ED Care Triage Actively Engaged Patient Modifications PIC

ED Care Triage Actively Engaged Patient Modifications PIC Discussion July 19 th , 2016

ED Care Triage Reporting Requirement • DOH “Actively Engaged” Definition: • “The number of participating patients presenting to the ED, who after medical screening examination were successfully redirected to a PCP as demonstrated by a scheduled appointment. ” • DOH Clarifying Information: • “The term successfully redirected means that the patient had and was made aware of an appointment with a PCP within 30 days after ED presentation and medical screening. It is expected that the redirection could occur within or en route to the ED. ” • CNYCC Additional Reporting Requirement: • While subject to change, CNYCC is currently interpreting the expectation that “redirection could occur within or en route to the ED” to be satisfied if the patient has a scheduled appointment and is notified of that appointment within 2 calendar days of the date of discharge from the Emergency Department.

Partner Discussion and Feedback • Trial of 2 Calendar Day Notification • DY 1 Q 4: Low Actively Engaged Patient numbers Temporary removal of 2 -day stipulation DY 2 Q 1 Targets (as of 7/18) Organizations Participating in ED Care Triage with submitted Actively Engaged Patient Counts • • Auburn Community Hospital (40) Lewis County General Hospital (136) MVHS (16) Oneida Healthcare (123) Oswego Hospital (301) Rome Memorial Hospital ( ~600 ) St. Joseph’s Hospital Health Center (213) Upstate University Hospital (67) Q DUE Target Actual Gap to Goal DY 2 Q 1 1600 1496 (104)

DOH Change in Actively Engaged Definition • DOH “Actively Engaged” Definition: • “The number of participating patients presenting to the ED, who after medical screening examination were successfully redirected to a PCP or Health Home care manager as demonstrated by a scheduled appointment. ” • DOH Clarifying Information: • “The term successfully redirected means that the patient had or was made aware of an appointment with a PCP or Health Home care manager within 30 days after ED presentation and medical screening. Health Home care manager will only serve an option for those patients enrolled in a Health Home at time of presentation to the ED. A redirection could occur within or en route to the ED. ”

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) • Instead of only connecting a patient to a/their PCP, now a patient can be directed to their Health Home Care Manager • Responsibility for notification & scheduling of appointment can be shifted to an entity other than the ED • Timeframe to make an individual aware of their appointment. • Reporting back to CNYCC if an entity other than the ED is making an appointment with the patient.

Decisions to Be Made • Who is responsible for scheduling and notifying individual of their appointment? • Does responsibility completely lie with Emergency Departments? • Are partners willing and able to have a shared responsibility in this project? • For example: have Health Homes/PCP’s take the lead on scheduling and notifying patients • What is in the best interest of the patient? • Could be different for each patient • Timeframe for notification/reach out to patient • Does the current 2 business day notification make sense? • Health Homes current policy: 24 hours or next business day • Primary Care Provider: • Based on follow-up notes in discharge summary • NYS DOH Requirement: within 1 week

Decisions to Be Made • Reporting Information to CNYCC • Which entity is taking ownership of project activities to report back to CNYCC? • Are partners willing and able to have a shared responsibility in this project? • For example: ED’s would provide a list of navigated to CNYCC will work with Health Homes/PCP’s for the additional information to conclude a successful Actively Engaged Patient. • Payment Policy Implications