Neighborhood Health says new program reduces ER visits for its most complex members

NEIGHBORHOOD HEALTH Plan of Rhode Island said its new Health@Home program has reduced emergency room visits by 26 percent for its most complex members.
NEIGHBORHOOD HEALTH Plan of Rhode Island said its new Health@Home program has reduced emergency room visits by 26 percent for its most complex members.

PROVIDENCE – Neighborhood Health Plan of Rhode Island said its new Health@Home program has reduced emergency room visits 26 percent for its most complex members.
The program was implemented to “disrupt the cycle of high risk and high cost for its most complex members” and initial data shows that in addition to the decline in emergency room visits, medical inpatient days have been reduced 30 percent when compared with the same period last year.
The program is expected to grow to serve 450 members and save at least $2.7 million in net expenses during 2015, its first year of operations, according to Neighborhood Health.
Health@Home delivers Neighborhood-staffed primary care at home for a limited time until the member stabilizes and reconnects with their regular doctor.
According to Neighborhood Health, the average “frequent utilizer” member accounts for $58,000 in medical costs per year through seven emergency room visits, at least two hospital admissions and nearly two dozen prescriptions.
“We know from our work with [the Executive Office of Health and Human Services] that 7 percent of Rhode Island Medicaid enrollees account for approximately 66 percent of program spending, costing the state over $1 billion a year,” Dr. Francisco Trilla, Neighborhood Health’s chief medical officer, said in a statement. “For this group, routine clinic-based care is often not effective due to complex medical, social and behavioral conditions. This lack of routine care can lead to frequent preventable emergency room visits, hospitalizations and inappropriate medicine usage.”

Members voluntarily enroll in Health@Home. They receive an initial assessment of their medical, social, psychological and pharmacological needs, and each member works with a health care team to create a personal plan of care and address life goals. Members can access their team 24 hours a day, seven days a week, through in-person and telemedicine interactions.
Members enrolled in the program receive two to three home visits per month.

“Each interdisciplinary health care team is led by a nurse practitioner and includes community health workers and a social worker,” Alison Croke, Health@Home’s director, said in a statement. “During a member’s participation in Health@Home, the team works to identify the barriers to primary care and how to best address them. Examples of barriers might include lack of transportation, motivation or education. The goal is to have a member ready to transition back to office-based primary care within six to 12 months and help them regain some control over their health care.”

To qualify for Health@Home, Neighborhood members must meet the following criteria:

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  • Member is over the age of 21 and fully eligible for Medicaid
  • Member is only eligible for Medicaid (not Medicare also)
  • Member does not reside in a nursing home, or other long-term institutional setting
  • Member has more than $25,000 in medical expenses during the most recent 12-month period
  • Member has had more than two inpatient stays and/or more than two ER visits in the previous 12-month period
  • Member is not taking more than two opiate prescriptions (opiate-seeking members are not appropriate for program referral)
  • Member has one or more of the following chronic physical conditions: diabetes, asthma, congestive heart failure, chronic obstructive pulmonary disease, hypertension
  • Member may have co-occurring behavioral health conditions that include anxiety, depression and mood disorders

Health@Home is based on national models, including the Veterans Administration home-based primary care program, which have demonstrated savings and reduced utilization in inpatient admissions, emergency room visits and skilled nursing facility admissions.

“Governor Raimondo and Secretary Roberts have been effective in leading the effort to find ways to improve health outcomes and reduce costs for challenging Medicaid populations,” Peter Marino, president and CEO for Neighborhood Health Plan of Rhode Island, said. “We offered Health@Home as a program policymakers could build upon and believe it will prove to be an effective initiative to help control costs while ensuring high-quality care to Neighborhood members.”

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