Neighbors Caring for Neighbors Clinic

ObjectivesObjectives

1.

2.

NCNC General InformationNCNC General Information The Neighbors Caring for Neighbors

Clinics are Nurse Practitioner run clinics providing needed medical care to low income persons who are without insurance.

This model of a free clinic, in which the staff is hired, provides continuity of care for the patient enabling better health outcomes.

 

  

The mission of the Neighbors Caring for Neighbors Clinic (NCN Clinic) is to provide primary health care services to persons who are of low income, without insurance or underinsured and reside in Macomb County. This is done with respect and loving embracing care for each person at each encounter.

Neighbors Caring for Neighbors Clinic

BackgroundBackground• Opened February 4, 1998Opened February 4, 1998 through a

3 Year Emily George (Sisters of Mercy) Grant

• June 1998June 1998; Second site added in Romeo (Now Washington Township) through a

4 County Foundation Grant

• July 2000July 2000 operations fully funded by St. Joseph’s Mercy Hospital (Henry Ford Macomb Hospitals)

Service FeaturesService Features• Continuity of Care

• Eligibility:

>Uninsured persons of all ages

>Macomb County residents

>Household income less than

$30,000

• 3 Days per week – Mt. Clemens

• 1 Day per week -- Washington

• 2 Days per week -- Warren

UNIQUE PATIENTS COMPARISON BY AGE2001-2004: 3935 2005-2008: 4639

0

500

1000

1500

2000

2500

0-19 20-30 30-50 51-64 65+

AGES

NU

MB

ER

S O

F P

ATI

EN

TS

2001-2004

2005-2008

Income Range at First Visit

0

200

400

600

800

1000

1200

$0.00 $1.00 -5,000

$5,001-10,000

$10,001-15,000

$15,001 -20,000

$20,001 -30,000

Income Ranges

Num

ber o

f Pat

ient

s

2002-2005

2006-2008

 

Total patients served since the Clinics openedIn 1998

Mt. Clemens – 12,600 Active: about 1,860 Washington - 3,065 ***************************************************************  Generally about 33 new patients per week

  ******************************************************** Total Visits: Mt. Clemens + Washington Twp. 2008 January to June: 2710 2009 January to June: 3338

STATISTICS

Types of ServicesTypes of ServicesIn Collaboration with Assigned Medical

DirectorFamily and Adult Nurse Practitioners provide

the following medical and nursing care:• Management of acute and chronic

medical problems• Well person, employment and school

physicals• Education on diseases and healthy

living

0% 5% 10% 15% 20%

1

TOBACCO ABUSE

STD

RESPIRATORY

OBESITY

NEUROLOGICAL

MUSCULOSKELETAL

MENTAL/EMOTIONAL

HYPERLIPIDEMIA

HTN

HEALTH MAINTENANCE

GI

ENDOCRINE

DIABETES

CARDIOVASCULAR

ADDICTION

ACUITE ILLNESS

ALL DIAGNOSES by %1998-2008 NEIGHBORS CARING FOR NEIGHBORS CLINIC

Clinic Visits by Diagnoses 2006-2008

0 500 1000 1500 2000 2500 3000 3500 4000

1

Dia

gnos

es

Visits

TOBACCO ABUSE

STD

RESPIRATORY

NEUROLOGICAL

MUSCULOSKELETAL

HTN

HEALTH MAINTENANCE

GY/GYN

GI

ENDOCRINE

DIABETES

CARDIOVASCULAR

ADDICTION

ACUITE ILLNESS

IMPACT ON CHRONIC DISEASES PERCENT IMPROVEMENT OVER ONE YEAR

249

98

72

288

263

131

0

50

100

150

200

250

300

350

BLOOD PRESSURE 45.4%

WEIGHT 39.7% SMOKING 27.3%

NU

MB

ER O

F PA

TIEN

TS

TOTAL NUMBER

NUMBERIMPROVED

Outcomes From the Outcomes From the Diabetic ProjectDiabetic Project

Changes in Hgb A1c %96 Patients had two or more Hgb A1c tests done in

2008 showing an average drop of 1.4%

40 Patients (42%) lowered their A1c to less than 7%

47 Patients (49% lowered their A1c by 1% or more

NCN Clinic Cost Savings ToolNCN Clinic Cost Savings Tool

Piloted 2006-2007 Revised to meet Clinic

Needs CY 2008

$892,880.00$892,880.00

Neighbors Caring for Neighbors Clinics for the Uninsured

The Process of Cost Savings The Process of Cost Savings and Avoidance Measurementand Avoidance Measurement

