Using Peer Engagement to Drive Down ED Overutilization Emergency Department Diversion for Behavioral Health patients at Bon Secours
Facilitators Dr. Aliya Jones, M.D. Bon Secours Baltimore Chair of the Department of Behavioral Health
Learning Objectives At the end of this session, you will be able to: Understand the need for biopsychosocial screening in South West Baltimore Understand the role of a peer recovery specialist and the importance of peer engagement Understand the overall goals of the ED Diversion project 3
BSHSI Mission To provide good help through compassionate, quality health care to those in need in West Baltimore To partner with our communities to create a more humane world, build health and social justice for all, and provide exceptional value for those we serve 4
Bon Secours Health System Founded by the sisters of Bon Secours in Baltimore in 1919; sponsored by Bon Secours Ministries; headquartered in Marriottsville, Maryland; employs 25,000 Owns, manages, or joint-ventures facilities in six states, including 19 acute-care hospitals, one psychiatric hospital, five nursing care facilities, four assisted living facilities and 14 home care and hospice services 5
Bon Secours Baltimore A 72 bed acute care hospital and anchor institution in West Baltimore in the southwest neighborhood, due south of Sandtown-Winchester Named a Baltimore Top Workplace for 2013, 2014 and 2015 by the Baltimore Sun. Selected as a 2014 Healthcare Innovator for Community Health by the Baltimore Business Journal. Bon Secours Baltimore was chosen for dedicating nearly 12% of its operating budget to community benefit. 6
Bon Secours Baltimore In addition to the hospital, other offerings include: A full range of behavioral health programs A Family Health and Wellness Center Community Works, a social services subsidiary, which offers workforce development, financial counseling, youth programs, early head start, etc. Unity Properties, which develops low income housing and manages almost 800 units 7
Bon Secours Community Works Family Support Center: Offers facilitybased and in-home services including: GED prep classes parenting education employment preparation teen parent and fatherhood groups Service 170 at-risk, young families annually Women's Resource Center: provides supportive services to women who are homeless or at-risk to become homeless. Serves at least 200 women annually Financial Services: financial education, eviction prevention assistance,(105 annually), tax preparation (1,200 annually), and benefit screenings (620 annually). Open Space Management: vacant lot maintenance (450 city lots), neighborhood beatification, workforce training (8 trainees annually). Career Development: Job preparation, placement, work-related services and post-placement follow-up for 55 youth and 100 adults annually. 8
Baltimore Neighborhoods
Our Community Bon Secours primary service area of West/Southwest Baltimore is home to Maryland s poorest and sickest citizens Employment: 24.9% are unemployed vs. 14.2% in Baltimore City as a whole Household Income: 44% of households make less than $25,000 Education: 31.4% do not have a high school diploma Housing: 27% Vacant and Abandoned residential properties (Median Price of Homes Sold: $22,000) Leading causes of health-related deaths: heart disease, HIV/AIDs, substance abuse and diabetes 10
Bon Secours has been addressing the social determinants of health in West Baltimore for the last 25+ years. 11
Our Community Large city African American Poverty (23% Baltimore vs 10% MD) Poor health status/shortened life expectancy (74 vs 80yrs) One of most dangerous cities in the country (Top 10) 10% unemployment (vs 7% in MD- 2013) 12
Our Community: Summary Homelessness Expensive housing Mental illness slightly less than state More illicit drug use Less alcohol use, more alcohol use disorders Children not safe/happy Children use more drugs and earlier 13
Need The top five reasons for hospital admission through the Emergency Department : Psychoses Depression Septicemia (drug-related) Heart failure Alcohol or Drug Abuse 90% of the patients who come to the Bon Secours ED are admitted to the hospital Less than 10% of Bon Secours patients have commercial insurance 14
Need In mid-2015, KPMG (a global tax, audit and advisory firm) analysis of high utilizers with behavioral health co-morbidities: The highest ED utilizers (3 or more visits) constituted over 11% of this population Developed a high utilizer profile 15
High Utilizer Profile African American Male Late 40s Schizophrenia and/or bipolar Medicaid 10 ED Visits a year Inpatient admission: 4 or 5 times a year DAMA: 40% of the time 16
Background: Grant Opportunity Open Society Institute grant opportunity: To support a pilot program for Emergency Department (ED) high utilizers with behavioral health issues To provide personal support through a referral process to Bon Secours and community-based treatment venues that are more appropriate to treating the underlying condition than the ED 17
Background: Grant Opportunity Purpose: To screen high-utilizers in the Bon Secours ED for unidentified biopsychosocial needs for purposes of referral and management To determine if a Peer Recovery Specialist is helpful in engaging and facilitating connections to needed resources To ultimately reduce overutilization of the ED and contribute to positive health outcomes in the SW Baltimore community 18
Approved Budget Peer Recovery Coach Training Mileage Tablets Supplies Screening Tool: BH-Works Staff Training Medication Copays Bus Tokens 19
Intervention Identify Target Population Screening Tool: BHWorks Peer Recovery Specialist ED Diversion 20
Target Patient Population 150 High Utilizers Patients who have had a psychiatric diagnosis and two or more hospital admissions for any reason in a 90-day period 21
BHWorks 100% Web-based & HIPAA Compliant Easy to Use desktops, laptops, tablets, phones Staff and/or Participant Entry Integrates into clinical workflow & EMRs Multi-level reporting (individual, longitudinal, population) All data is stored centrally for easy management/analysis Developed, Validated, & Clinically Tested
Peer Recovery Specialist Provides lived experience support: Fosters supportive peer relationships Direct/indirect recovery experience: Instill a sense of hope and optimism for persons in recovery Engage and serve the consumers enrolled: Contribute to the overall success of the consumer s recovery process Carry out duties with flexibility and an individual focus
Phase I: Internal Referrals Month 1-9 Primary Care Family Health and Wellness Community Works Re-entry Success Clean and Green Program Youth Programs Financial Services Women s Resource Center Behavioral Health Outpatient Mental Health Center Assertive Community Treatment Substance Abuse Treatment Programs 24
Phase II: Internal and External Referrals Month 9-18 External Site Community Works Re-entry Success Clean and Green Program Youth Programs Financial Services Women s Resource Center Primary Care Family Health and Wellness External Site External Site Behavioral Health Outpatient Mental Health Center Assertive Community Treatment Substance Abuse Treatment Programs 25
What does that process look Like?? 26
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Goals Screen 50% of the cohort Enroll 75% of those screened in at least one medical, social and/or behavioral health program to which they were referred 28
Goals Decrease ED utilization for referred individuals by 30% Decrease 30 day hospital readmissions for referred individuals by 30% Decrease 90 day hospital readmissions for referred individuals by 30% 29
Progress to Date 25+ BSHSI Staff trained to use BHWorks tool Screened to Date: 14 individuals since early May Target: 75 patients by October 2018 Identified 7-8 external referral sites to participate in program 30
Lessons Learned Screening Length Identifying needs: Homelessness Expanding BHWorks to other providers Identifying new incentives: Government phones Food subsidies 31
Patient Story: Is Anyone Listening? Patient: African American Male in his 40 s Diagnosis: Cellulitis, substance abuse, homelessness Anxious and aggressive (about situation) Peer Recovery Specialist: Active listening and engagement Patient calmed down and took Universal Screen Healthcare for the Homeless Patient felt heard and is now participating in treatment 32
Patient Story: Is Anyone Listening? Outcomes: Patient hospitalized in the following weeks for below the knee amputation Patient remained not interested in substance abuse treatment Patient felt heard and is now participating in medical treatment Peer Recovery Specialist continues to engage with patient 33
Questions? 34