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Preliminary Outcomes Executive Summary

REMSA’s Community Health Programs (CHP) are creating new care and referral pathways which assure patients who have entered the 9-1-1 emergency medical services system with urgent, low-acuity medical conditions receive the safest, and most appropriate, levels of quality care at a lower overall cost. Funded by a Centers for Medicare and Medicaid Services Health Care Innovation Award, these programs will reduce total patient care expenditures by $10.5 million over three years:

  • Nurse Health Line – Nurse Navigators provide 24/7 assessment, clinical education, triage and referral to health care and community services via a non-emergency number available to all Washoe County residents (launched October 2013).
  • Community Paramedicine – Specially trained Community Health Paramedics perform in-home delegated tasks to improve the transition from hospital to home, perform point of care lab tests and improve care plan adherence (launched June 2013).
  • Ambulance Transport Alternatives – Following an advanced assessment in the field, paramedics provide alternative pathways of care for 9-1-1 patients, including transport of 9-1-1 patients with low acuity medical conditions to urgent care centers and clinics, transport of inebriated patients directly to the detoxification center, and transport of psychiatric patients directly to a mental health hospital (launched December 2012).

Preliminary Outcomes Show Progress in Achieving the Triple Aim

Nurse Health Line – This intervention has experienced extraordinary levels of community demand with callers and referral sources representing a broad spectrum of individuals, community groups and healthcare professionals. A recent independent call review was highly complementary and shows very high overall protocol compliance. Preliminary results, based upon data from October 2013 to June 2014, include:

  • 1,149 ED visits avoided
  • 190 ambulance transports avoided
  • 4.6% NHL to 9-1-1 transfer rate
  • 15,941 total calls (2,000 calls/month)
  • 5,128 protocols

Estimate of savings to date:

  • $4.3 million (avg. charges)
  • $1.5 million (avg. payments)

Community Paramedicine – Preliminary results show that Community Health Paramedics can safely avoid hospital readmissions while simultaneously improving care coordination, as well as, patient quality of life and satisfaction scores. Preliminary results, based upon data from June 2013 to June 2014, include:

  • 28 readmissions avoided
  • 97 ED visits avoided
  • 109 ambulance transports avoided
  • 444 total patients enrolled
  • 2,024 total in-home visits

Estimate of savings to date:

  • $1.6 million (avg. charges)
  • $560,000 (avg. payments)

Ambulance Transport Alternatives – Preliminary results demonstrate that transport to alternative destinations is a safe and reliable way to help patients receive the right care at lower cost. However, barriers still remain including: frequency of patient consent, operating hours of participating facilities, facility consent to accept patient, and facility acceptance of patient’s insurance. Preliminary results, based upon data from December 2012 to June 2014, include:

  • 550 ED visits avoided
  • 55 ambulance transports avoided
  • 4.4% repatriation rate

Estimate of savings to date:

  • $2 million (avg. charges)
  • $700,000 (avg. payments)

Community Health Programs Summary – Preliminary results show progress in achieving all program aims:

  • 43,466 Contacts
  • 15,941 Nurse Health Line Calls
  • 2,024 Community Paramedic Visits
  • 574 Alternative Transports
  • 1,795 ED Visits Avoided
  • 354 Ambulance Transports Avoided
  • 28 Hospital Readmissions Avoided
  • $7.9 million Program Savings (charge)
  • $2.8 million Program Savings (payment)

Future Opportunities
With a strong early foundation supported by these preliminary outcomes, we look forward to working with payors and partners to sustain and expand the gains achieved to the benefit of the entire health care delivery system and, more importantly, the patients the system serves. REMSA’s Community Health Programs will:

1. Improve 24/7 access to assessment, triage, referral

o Navigate patients to appropriate levels of care

2. Improve overall patient satisfaction and quality of care

3. Lower the total cost of care o Reduce ED visits, ambulance transports, all-cause admissions and readmissions

Our goal is to develop new payment models based upon these preliminary results to preserve and sustain program savings.

A Note about Preliminary Outcomes – The preliminary outcomes presented herein are initial estimates and reflect a best faith effort to present an accurate description of our progress in improving the quality and experience of care, improving the health of populations and reducing the overall cost of care. All savings estimates are calculated based upon average charges from data provided by the Nevada Center for Health Statistics & Informatics at UNR. The estimate of payments avoided is based upon a generic 35% reimbursement rate. We continue to test and confirm the methodology and the data sources. These savings estimates will be updated as new data is identified and our methodologies are validated.

The project described was supported by Grant Number 1C1CMS330971 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies. ©2014 REMSA. All rights reserved. Contact REMSA to request permission to copy, distribute, retransmit, or modify any of these materials.

 

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Funded in part by Medtronic Philanthropy.


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