1. NP completes Daily Sheet makes judgment re: CS/A

2. Daily Sheets entered into EXCEL spreadsheet quarterly

3. Data reviewed and reported for HFHS Community Pillar report card and to other interested

NEIGHBORS CLINIC DAILY SHEET

PT#__________ DATE:________ TIME IN_________APT:________ ADD ON:_______ WALKIN:________PROVIDER: Anne____ Denise______ Jean _____ Val___ Nadine____Suzanne:___ Dr Naughton____ Other_______ ER since last clinic visit? Yes____ NO____

TODAY’S PROBLEMS IF NEW1Dx______________________________Category

2Dx______________________________Category

3Dx______________________________Category

4Dx______________________________Category

LEVEL: A_ B_ C_ REFERRED TO:____________________

_____ER AVOIDED ____HOSPITALIZATION AVOIDED

OTHER DIAGNOSIS ADDRESSED TODAY

*** CIRCLE PRIMARY DIAGNOSIS***ACUTE ILLNESSADDICTIONCARDIOVASCULARCHFDENTALDERMATITISDIABETES: 1ST A1C_____ LAST_____EMPLOYMENT PEENDOCRINE 1ST TSH____LAST___ENTENVIRON. ALLERGIESGU/GYNGIHEALTH MAINTENANCEHEMATOLOGY

HEPATITIS: A__B__C__HTN:1ST__ _ ____STAGE_____ LAST_ ______STAGE_____HYPERLIPIDEMIAMENTAL EMOTIONALMUSCULOSKELETALNEUROLOGICALPVDOBESITY:1st_____LAST______OTHERRESPIRATORY: TX_________SCHOOL PESTDTOBACCO ABUSE 1ST_______ LAST_______TRAUMAED:_______________________

$892,880$892,880

Individual Diagnostic Group WorksheetsWorksheets were created for each Primary Diagnosis. It is on these worksheets that individual cost savings outcome data will be inserted. Below is a sample view of the worksheet tabs at the bottom of the spreadsheet. Each tab represents a different primary diagnosis. In EXCEL, each TAB (summary, ADD, CAR, DEN…) is a worksheet. Data is only entered on the worksheets, NOT the summary sheet. 

REPLACE

SUMARRY CHA ADD CAR DEN DIAB END ENT GI GYN

Insert Tab Sheet - HTN

Insert Tab Sheet - Diabetes

NCNC AVOIDED CASES BY TYPE CY 2008

2%

0%

6%

92%

0%

AVOIDED IP CASES N=93 AVOIDED Therapy N=5ER VISIT N=277 Physician Office Visit N=4481Avoided Medication N=5

NCNC Cost Savings/Avoidance Dollars CY 2008

$340

$300

$113,570

$313,670

$465,000

AVOIDED IP CASES N=93 AVOIDED Therapy N=5 ER VISIT N=277

Physician Office Visit N=4481 Avoided Medication N=5

$-

$50,000.00

$100,000.00

$150,000.00

$200,000.00

$250,000.00

$300,000.00

$350,000.00

AvoidedHospitalization

ER Visits Physician office visit Total Savings

Cost Avoidance/Savings CY 2008 by Quater

1st

2nd

3rd

Total Savings: $737,590

62 10 11

163 34 38

1274

878 1080

0

200

400

600

800

1000

1200

1400

Avoided Hospitalization ER Visit Physician office visit

Cases Avoided for Other Services CY 2008 by Quarter

1st

2nd

3rd

Total: 83

Total: 235

Total: 3232

• Calculation of Cost Benefit -- NCNC Calculation of Cost Benefit -- NCNC CY 2008 Benefit: $1 Community Benefit Dollar to $2.5 Cost Avoidance to Community!

• Recruitment of Community PartnersRecruitment of Community Partners

•Reporting of Community Benefit contacts and Reporting of Community Benefit contacts and dollarsdollars

•Justification of philanthropy and operation dollarsJustification of philanthropy and operation dollars

•Evidence of benefit of clinics to community and Evidence of benefit of clinics to community and health systemshealth systems

USES OF COST SAVINGS/AVOIDANCE DATA

Hospital System of Choice DataShould be collected and shared!

• Demonstrates who (which system) clients view as their source of support

• Helpful to request support/ collaboration and partnerships for clinics

• Demonstrates where clients are likely to go for hospitalization

Thank You!

Questions?