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Home My WebLink AboutQ3 2019 FireFire Q3 2019 | September 24, 2019 Project Updates Project Updates Project Timeline Proposed Station 12 On hold Updates to Prevention Unit –Online Portal On hold Rotating BC Chief Aid On hold -Staffing No Billing/No Call Match –Audit of PSAP/Billing Not Started –PSAP implementation ISO –Hydrant Inspection (higher priority)Live Now ISO -Plan review for new residential construction (lower priority) Not Started –Ordinance change ISO –Flow Testing (higher priority)Live Now Community Paramedicine Pilot Evaluation Community Paramedicine •Community Paramedicine is an emerging EMS program around the country •In South Bend, our Community Paramedic, Suzie, connects with overutilizers of the EMS system to identify and solve underlying issues that lead to excessive 911 calls. •She meets clients where they are and work with them one-on-one to get them they help they need Pilot Launch Initial Proposal •Targeting overutilizers in the EMS system to reduce their number of transports •Better use of emergency care services •Find a medical home for patients in need •Support our EMS personnel Initial Proposal •How do we measure success? •Increased patients with a medical home (primary care doctor) •Decreased call volume (for these people) •Social issues addressed –not always a medical home Metrics –From Initial Proposal •Call Volume and Transports •Not every call results in a transport •Emergency department transports in target population •Primary care visits •Referrals to needed/eligible services •Not currently tracking •Medication adherence •30-day readmissions Inputs •Visiting clients to provide medical and social services. •Also includes: •Paramedic’s time •Paramedic train to run CP •MHIN partnership Outputs •Paramedic connects client with medical home, insurance, or transportation and facilitates those relationships •Paramedic provides some medical care Outcomes •Clients reduce the use of 911 services for non-emergencies •EMS and transports and call volume decreases •Emergency room has less non-emergency patients •Financial reimbursement –formerly nonpaying patients getting Medicare/Medicaid Impacts •EMS has a more positive outlook on the impact of their work EMS •CP expands services of SBFD •CP leads to increased quality of life for clients •Clients have a more positive outlook on their health•CP clients connecting friends and family with social services •City and SBFD are leaders in CP Assumptions •The clients CP visits are calling 911 with non- emergencies •The clients CP visits are not using the health care system as intended •Unfamiliar with healthcare system •Calling 911 to avoid healthcare system•The clients are willing to work with CP •The clients have no medical home Assumptions •Client gets appropriate medical and social attention •Client goes to doctor, take prescriptions•Client meets requirements to maintain insurance and services •Client calls PCP or other medical home or CP rather than 911 Assumptions •Client takes initiative on health and social services •Previous issues were contributing to a negative quality of life•Get something out of the program –positive experience Our Clients How many clients •116 patients were entered into the MHIN system •We weren't able to work with everyone who was recommended •Not able to get in contact, not interested in program, etc. •Clients were unable to complete the program for various reasons •Death, moving away, losing contact, etc. Demographics of Clients •From MHIN •Age, ethnicity, race, gender, address •Issue with a few clients' birth years –most likely used 20 instead of 19 in the year. •DASHBOARD What We Did Referrals •Social service referrals •SBFD, MICHO often provided the resource •Healthcare referrals •PCP was much lower than our initial expectation •DME seems low based on anecdotes (need breakdown of what was done) •Challenges in defining referrals –we’ll cover later in this presentation •DASHBOARD Ride-alongs •Working with IUSB, Ivy Tech, Notre Dame •Paramedic students •Social services students Outcomes Utilization Info •DASHBOARD •Emergency visits, PCP visits, Inpatient/Observation before, during, and after the program •Utilization decreased in all three categories (Emergency, PCP, Inpatient) •NOTE •Very few patients have had a full year after completing the program. This most likely results in lower numbers in the “after” section of the data if not filtered correctly. SBFD Outcomes •Call Volume and Transport Volume •Not every call results in a transport •Anecdotally, people will ask to be transported in order for the care to be covered by insurance •DASHBOARD Days in Program •DASHBOARD •The number of days clients remain in the CP program has gone down since the program first •Getting more comfortable with the program, learning more about connecting people to resources, developing an understanding of when a client is ready to leave the program •This means that the number of client lifecycles could increase as the program continues Financial Impact •We've looked at financial impact in previous meetings •No major changes •Calculator System Savings –from MHIN •Average ED visit cost is $1,200 