To curb unnecessary ED use, Detroit Medical Center (DMC) implemented an innovative new program to provide frequent ED users with coordinated care services—with dramatic results, Jay Greene writes for Crain's Detroit Business/Modern Healthcare.

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Background

According to Greene, the Affordable Care Act aimed in part to reduce unnecessary ED use. And while a 2016 CDC report found that relatively little improvement was made in that area as of 2014, hospital officials have said caring for "frequent flyers"—people who seek out ED care at least five times per year—can help address the problem.

While several hospitals have sought to address the problem by referring frequent flyers to external primary care providers, DMC's Gateway program provides coordinated care services within the health system. DMC CMO Suzanne White said, "If you have the patient in front of you, you have an opportunity for patients to have teachable moments in the ER." She added, "When you refer them to a clinic a block away, typically that model fails with that patient because it requires a lot of navigation up front."

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How the program works

Under the program, participating DMC hospitals—DMC Harper University Hospital, DMC Detroit Receiving Hospital, DMC Sinai-Grace Hospital, and DMC Children's Hospital of Michigan—use the health system's EHR to identify "frequent flyers" and/or patients without primary care providers who have at least one of seven chronic conditions.

When those patients seek out unnecessary ED care, the ED staff meets with them, tells them about the Gateway program, and recommends they enroll. The program gives patients access to coordinated care services at the program's outpatient facilities—all of which are adjacent to the hospitals' EDs and range in hours between 8 a.m. and 11 p.m.

The program, which is funded by a three-year, $10 million grant under the ACA, so far has enrolled more than 6,500 patients, with conditions including asthma, chronic lung disease, diabetes, depression, heart failure, HIV, and hypertension, White said. Of those patients, about 51 percent are Medicaid beneficiaries, 25 percent are uninsured, 14 percent are Medicare beneficiaries, and 10 percent have private insurance.

Positive results

Though finalized data on patient outcomes and financial savings are not expected until later this year, White said early data on patient outcomes have been so compelling that the federal government extended the grant for a fourth year, through September 1, 2018.

For instance, the preliminary data show that between January 2015 and May 2017 the program:

• Arranged 16,000 visits to Gateway outpatient facilities, where patients had access to multidisciplinary care teams;
• Achieved an average satisfaction score of 95 percent from participants;
• Treated more than 285 patients for diabetes at least once, and of the 112 diabetic patients who made multiple visits, 70 percent reported improved blood sugar levels;
• Treated 771 patients for hypertension, and of the 232 hypertension patients who made multiple visits, 51 percent showed improvement in their cholesterol levels;
• Cut the number of multiple ED visits by program participants by about 70 percent, with 2,075 participating patients showing a decrease in ED use after their initial Gateway visit and another 1,153 participating patients making no additional ED visits.

White said DMC hopes to sustain the program "by working with payers to develop reimbursement models." She added, "This is an innovative model, the first step in the direction for direct access to primary care" (Greene, Modern Healthcare, 6/26).

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