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Karen Michael, RN, MSN, MBA Vice President, Clinical Services, Keystone Mercy Health Plan

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Collaboration Between a Health Plan and a Community Health System to Improve Care Coordination for a Medicaid Population. Karen Michael, RN, MSN, MBA Vice President, Clinical Services, Keystone Mercy Health Plan 215-937-8546 [email protected] Grace Lefever, PT, MS, MPH

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Collaboration Between a Health Plan and a Community Health System to Improve Care Coordination for a Medicaid Population

Karen Michael, RN, MSN, MBA

Vice President, Clinical Services, Keystone Mercy Health Plan

215-937-8546 [email protected]

Grace Lefever, PT, MS, MPH

Project Leader Coordinated Care Management,

Mercy Health System, Southeastern PA

610-567-5293 [email protected]

who we are
Who we are
  • Mercy Health System Southeastern PA
  • Keystone Mercy Health Plan (KMHP)

Value of Collaboration

  • Aligned organizational goals
  • Opportunity to connect and enhance care coordination
building a new care coordination model
Building a New Care Coordination Model

Health Plan

Emergency

Services

Specialty Physicians

Primary Care Team

“Medical Home”

Home Health

Hospital

Care Coordination

Individual and Family

Functional IT

Community Based Resources

elements of mercy care coordination pilot
Elements of Mercy Care Coordination Pilot
  • Primary Care Transformation / Embedded KMHP Care Coordinator
  • Hospital Transition Manager (KMHP sponsored RN)
  • Planning for coordinated access and referrals to Multi-Specialty Care
  • Linking with community based providers / resources
  • Patient self-management support – education / wellness
  • Technology enablement
  • Data Management / Program Evaluation
pilot outcomes
Pilot Outcomes
  • Enhanced Primary Care Coordination (180 members)

-Hospitalization admissions reduced (17%), shorter LOS (37%) for a decrease of inpatient days /1000

members of 48%

    • 30 Day Readmission reduced from 30% pre to 7% after intervention (members not engaged in care coordination changed from 16% in 2008 to 13% in 2009)
    • Readmission to same hospital increased from 29% to 67% resulting in more care at Mercy
    • Engaged members had better persistency with the medical home, 26% of non-engaged members were capitated less than 3 months with only 42% for 10 months or longer; Engaged members only 5% were capitated less than 3 months and 67% for 10 months or longer
  • Hospital Based Transition Manager
    • Successfully integrated health plan transition RN into hospital workflow
    • Engages members face to face, surveys ED patients about barriers to PCP care
    • Connects members to KMHP care management and ambulatory care provider
  • Community Based Health Worker
    • Community outreach services from KMHP visit members lost to contact /overdue for PCP visit
    • Community health worker team (local Community Development Corp) engaged for follow up visits to members discharged from hospital
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Challenges

  • Framework to scale and sustain pilot lessons
  • Leveraging data / technology
  • Finding local champions
  • Adopting work redesign and new team roles
  • Measuring care coordination
  • Promoting innovations without aligned financial and performance incentives
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