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Presented to Florida Hospital Association Webinar February 18, 2010 By Wally Plosky, Program Director HERAP Duval County Health Department. HERAP Focus. Uninsured and low income populations. Patients without a family physician.

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Presented to Florida Hospital Association Webinar

February 18, 2010

By

Wally Plosky, Program Director HERAP

Duval County Health Department


Herap focus
HERAP Focus

  • Uninsured and low income populations.

  • Patients without a family physician.

  • Patients requiring case and disease management assistance (for diabetes, cardiovascular, pulmonary and other chronic conditions).

  • Patients who have trouble filling prescriptions.

  • Zip codes with high hospital use for Ambulatory Care Sensitive conditions.


Herap components
HERAP Components

  • Coordination of hospital ER and inpatient referrals.

  • Primary care medical homes.

  • Multi-disciplinary disease management services.

  • Free walk-in medical condition management centers (MCMCs).

  • Neighborhood community living rooms (CLRs).

  • Medication assistance program (MAP).

  • Expanded clinic hours – evenings and Saturdays.

  • Stanford Medical School’sChronic Disease Self Management Program (CDSMP) - Living Healthy.

  • Regional health information exchange (JHIN).


Herap staffing
HERAP Staffing

  • RN disease managers

  • Financial eligibility specialists

  • Clinical pharmacologists/pharmacists

  • Registered dietitians/certified diabetic educators

  • Health educators

  • Mental health counselors

  • Patient navigators


2009 herap accomplishments
2009 HERAP Accomplishments

  • Received 2,697 client referrals from hospitals and community partners.

  • Connected 70% of hospital-referred patients with medical homes in the community.

  • Reduced emergency room utilization of HERAP-enrolled clients by 55.4%.

  • Reduced hospitalization of HERAP-enrolled clients by 89.8%.

  • Coordinated with hospitals to recoup over $1M in billable Medicaid dollars.

  • Helped hospitals in accessing over $75,000 in billable Medicaid under the Medically Needy Share of Cost program.


2009 herap accomplishments cont d
2009 HERAP Accomplishments (cont’d)

  • Submitted 264 medication assistance applications totaling $83,841.

  • Provided chronic disease management services for an average of 200 patients monthly

  • Conducted three 6-week Stanford Medical School Chronic Disease Self Management Programs (CDSMP), graduating 30 participants

  • Held 28 CLR outreach events, attended by 1007 participants, resulting in 227 HERAP enrollments

  • Implemented innovative technology to streamline financial eligibility for hospital-referred clients needing access to medical homes within 72 hours

  • Provided office space and IT support for the Duval County WE CARE program and a volunteer Project Dentists Care


Key herap partners
Key HERAP Partners

  • Baptist Health (BMC – Baptist South)

  • Memorial Hospital (HCA)

  • St. Vincent’s Medical Center (includes St. Luke’s)

  • Jacksonville Health Information Network (JHIN)

  • DCHD Institute for Public Health Informatics and Research (IPHIR)

  • Agape Community Health Center Network (Co-Applicant public entity FQHC with DCHD)

  • WE CARE, Inc.


Herap referral sources
HERAP Referral Sources

Hospitals/

ERs

Agape CHC

Network

Community

partners

Volunteers in

Medicine

We Care

HERAP

Community

physicians

Community

outreach

DCHD

programs

Self referral

I M Sulzbacher


HERAP Referrals by ZIP Codes

>40

30-39

24-29

10-23

<10


Duval county herap cost effectiveness review
Duval County HERAP Cost Effectiveness Review

  • Objectives

    • Evaluate the impact of HERAP’s comprehensive multi-disciplinary disease management and medical home program on:

      • Emergency room utilization

      • In-patient hospital admissions/stays

    • Evaluate the effectiveness of a health information exchange in monitoring HERAP effectiveness (Jacksonville Health Information Network – JHIN)

    • Measure the effectiveness of a multi-hospital partnership model with individual hospital-specific program elements


Duval county herap impact analysis
Duval County HERAP Impact Analysis

  • Methods/Procedures

    • Data set stratification

      • 521 uninsured patients formally enrolled in HERAP’s disease management program with at least one emergency room visit or one in-patient admission

      • January 1, 2009 – September 30, 2009

    • “Before and after” utilization rate comparison

      • Time bounded: 180 days immediately prior to and following HERAP admission


Duval county hospital emergency room alternatives program herap impact analysis
Duval County Hospital Emergency Room Alternatives Program (HERAP) Impact Analysis

  • Emergency room visits

    • Reduction: 55.5%

    • Projected six month savings:

      • $176,490

  • Hospital in-patient admissions

    • Reduction: 89.8%

    • Projected six month savings:

      • $4,324,260


Resources our partner hospitals want for their discharged patients
Resources Our Partner Hospitals Want for Their Discharged Patients

  • Assistance with non-compliant clients.

  • Primary care medical home.

  • Prescription access.

  • Chronic disease care and case management.

  • Knowledge of available community resources and how to connect clients to those resources.

  • Dental access.

  • Behavioral health and substance abuse services.


Herap contact information
HERAP Contact Information Patients

Hospital Emergency Room Alternatives Program

Duval County Health Department MC-92

900 University Blvd. N., Suite 202

Jacksonville, FL 32211

Tel: (904) 253-1444

Fax: (904) 745-3005

http://www.dchd.net/herap.htm

Wallace B. Plosky, MBA, Program Administrator

[email protected]

Brenda Bernardez, MSN, Project Director

[email protected]


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