines. Concerns were expressed regarding PCP responses when EDs attempt to |

| |schedule follow-up appointments for patients and are then told by the PCP that they don’t need to be seen. |

| | |

| |Slide: Impacts on ED Care Triage |

| |Had or made aware of an appointment with a PCP or Health Home care manager within 30 days (if currently established with a |

| |health home care manager) |

| | |

| |Comment in regards to the term “redirected” – be careful about rollout. Critical value reports. With certain patient |

| |conditions, a primary care appointment is the medically necessary follow-up. Be aware that this now could take primary care |

|Discussion |out of the loop for patient care with new Health Home option. |

|(continued) | |

| | |

| |If someone comes in with a medical condition they need to be connected to the most appropriate person, and we need to keep in |

| |mind what’s in the best interest of the patient. There must be a distinction between criteria for reporting a patient as |

| |engaged and for activities to be eligible for actively engaged patient reporting. This should not dictate that only one action|

| |should be taken by ED staff. |

| | |

| |Upstate has been documenting when patients have Health Home Care Manager, and would be easy to reach out to those Health Homes|

| |who have on-call phone numbers 24/7. |

| | |

| |Discussion on Health Home protocol: They typically reach out within 24 hours or the next business day to a patient, which |

| |makes referring to health home managers a more feasible option. |

| | |

| |Slide: Decisions to be Made |

| |Who is responsible for scheduling and notifying individual of their appointment? |

| |Timeframe for notification/reach out to patient |

| |Could be different for each patient |

| |Reporting information to CNYCC |

| |Payment Policy Implications |

|Discussion | |

|(continued) |Discussion |

| | |

| |Connection to a PCP care manager count?: |

| |The requirements specifically state patients must be referred to a health home care manager, not a PCP care manager. The PCP |

| |should make the patient aware of the appointment. However, the actual language states “PCP or Health Home care Manager”. Does |

| |this mean PCP Care Manager or Health Home Care Manager? This could be interpreted different ways. CNYCC will clarify with |

| |NYS. |

| | |

| |2-day notification stipulation: |

| |St. Joe’s: indicated that the 2-day rule is onerous especially for programs that are attempting to get off the ground and |

| |asked if there was a way to incentivize new programs since revenue is needed to get them up and running. CNYCC hears these |

| |concerns; currently, our priority is patient behavior being impacted by the actions of the navigators, and we emphasize that |

| |no dollars are being unearned in this project. Targets are being hit and our collective hospital partners are able to engage |

| |the appropriate number of patients. We plan to continue in open conversation. |

| | |

| |Division of responsibilities: |

| |Ideally, patient education happens in the ED, but if not then it makes sense that this falls on the Health Home Care Manager. |

| |This education can assist in changing patient behavior in order to not return to the ED. |

| | |

| |Is this [follow-up] in line with what Health Homes are currently doing? Does the Health Home Care Manager report back to |

| |CNYCC? Currently Health Homes conduct outreach after ED presentation and work with a patient to fulfill their needs. Depending|

| |on the structure, a Health Home could report back to CNYCC if the partnership between the ED allowed for this division of |

| |responsibilities. |

| | |

| | |

| |Utilizing Health Homes: |

| |In our (Upstate’s) EMR, we don’t have the capability to add non-clinical appointments as there is no field to do so. In the |

| |near term, it seems to make sense to have Health Homes do reporting. |

| | |

| |We are working with HealtheConnections on the RHIO alert, and emails should go out to Health Homes or Health Home Care |

| |Managers. |

| | |

| |Follow-up with patient vs. notification of PCP appointment: |

| |What is currently done? Sherry/Oneida Healthcare – our ED staff already follows up with some patients. |

| | |

| |Cipher Health provides an automated call service for anyone discharged from the ED occurring within 48-hour window. |

| | |

| |The group was asked if they felt there was any risk of false appointments being made without notifying the patient to inflate |

| |engaged numbers. All agreed this was an important item to consider, but that more baseline data was needed to answer the |

| |question accurately. |

| | |

| |The ‘reach out’ is the most important element as patients are coming back to the ED partly due to uncertainty. Do attendees |

| |feel that follow-up or notification is more important/effective? |

| | |

| |Action item: |

| |A pilot approach to determine the effectiveness of follow-up vs. notification was discussed, in which hospitals would be split|

| |into two groups and each group takes a different approach, and then checking in after one quarter to discuss results. This |

| |will require additional work on the back end to determine which approach is more effective. |

| | |

| |CNYCC will reach out to each entity to determine which pilot they are willing to undertake to determine which is more |

| |effective. |

| | |

| |Actively engaged goal for next quarter is 3,200; up from 1,600. |

| | |

| |Reminder |

| | |

| |Please use CNYCC-provided rosters for reporting without making any changes to formatting or timestamps added. Thank you! |

| | |

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