Indigent Care Collaboration
HIE Supports Community Collaboration
February 9, 2007
Ann Kitchen  Executive Director
Indigent Care Collaboration  Austin, Texas
804-2090 ext.201  akitchen@icc-centex.org
1
Introduction to the ICC
2
ICC Mission

Affordable access to effective healthcare for the
uninsured in central Texas.

ICC initiatives designed to give safety net providers
collaborative tools




to undertake initiatives together
that none could do as effectively alone
that result in increased revenues or reduced costs
in providing health and mental health care to low income
patients
3
Asthma Patient Utilization History





44 year old male, height: five foot ten, weight: 205 with BMI of 29.4
History of asthma and type II Diabetes
In the I-Care database since 5/14/2002
Pharmacist started working with patient on 12/28/05
Resource use, before and after Pharmacist intervention:
15
10
5
0
2003
2004
2005
2006
ER
Inpatient
out-patient
clinic
4
10
11
2
2
0
0
0
1
1
6
0
1
0
5
3
4
ICC Regional Membership
Williamson County
Travis County
Hays County
Medical
Residency
School
of Nursing
MHMR
Hospital
District
Medical
Society
Hospital
Systems
Health
Depts
FQHCs
Clinics
5
2006 Regional Priority Projects

ICare Capacity Building Project

PECSYS Care Coordination Project

RWJ Connecting Public Health Project

Primary Care Capacity Report

Affordable Health Insurance Project

Clinical Pharmacy Case Management

Respite Care Project
6
ICC Initiatives and Data

Emerge Program

Seton Nurse Hotline

Katrina Help Line and Evacuee Data

Regional Emergency Department Study

Eligibility Screening – Medicaider and MedData

Proxy Pricing Methodology
7
HIE Information
8
ICare Vision
Goal - fully operational, physician and user friendly System
containing timely and complete data sufficient to support two
primary uses – program evaluation and clinical care.
Aggregate Health Data
Supports:
Shared Health History
Supports:

Program Evaluation and Grant
Requests

Population Research / Planning
including Regional Care Profiling


Managing Chronic Conditions /
Diseases
Physicians in Understanding
and Improving Clinical Care
9
I-Care System

Two different databases (MPI/CDR & PECSYS), each with a
different focus, that can talk to each other.

MPI/CDR includes a shared health history for all patients of
demographic, encounter (diagnosis, procedures), pharmacy and
other clinical data.

PECSYS includes a more detailed level of clinical data for a
subset of case managed patients, including lab data, referrals,
care planning information and more.
10
ICare Shared Health History

ICC Members share patient demographic,
encounter, pharmacy and other data
electronically with the ICC through HIPAA
compliant Business Associate Agreements.

Master Patient Index/Clinical Data Repository
created using Application Service Provider.

Aggregate data available for all patients.

Providers access individual shared health
records after authorizations are signed and in
system.

No duplicate data entry required.
11
ICare Snapshot December 2006

47 locations: 13 hospitals, 31 clinics, 1 Mental
Health Authority, 2 Physicians Networks.

628,312 patients (uninsured / underinsured)

2.5 Million encounters, from 2002 – present.

426,298 prescriptions.

Data includes ICD-9, CPT-4, Provider, Payer

Encounter Types: Inpatient, Outpatient, ED, Lab,
Call Center, Clinic Visits, Prescriptions
12
HIE Supports Collaboration

Support collaborative initiatives with data

Identify problems

Measure results

Improve communication

Calculate value and community benefit of
collaboration
13
HIE Supports Accountability

HIE data = broader picture to measure results
and calculate community value

Data uniquely supports sophisticated outcomes
analysis:




Measure patient-specific utilization patterns over time
Factor in cost shifting across community systems
Compare costs for program enrollees to control groups
Design program evaluation to determine effectiveness
14
Attacking Fragmentation