Lessons Learned What assumptions changed •What changed in our theory of change •The main discovery was that finding a medical home was not the primary solution •Financial reimbursement was not as much of a problem as originally thought •Clients are referring their friends and family to CP, but we haven't gotten to the point where clients refer friends and family directly to social services •Diagnoses •What we initially thought vs what happened •Mental health and addictions –highest diagnoses, but only one referral Inputs •Visiting clients to provide medical and social services. •Also includes: •Paramedic’s time •Paramedic train to run CP •MHIN partnership Outputs •Paramedic connects client with medical home, insurance, or transportation and facilitates those relationships •Paramedic provides some medical care Outcomes •Clients reduce the use of 911 services for non-emergencies •EMS and transports and call volume decreases •Emergency room has less non-emergency patients •Financial reimbursement –formerly nonpaying patients getting Medicare/Medicaid Impacts •EMS has a more positive outlook on the impact of their work EMS •CP expands services of SBFD •CP leads to increased quality of life for clients •Clients have a more positive outlook on their health•CP clients connecting friends and family with social services •City and SBFD are leaders in CP Assumptions •The clients CP visits are calling 911 with non- emergencies •The clients CP visits are not using the health care system as intended •Unfamiliar with healthcare system •Calling 911 to avoid healthcare system•The clients are willing to work with CP •The clients have no medical home Assumptions •Client gets appropriate medical and social attention •Client goes to doctor, take prescriptions•Client meets requirements to maintain insurance and services •Client calls PCP or other medical home or CP rather than 911 Assumptions •Client takes initiative on health and social services •Previous issues were contributing to a negative quality of life•Get something out of the program –positive experience What do we need to do differently? •Data Quality •Doesn't reflect anecdotal social needs –need documentation to support •Adapting to changes in program and assumptions •Why were there data quality issues? •New process, new system •Getting on the same page with terminology, process, etc. •How will we address this? •Need new ways to chart referrals, closure reasons •Need more options for charting social needs •Ability to track follow-up with clients who have been closed out What do we need to do differently? •Should everything be counted as a referral? •Not capturing everything paramedic is doing - distributing canes, getting birth certificates,etc. •Not currently counting as referrals •Currently being recorded as notes on the case •How will we address this? •Tracking paramedic's time differently •New way to track non-medical issues handled by paramedic •Time spent outside of referrals –getting in contact, etc What do we need to do differently? •Should we change our target population based on what we've learned? •Infant mortality –Governor's initiative, dept of health •Housing needs •Referrals from engine crews •Falls •Not easy to pinpoint a target population based on needs Next Steps Adding Staff •Asking for an additional paramedic in 2020 budget •Would potentially double the capacity of the CP program •During the pilot year we served ~100 clients Infant Mortality •In Indiana, the overall infant mortality rate was 6.7 infant deaths for every 1,000 live births in 2012. •The rate in Iceland is 1.6 per 1,000 live births and around 2 out of 100,000 for Sweden, Finland, and Japan. (from Labor of Love) •Partners •My Brother's Keeper –Health Department •Governor's Initiative –Labor of Love •Prenatal and postnatal care Partnerships •MHIN •Re-evaluating relationship –contract renewal •Potential partnership with Beacon •Financial assistance •Readmission Data Analysis with other City Data •Overlaying CP data with data from other City departments •PSAP •311 •Code Enforcement •These datasets could serve as indicators for each other and for other City projects New Law for Reimbursement •Indiana Senate Bill 498 •"Provides that the office of the secretary of family and social services may reimburse certain emergency medical services provider agencies for covered services provided to a Medicaid recipient as part of a mobile integration healthcare program." •http://iga.in.gov/legislative/2019/bills/senate/498/#dige st-heading •CP for Medicaid recipients will be reimbursed •Currently, committees are determining reimbursement rates for CP programs Suggested Projects Suggested Projects •Outside of SB Stat •Moving Hydrant Inspections onto Open Data Portal •Low effort, medium impact •Q4 2019 SB Stat •Strategic Plan Update •EMS satisfaction survey •New strategic plan in 2020 •Medium effort, Medium impact •Q1 2020 SB Stat •Cancer research study with enFocus and Notre Dame •High effort, high impact Celebrating Our Values Celebrating Our Values •Working with Notre Dame on drone study •Funded by NSF ($1.2 mil) •Coauthors on study •Software program to automate drones in public safety •Excellence, Innovation