CENTER FOR INTEGRATIVE MEDICINE
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2 CENTER FOR INTEGRATIVE MEDICINE R. Corey Waller MD, MS, FACEP, ABAM Director, Center for Integrative Medicine Medical Staff Chief, Division of Pain Management Medical Staff Chief, Division of Pain Management Spectrum Health
3 TERMS Super Utilizer (SU)- person with greater than 10 visits to SH system ED s in one year System SuperUtilizer e (SSU)- person with greater e than 10 visits to any ED in one year Primary Psych- patient who s use of the ED revolves around their psychiatric i diagnosisi Primary Medical- patient who s use of the ED revolves around their medical issues Primary SUD- patient who s use of the ED revolves around their substance use issues Direct Cost- money actually paid for the patient
4 SU s 950 individuals per year 20,000 visits per year THE NUMBERS $50,000,000 in direct cost per year (includes MH/SUD treatment) SSU s 2000 individuals per year (Kent County, 635K pop.) 35,000 visits per year $87,500,000 in direct cost per year (includes MH/SUD treatment) State wide extrapolation based on population 29,000 individuals per year 600,000 ED visits per year (total state ED visits 4,493,665, 455/1000 pts) $1,500,000,000 in direct cost per year (includes MH/SUD treatment)
5 THE BREAK DOWN visits per year (62%) Mostly medical 70% are transient HFUs (1 year only) visits per year (28%) Mostly combination of medical, SUD and Psych However, trends toward SUD 85% are consistent HFUs (more than 1 out of every 4 years) 30 or greater visits per year (10%) Mostly psychiatric 95% are consistent HFUs (more than 1 out of every 4 years)
6 CLINIC CONCEPT Center for Integrative Medicine Comprehensive bio-psycho-social evaluation Risk reduction model of care No firing of patients, no contracts Care guides, Michigan Automated Prescription System (MAPS) check other systems Take over care from PCP and specialists for time in the clinic. Write all perscriptions and order all tests. Outcomes from random patients (1 st 100 pts) 73% showed for first visit 89% kept follow-up appointments Greater than 65% reduction in visits Works great for the primary medical, but not as well for the SUD and Psych until care plans are added
7 WHO OWNS THE EMPLOYEES Physician, APP, Medical Assistant (x4), office manager, (0.5 FTE) research assistant and administrative assistant are employed by Spectrum Health LMSW x 2 are employed by Network180 (Kent County community mental health organization) Healthier Communities collaborative effort between hospitals (mainly spectrum health) and has case managers and CHW
8 PAYMENT MODEL-EPISODE OF CARE Pilot with local payer, episode of care for 1 year Level 1 patient $1000 Level 2 patient t $1900 Level 3 patient $3000 Total cost of the Clinic $850,000/year Self pay is 12-16% We can see 450 new patients per year (will most likely increase) So 400 paying patients x average $1900 = $760,000 Leaving $90,000/year (currently covered by Spectrum) Spectrums payer has saved close to $500,000 in first year Spectrum Health has shown a 3.2 million year over year decrease in charges for patients seen in CIM
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10 COMMUNITY CONNECTIONS Healthier Communities Core Health CHW GRCC Health Information Exchange HIPPA Metro Saitn Mary's Community Clinics Medical Practices Patient Needs SHMG Housing Transportation Job Training CIM Community Medicine Private FQHCs General Stability Food Pantry Payer Relations Elder Care Emergency Departments Butterworth Community Mental Health Priority Health BC/BS-Michigan Blodgett Pine Rest Michigan Medicaid Metro Arbor Circle Saint Mary's Cherry Street MHPs
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12 CURRENT OUTCOMES Reduction in ED visits at 6 months for the 20 or greater visits per year group is over 65% Reduction for the visits per year group is around 80% Most difficult patients are those with a significant chronic illness (DM, Crohn s, etc) and axis 2, cluster B disorder such as boarder-line personality disorder 3 million dollar decrease in charges over 1 year
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