Enhanced Care Initiatives, Inc.
Situation
The medically disabled and elderly are the most rapidly growing segment of the Medicaid Dollar. This small population is responsible for the vast majority of costs.In 2002-2003, 56% of spending growth was in this population.
- 10 % of the Medicaid population is responsible for over 72 % of costs. 33% of this population is dual eligible
- 5% of the Non TANF Medicaid is responsible for over 30 % of costs
This is a very difficult population to connect with and impact.
One – The Community Profile
The profile - The community dwelling high cost patient typically has
- 7 active and chronic medical issues,
- No identified medical home,
- Significant behavioral issues,
- Psychiatric diagnosis, or
- Substance abuse, or
- Mental Retardation
- Over 60 % of their costs are medically driven and are avoidable
- Majority of spending for high cost beneficiaries in the community is for hospitalizations-40%; home health care-24%
Two – The Nursing Home
Residents in nursing homes are also often medically forgotten. They have extremely high utilization of the emergency room and frequent hospitalizations resulting in fragmented care and high costs. The average Medicaid patient residing in the Nursing Home has medical costs over $12,500 per year.
Solution
Enhanced Care Initiatives specializes in hands on solutions for the medically and socially complex patient.Our systems are built on our SAM ehr electronic health record.
SAM – Stratifies, Analyzes and helps our staff Manage this complex population. It combines clinical (in the field data) with administrative data, allows for rapid patient stratification, builds plans of care, prompts our staff with reminders, driving quality measures and tracking health outcomes. It is web based and available to our patients’ physicians as well. SAM integrates care.
Hands on clinical care – Easy Care – Our community based solution
- Our community based staff work with the patient and their caregiver in the home, building trust and establishing healthy practices.
- We link the patient to a medical home or create the home.
- We visit the doctor with our patients
- We put in place biometric devices when indicated – the right tool for the right patient at the right time.
- We have a hospital at home, MD in the home program – working to keep the patient out of the emergency room and hospital.
- Integrated medication management and formulary compliance programs
- 24/7 Caregiver support program. The caregiver is often a key link to maintaining patients in the community.
- Community based group wellness meetings- weekly meeting to promote wellness through exercise and socialization, these group meetings allow us to monitor a large group of people weekly.
Our NP Care division supplies medical management systems to nursing homes.
- Embed Nurse Practitioners into Nursing Home
- Establish systems of care which drive nursing care
- Automated risk assessments – prompting for preventive care
- Ability to deliver on site medical care
- Specialized programs for wound care, fall prevention, urinary incontinence, medication management and others
Better Health Lower Costs
Easy Care Outcomes:- Significantly improved medication adherence
- Improved diabetic management including HgbA1c levels, microalbuminuria screening, and foot exams
- Significantly improved influenza and pneumococcal immunization rates
- 42% reduction in hospital admissions; 35% reduction in ER visits
- 55% decrease in pmpm cost
- Outstanding acceptance by physicians, patients, and caregivers
