Stanislaus County Partners In Health. Stanislaus County Healthcare Strategy Meeting Quarterly Update August 21, 2015

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1 Stanislaus County Healthcare Strategy Meeting Quarterly Update August 21, 2015

2 Ceuticare Program Updates Participation Statistics Case Studies Health Bridges of N. California Program Updates Participation Statistics Bariatric Case Management Program

3 Stanislaus County Partners in Health Network Update Provider Updates Cardiac Rehabilitation Program Memorial Medical Center Emergency Room Utilization Report August 20 th Provider Meeting Briefing

4 CeutiCare Program Updates Cornerstone Family Practice Medical Group 135 Total Patient Candidates 10 Patients Were Not Considered Candidates 30 Patients Reviewed (Through 8/11/15) Type Of Case Number of Cases Diabetes 18 out of 30 Hyperlipidemia 15 out of 30 Hypertension 15 out of 30

5 CeutiCare Case Studies Case Study #1: 59 yo female with diabetes and on split mix insulin and A1c was not at goal of <7%. Recommendation was to discontinue using Humalog 50/50 and Invokana and temporarily hold metformin for 30 days. Proposed Treatment Included: Discontinue Humalog 50/50 and Invokana Hold using Metformin for 30 days Injecting 60 units of Lantus in the morning and at bedtime. Injecting 60 mcg of Symlin prior to dinner for 7 days. If no nausea, then increase to 120 mcg. Begin injecting 15 units of Humalog Kwikpen prior to breakfast and/or lunch with monitoring or blood sugars.

6 CeutiCare Case Studies Case Study #2: 45 yo male with diabetes, hypertension, and hyperlipidemia. A1c was elevated to 7.8%, BP was elevated to 142/90, and Lipids were elevated. Proposed Treatment Included: Continue titrations for both Lantus and Novolog at 1 unit dose/day. Start Symlin 60 mcg with two meals and then increase to 120 mcg if no nausea. Start Lisinopril 5 mg once per day to lower BP and for renal protection. Titrate Lisinopril to 10 mg once per day after one month if SBP is not <140. Then titrate to 20 mg once per day after another month is SBP<140. Discontinue atorvastatin 40 mg and change to Crestor 10 mg once per day at bedtime.

7 CeutiCare Case Studies Case Study #3: 51 yo male with diabetes, hypertension, and hyperlipidemia. A1c was elevated >7.0%. BP was elevated to 140/80, and Lipids were elevated. Proposed Treatment Included: Due to elevated A1c initiate diabetic medications and start Tradjenta 5mg one time per day and Metformin 500mg twice daily. If morning blood sugars are not <110 then titrate Metformin up to 1000 mg twice daily. Discontinue Atenolol 50 mg and switch to Carvedilol 6.25mg twice daily due to possible increase triglycerides with atenolol. Start Fenofibrate 160 mg one time per day decrease TG and increase HDL.

8 Health Bridges of Northern California Program Updates Service Number of Members 1 Post Discharge Phone Calls 43 Care Gap Engagement 107 Medication Compliance 57 Total June and July 2015

9 Health Bridges of Northern California Program Updates Disease Category Number of Members 1 Diabetes 94 Hypertension 32 CAD 17 Hyperlipidemia 6 All Others 19 TOTAL June and July 2015

10 Health Bridges of N. CA Bariatric Case Management Program Because of the risk involved with bariatric surgeries and high complication rate post-surgery a bariatric case management program through Health Bridges should be considered. Member had a gastric sleeve operation performed in early July and patient was not being managed effectively post-surgery. Member was unable to adjust to post-surgery diet and went to ER mid-july and had gall bladder removed. Member continued to have issues with post-surgery diet and went back to the ER and was admitted to have TPN port inserted.

11 Health Bridges of N. CA Bariatric Case Management Program The framework of the program would include the following: 3 Weeks Prior to Surgery HB assists member in following the pre-surgery diet (very critical) HB works with the surgeon s office to ensure all pre-surgery routines are being followed. HB will make sure member has all contact information should any challenges arise. Any deviations will be documented and communicated to surgeon s and PCP s office. During Hospital Stay HB hospital liason will visit patient and work on any post-discharge needs Within 48 Hours Post Surgery HB will make home visit to assess patient and verify patient is compliant with post surgery diet (Critical) Any deviations will be communicated to surgeon s and PCP s office.

