PROJECT 25. San Diego s Frequent User Initiative. California Association of Public Hospitals Conference December 2014

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1 PROJECT 25 San Diego s Frequent User Initiative California Association of Public Hospitals Conference December 2014

2 Project 25 Overview 3 year pilot funded by the United Way of San Diego County St. Vincent de Paul Village is the lead agency Established Frequent User list 36 chronically homeless Frequent Users Housing First model Health Home Model Harm Reduction Emphasis on data collection It costs more to do nothing.

3 Goals Housing stability Preventative Care Decrease Use and Cost of Services Improved Quality of Life

4 Project 25 List Jail City EMS/911 Excluded people who did not access at least two systems Final list had 71 names ranked by costs 2 Local hospitals Project 25 List County Behavioral Health Services Targeted top users on list and enrolled 35 people Those who accessed behavioral health services were targeted for ACT model 13% of people on list were deceased when outreach started in Spring 2011

5 Baseline Snapshot Health Insurance None = 15 Medicaid = 9 Medicare = 5 County = 7 21 Ambulance Rides (12 months prior) Sex: Men = 30 Women = 6 41 ER Visits (12 months prior) Age: Avg = 46 Range = 21 to 60 5 under age 30 Average Per Person Cost $120, Hospital Admissions 45 Hospital Days (12 months prior)

6 Project 25 Service Delivery Model Intensive Case Management High frequency of contact/very low staff to patient ratio Life skills, substance abuse services, medication management, and expedited SSI/SSDI obtainment Real time alerts if accessing ED through Community Information Exchange Medical and Psychiatric Care Permanent Housing Concierge level care at St. Vincent s FQHC Coordinated and integrated health care services with P25 Case Managers Access to State Certified Outpatient Alcohol and Drug Treatment Program at St. Vincent s Housing First Model Immediate placement in temporary housing Subsidized apartment that patient will be able to keep Furniture, food, household goods Payee services to ensure rent and other bills are paid

7 Examples of Housing

8 Medical Home St. Vincent de Paul Village Family Health Center Federally Qualified Health Center Serves homeless and tenants in FJV PH UCSD Dual Residency Program- One white coat Limited dental services

9 Hutch

10 Hutch in $168, Ambulance Rides ER Visits Hospital Admissions Hospital Days 15

11 Hutch in Project Homeless P25 Year 1 P25 Year Passed away in July 2014 in his own home 11 months sober Ambulance Rides ER Visits Hospital Admissions Hospital Days 15

12 Client 2 in 2010 $290, Ambulance Rides ER Visits Hospital Admissions Hospital Days 85

13 Client 2 in Project 25 Lives in a 2 bedroom apartment with adult son Obtained SSI through HOPE SD (Local SOAR model) See doctors regularly at St. Vincent s Clinic Homeless P25 Year 1 P25 Year Ambulance Rides ER Visits Hospital Admissions Hospital Days

14 Project 25 Works Year 1: 66% Decrease in ER Visits 62% Decrease in Ambulance Rides 56% Decrease in Hospitalizations 58% Decrease in Hospital Days Year 2: 64% Decrease in ER Visits 67% Decrease in Ambulance Rides 70% Decrease in Hospitalizations 64% Decrease in Hospital Days Ambulance Rides ER Visits Homeless P25 Year 1 P25 Year Hospital Admissions Hospital Days Days in Jail

15 Decrease in Costs Public Costs in 2010 $987,371 $332,316 $147,600 $2,626,712 Ambulance Rides ER Visits Hospital Days Law Enforcement Other Public Costs Year 2 $135,430 $4,229,429 $1,574,839

16 Data Partners Hospitals Alvarado Hospital Alvarado Pkwy Inst Kaiser Foundation Palomar Pomerado Health Paradise Valley/Bayview Promise Hospital SD Sheriff Psych Unit SD County Psych Hospital Scripps Health SHARP HealthCare Tri-City Medical Center UCSD Medical Center VA Medical Center Ambulance EMS Rural/Metro American Medical Response Other Partners County of SD HHSA SD Sheriff s Dept SD County Public Defender Shelters Alpha Project Catholic Charities Salvation Army SD Rescue Mission St. Vincent de Paul Village Veteran s Village of San Diego

17 What s Next? September 2014: Received a SAMHSA grant. In discussion with health plans Future April 2014: Medi-Cal Health Plan referred AND paid for their first patient Fully sustainable through Medi-Cal. Excited about Health Home bill and other opportunities March 2014: United Way funding ended (Provided 100K extension)

18 SAMHSA Grant 3 year federal grant to serve 20 more people. Start immediately. Grant does not cover the full cost of the intervention Targeted at people who are frequent users and have extremely high health care costs In Discussion with Health Plans and there is good interest Chronically Homeless Frequent User and high health Costs Enrollment Criteria Must have Behavioral Health Issue (SMI or SUD) Current support is not working Targeted at people not helped by Plans inhouse case management

19 Patient Selection St. Vincent s will work with each plan to select appropriate patients In a 12 month period: Option 1 At least 12 ED Visits Option 2 St. Vincent s will provide each plan with 15 names of high users of the 911 system on their plan The plan can cross check these names in their system and see how much they are costing them Over $100,000 in Medical Costs St. Vincent s and Health Plan will jointly approve each referral Each plan can look internally in their system to select patients given the above criteria and grant criteria

20 Length of Program Months from Outreach to Transition Stabilization Transition Transition includes working with the Health Plans case managers to assume responsibility of care coordination. Outreach/Engagement and Housing Placement Patient will still be able to receive primary and psychiatric care at St. Vincent s Clinic Keeps the housing subsidy Can continue to use P25 as their Representative Payee

21 Questions? Contact Info: Kris Kuntz Marc Stevenson