What’s missing - integration of medical
management across safety net system

Using data for community-wide care coordination

Identify patients that benefit from care coordination

Standardize interventions, data collection, measures

Share information to improve care

Measure results and calculate community benefit
15
Data Analysis Examples
16
Demographic Characteristics
Exhibit 4:
Demographic Characteristics of Uninsured and Underinsured Patients Visiting Indigent Care
Collaboration (ICC) Providers in 2005
All Patients
Number of Patients (%) 1
Race / Ethnicity %
AfricanAmerican
Caucasian
Hispanic
/
Latino
2
Other
Unknown / Not
specified
Number of Patient Visits n (%) 1
Average Encounter Rate 3
1.
2.
3.
Female
Male
All
121,188 (61.7)
75,176 (38.3)
196,442 (100.0)
12.3
29.0
43.2
1.2
14.2
11.9
33.5
41.2
1.5
11.9
403,309 (67.8)
191,130 (32.1)
594,685 (100.0)
3.3
2.5
3.0
11.6
36.3
39.9
1.7
10.4
Some numbers may not be additive across rows due to a small number of patients with unspecified gender that are
included in the last column.
‘Other’ includes American Indian / Eskimo, Asian /Pacific Islander and Multi-Racial.
Gender disparity persisted after correcting for encounters related to pregnancy and reproductive health.
17
Ratio of ED Visits to Overall Visits
Exhibit 6:
Emergency Department Encounters as a Percentage of All Encounters for Uninsured and Underinsured
Patients Accessing Care through Indigent Care Collaboration (ICC) Providers in 2005, Stratified by
Age, Gender and Race
0-17 Years
18-44 Years
45-64 Years
≥ 65 Years
Female
33.6
17.2
15.3
4.5
Male
38.0
48.1
21.7
5.5
African American
50.3
38.0
19.2
3.3
Caucasian
45.2
25.1
20.4
7.0
Hispanic Latino
29.0
15.0
12.6
3.4
Other 2
37.0
11.8
10.5
4.2
Unknown
48.1
46.7
27.8
11.1
Gender 1
Race / Ethnicity
1
Gender difference persisted after correcting for encounters related to pregnancy and reproductive health.
2
‘Other’ includes: American Indian / Eskimo, Asian American / Pacific Islander and Multi-Racial.
18
Patients with ED Encounters Only
Exhibit 5:
Pattern of Emergency Department (ED) Utilization by Uninsured and Underinsured Patients Attending Indigent
Care Collaboration (ICC) Providers in 2005, Stratified by Age and Gender
Age Band (Years)
0-17
18-44
45-64
≥65
All
PATIENTS WITH ED ENCOUNTERS ONLY
Number of Patients (%)1
Female
10,352 (40.6)
12,535 (49.1)
2,368 (9.3)
262 (1.0)
25,517 (100.0)
Male
11,164 (37.4)
15,809 (52.9)
2,700 (9.0)
201 (0.7)
29,874 (100.0)
All
21,516 (38.8)
28,344 (51.2)
5,068 (9.1)
463 (0.8)
55,391 (99.9)
Female
31.2
18.1
17.0
7.1
21.2
Male
34.7
53.5
25.2
10.7
40.2
All
32.9
43.4
20.5
8.3
28.4
Patients with ED Encounters only as a
% of All Patients with Encounters
1
Some percentages across rows may not add to 100.0, due to rounding.
19
Differences in ED Use by Payer
Population-Adjusted Emergency Department Encounter Rates
for Travis County Patients by Payer, 2005
Visit rate per 100,000 population
100,000.00
90,000.00
80,000.00
70,000.00
60,000.00
50,000.00
40,000.00
30,000.00
20,000.00
10,000.00
0.00
Uninsured
Commercial
Medicaid
Medicare
Payer
Note: Population data from the 2005 U.S. Census Bureau report were applied to the ICC 2006 ED report data for patients with a Travis County zip code to
obtain an estimate of the ED encounter rate by payer per 100,000 population. Source: Charting the Future: Recommendations for Increasing Access to
Primary Care for Central Texas Residents, Report of ICC Primary Care Capacity Team, February 2007
20
Trends in Health Care Utilization by
Patients Completing EMerge Program

Health care utilization by a subset of
160 patients who had their cases
closed b/w 1/1/2005 and 3/31/2005
was reviewed using ICare data.

In the twelve months prior to their
case being closed, these patients
averaged 6.3 clinic visits and nearly
3 ED visits per person for nonmental health related diagnoses.

In the twelve months following case
closure, the number of clinic
encounters declined to an average
of 4.5 encounters / person while
there was a 16 % reduction in ED
visits.
7
6
5
4
3
2
1
0
12 Months Prior to Case
Closure
ED Visits
12 Months After Case
Closure
Clinic Visits
During CY 2005, the EMerge program counselors saw 2,373
patients for a total of 5,243 encounters, or an average of 2.2
encounters per patient.
21
PharmCare Preliminary Results:
25

Snapshot of the results
for 50 patients from
reporting period of
9/1/06 to 11/30/06
24
20
15
10

Change in the number
of Inpatient Admissions
5
0
9/1/06
0
11/1/06
Asthma Inpatient Admissions
22
PharmCare Preliminary Results:
60


Snapshot of the results for
50 patients from reporting
period of 9/1/06 to 11/30/06
Change in the number of
Emergency Room Visits
53
50
40
30
20
10
10
0
9/1/06
11/1/06
Change in ER encounters
23
Asthma Patient Utilization History





44 year old male, height: five foot ten, weight: 205 with BMI of 29.4
History of asthma and type II Diabetes
In the I-Care database since 5/14/2002
Pharmacist started working with patient on 12/28/05
Resource use, before and after Pharmacist intervention:
15
10
5
0
2003
2004
2005
2006
ER
Inpatient
out-patient
clinic
4
10
11
2
2
0
0
0
1
1
6
0
1
0
5
3
24
I-Care Encounter History 2005/2006
25
I-Care Encounter History 2005
26
I-Care Encounter History 2005/2004
27
I-Care Encounter History 2004/2003
28
I-Care Encounter History 2003/2002
29
Mapping Emergency Visits
2005 Ten Zip Codes:
• Highest volume of
self pay (uninsured)
ED visits; and
• Highest rates of
potentially preventable
ED visits per NYU
algorithm
Source: Charting the Future: Recommendations
for Increasing Access to Primary Care for Central
Texas Residents, Report of ICC Primary Care
Capacity Team, February 2007
30
Mapping by Census Tract
Census tract level analysis,
comparing utilization, chronic
conditions, demographic and other
relevant data Can be useful in informing efforts
to address barriers and needs re
primary care access at the
neighborhood level.
Example: I-Care ED Visits
b/w 8am and 6pm by Adult
Patients (18-64) with a
Diagnosis of Hypertension,
in 2005, by Census Tract
within Zip Code 78741.
31
Value of Prescription Assistance
ICC Prescription Assistance Program
Cumulative***
Total number of applications sent
41,880
Total unduplicated patients who applied for PAP meds*
4,916
Total number of prescriptions filled
30,031
Total unduplicated patients receiving PAP meds*
3,599
Total # patients served by multiple locations
269
Cumulative***
Total AWP Value of PAP Meds**
$9,031,756
* This number may include a small number of duplicates from patients who were seen by more than one site and were given separate patient
numbers.
** 2 ICC members do not always verify that patients received drugs; therefor, # prescriptions filled, # pts who received meds, and AWP values
are under-reported.
*** Cumulative data represents all the data from the inception of the shared ICC database in MDS in June of 2004, up until the end of this
reporting period
32