5214.0: Wednesday, November 15, 2000 - 3:30 PM

Abstract #9545

Healthy Outcomes: An innovative collaboration between Public Health and Managed Care to decrease Emergency Department (ED) utilization

Susan Karlins, MPH1, Julie Grisham, PHN, MA2, Kent Imai, MD1, Greg Price1, Immaculate S. Cantos, MPHc1, Bonnie Broderick, MPH, RD2, Nhien Luong, MPH2, Rocio Gonzalez, MPH2, Su-Lin Wilkinson, MPH2, and Cara Mai, MPH3. (1) Valley Health Plan, Santa Clara Valley Health and Hospital System, 3003 Moorpark Avenue, San Jose, CA 95128, (408) 885-4038, karlisus@wpgate.hhs.co.santa-clara.ca.us, (2) Department of Public Health, Santa Clara Valley Health and Hospital System, 645 S. Bascom Avenue, San Jose, CA 95128, (3) Centers for Disease Control, Atlanta, GA

Background Valley Health Plan (VHP) began providing managed care services to Medicaid members of our Local Health Plan in 1997. This population previously had few options for after-hours care. VHP’s culturally diverse members were given a “medical home” at a clinic and after-hours telephone triage and urgent care options were expanded. Nevertheless, almost 90% of members’ Emergency Department (ED) visits were for non-emergency care. Development of Collaborative Program An innovative collaboration was developed to decrease ED utilization and assist members to access primary and urgent care from their regular doctor. Bilingual Public Health Assistants (PHAs) from SCC PHD contact each member who visited an ED to provide education and to decrease barriers to access to primary and urgent care. PHAs ask members about the recent ED visit and provide education about access to primary and urgent care and nurse advice. Barriers to care are assessed and community resource referrals are offered. Members are queried about untreated chronic illnesses or pregnancies and appointment-making help is offered. Attractive, multilingual materials reinforce the key messages. Data regarding barriers to utilization of care services is collected and analyzed. Outcome Over 2,000 members were contacted during 1999. Untreated chronic illnesses and pregnancies were identified in 23% of them and follow up is underway. System problems, such as ineffective after-hours telephone services, were identified and are being remedied. Preliminary data indicates that the rate of ED utilization decreased 17% in the seven months after the start-up period. More recent data will be analyzed and reported.

Learning Objectives: Participants will be able to:

  1. Discuss access to care issues faced by members of Medicaid managed care plans
  2. Describe successful components of a program to decrease ED utilization by Medicaid managed care plan members.
  3. Describe three benefits of collaboration between local health departments and county managed care plans.

Keywords: Access to Health Care, Collaboration

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: I am employed by the County of Santa Clara which funds this program.

The 128th Annual Meeting of APHA