12 Network Updates June 2015 Provider Updates Provider Name Specialty Location Action Effective Date Margaret Hunter, MFT Marriage and Family Therapy Turlock/ Modesto New 6/1/15 Gina Lima-Vieira, MSW Mental Health Counselor Turlock New 6/12/15 Daniel Bruce, LCSW Psychotherapy Modesto New 6/18/15 Raymond Racela, MD (First Choice Physicians) Mohsen El Ramah, MD (Valley Nephrology Assoc.) Surgery Modesto New 6/25/15 Nephrology Modesto New 6/30/15

13 Network Updates July 2015 Provider Updates Provider Name Specialty Location Action Effective Date Active Life Medical Products Inc. Yuqiang Ge, MD (Modesto Kidney Medical) DME Stockton New 7/28/15 Nephrology Modesto New 7/30/15

14 Network Updates August 2015 Provider Updates Provider Name Specialty Location Action Effective Date Joanna Torre, MD (Emmanuel Medical Ctr.) Orthopedics Turlock New 8/1/15 Charles Hoogendorn, DC Chiropractic Manteca New 8/5/15 Integrated Care Systems Home Infusion Visalia New 8/5/15

15 Network Updates Cardiac Rehabilitation Program DMC does not have a cardiac rehabilitation program. No other local alternatives other than Memorial Medical Center. Plan of action is to enter into single case agreements with Memorial Medical Center for members needing this service.

16 Network Updates Emergency Room Utilization Report 2014 ER Utilization Report Doctors Medical Center DIAGNOSIS GROUPINGS CLAIMS TOTAL PD. PERCENT PD. SYMPTOMS, SIGNS, AND ILL-DEFINED CONDITIONS ( ) 122 $ 230, % INJURY AND POISONING ( ) 124 $ 125, % DISEASES OF THE GENITOURINARY SYSTEM ( ) 51 $ 105, % DISEASES OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE ( ) 33 $ 90, % DISEASES OF THE DIGESTIVE SYSTEM ( ) 31 $ 88, % DISEASES OF THE NERVOUS SYSTEM AND SENSE ORGANS ( ) 52 $ 65, % DISEASES OF THE CIRCULATORY SYSTEM ( ) 12 $ 33, % DISEASES OF THE RESPIRATORY SYSTEM ( ) 39 $ 31, % DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE ( ) 29 $ 20, % NONE 12 $ 16, % INFECTIOUS AND PARASITIC DISEASES ( ) 13 $ 13, % MENTAL DISORDERS ( ) 18 $ 13, % DISEASES OF THE BLOOD AND BLOOD-FORMING ORGANS ( ) 5 $ 11, % ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES, AND IMMUNITY DISORDERS ( ) 3 $ 2, % CERTAIN CONDITIONS ORIGINATING IN THE PERINATAL PERIOD ( ) 3 $ 2, % SYMPTOMS, SIGNS, AND ILL-DEFINED CONDITIONS ( ) 1 $ 1, % COMPLICATIONS OF PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM ( ) 1 $ % NEOPLASMS ( ) 1 $ % Totals 550 $ 854, %

17 Network Updates Emergency Room Utilization Report 2015 ER Utilization Report Doctors Medical Center DIAGNOSIS GROUPING CLAIMS TOTAL PD. PERCENT PD. INJURY AND POISONING ( ) 59 $ 174, % SYMPTOMS, SIGNS, AND ILL-DEFINED CONDITIONS ( ) 65 $ 125, % DISEASES OF THE GENITOURINARY SYSTEM ( ) 19 $ 49, % DISEASES OF THE DIGESTIVE SYSTEM ( ) 14 $ 18, % DISEASES OF THE RESPIRATORY SYSTEM ( ) 17 $ 15, % DISEASES OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE ( ) 19 $ 14, % DISEASES OF THE NERVOUS SYSTEM AND SENSE ORGANS ( ) 10 $ 9, % DISEASES OF THE CIRCULATORY SYSTEM ( ) 4 $ 6, % MENTAL DISORDERS ( ) 6 $ 5, % DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE ( ) 11 $ 4, % NONE 5 $ 4, % INFECTIOUS AND PARASITIC DISEASES ( ) 3 $ 3, % ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES, AND IMMUNITY DISORDERS ( ) 3 $ 3, % DISEASES OF THE BLOOD AND BLOOD-FORMING ORGANS ( ) 3 $ 2, % TOTALS 238 $ 438, %