Santa Cruz CountyProject Connect

Measuring Cross-System Outcomes for Enrolled Frequent Users -

Methods and Findings to Date 9/28/2006

Outcomes Measured

Post-enrollment change in service utilization for the following settings/services: 2 Hospital Emergency Departments

Change in number of ED visits and related charges

2 Hospital Inpatient UnitsChange in number of admissions, and

number of inpatient days and related charges

Outcomes Measured

1 Hospital Inpatient Behavioral Health UnitChange in number of inpatient days and

related charges

Ambulance Services (County served by one ambulance company)Change in number of transports

County Detention ServicesChange in number of jail bookings and

number of days incarcerated

Outcomes Measured

Also measuring: Changes in housing status:

Counting number of enrolled individuals entering permanent housing

Changes in benefits status: Counting number of enrolled individuals

qualifying for Soc. Sec. Disability benefits with a new link to Medi-Cal

Methodology

Collect data on service utilization for each enrolled client from each setting/service for the 12-month period prior to enrollment

Collect post-enrollment service utilization data from each source at 3-month intervals

Methodology

Compare 12-month pre-enrollment service utilization (averages for cohort) to: Annualized post-enrollment service

utilization for cohort of all enrolled Post-enrollment 12-month service

utilization for 2 smaller cohorts: 1) those who have been enrolled at least 12-

months, and 2) those who have been enrolled at least 24-

months

Methodology

Data Collection Methods: Hospitals: We provide medical record

numbers for each enrolled client back to hospitals and they provide us an updated data base with post-enrollment visits and admissions

Ambulance: County EMS program supports ambulance service data base that we are able to access directly

Methodology

Jail Data: Health Services Agency is provided access to jail data base for relevant time periods

Annualizing: Example: Total potential days pre-enrollment year = 365 Total post enrollment days for cohort = 455 365/455=.80 Post-enrollment ambulance transports 466 x 365/455= 374 Compare 836 transports during 12 mo. Pre-enrollment to 374

transports (annualized) post-enrollment = 55% reduction

Methodology

Charges and Cost: An average charge-to-cost ratio across 2

hospitals was calculated Spring ‘06. Ratio is used to convert charges to estimated cost

An average cost per booking and jail day was provided by the Sheriff

Charges for ambulance services are based on cost and an average pt. Charge is calculated by AMR each month

Findings to Date

Last data analysis completed includes service utilization through June 30, 2006

N = 86 individuals enrolled

51% FEWER JAIL BOOKINGS/COST REDUCTION

J ail Booking Fees One Year Prior and Since Enrollment (annualized) N = 86

$29,273

$14,465

$-

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

Prior Year Since Enrollment

J ail Bookings One Year Prior and Since Enrollment (annualized) N = 86

277

137

0

50

100

150

200

250

300

Prior Year Since Enrollment

12

37% DECREASE IN JAIL DAYS/HOUSING COSTS

Prior YearSince

Enrollment

2,307

1,454

0

500

1,000

1,500

2,000

2,500

J ail Days One Year Prior and Since Enrollment (annualized) N = 86

Prior YearSince

Enrollment

$176,347

$111,171

$-

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

$160,000

$180,000

J ail Housing Costs One Year Prior and Since Enrollment (annualized) N = 86

55% DECREASE IN AMBULANCE RUNS

Ambulance Runs in the Year Prior to and Since Enrollment

(annualized) N = 86

836

373

0

100

200

300

400

500

600

700

800

900

Prior Year Since Enrollment

DECREASES OF 56% AND 37% IN NUMBER OF ED VISITS AT RESPECTIVE HOSPITALS

ED Visits One Year Prior and Since Enrollment (annualized) N = 86

423395

184

248

0

50

100

150

200

250

300

350

400

450

Dominican Watsonville

Prior Year Since Enrollment

51% AND 47% DECREASE IN HOSPITAL INPATIENT DAYS

AT RESPECTIVE HOSPITALSI nPatient Days One Year Prior and Since Enrollment

(annualized) N = 86

395

184192

97

0

50

100

150

200

250

300

350

400

450

Dominican Watsonville

Prior Year Since Enrollment

TOTAL ANNUAL REDUCTION IN INPATIENT CHARGESDOMINICAN: $1,310,512 WATSONVILLE: $1,471,050

46% AND 52% REDUCTION IN INPATIENT CHARGES AT RESPECTIVE HOSPITALS

I nPatient Charges One Year Prior and Since Enrollment (annualized) N = 86

$2,876,893 $2,808,247

$1,566,381

$1,337,197

$-

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

$3,500,000

Dominican Watsonville

Prior Year Since Enrollment

Example of Different MethodologyPresenting ED Visit Data

Number of ED VisitsOne Year Pre and One Year Post

N = 64

635

326

0

100

200

300

400

500

600

700

PreEnrollment PostEnrollment

Number of ED VisitsOne Year Pre and Second Year Post

N = 39

344

147

0

50

100

150

200

250

300

350

400

PreEnrollment PostEnrollment

Clients enrolled at least 12 months

Compare 1 year pre to 1st year post

Clients enrolled at least 24 months

Compare 1 year pre to 2nd year post

Project ConnectEstimating Costs from Charges at 2 HospitalsTotal Cost Reduction as of March 2006

InpatientTotal Costs Prior and Since $1,561,238Total Days Prior and Since 753Cost/Day $2076

InpatientTotal Days Prior 469Total Days Since 283Reduction: 186

InpatientCost/Day $2076x 186 Days =

$386,136

EDTotal Costs Prior and Since$400,864Total Visits Prior and Since 946Cost/Visit $424

EDTotal Visits Prior 634Total Visits Since 312Reduction: 322

EDCost/Visit $424x 322 Visits =

$136,528

Intensive Service Model for Frequent Users Requires a Bigger Investment, but Produces Significant Annual Savings

Service Average Annual CostPer FU Client Pre-Enrollment

Average Annual CostPer FU Client Post-Enrollment

Annual CostAvoided PerFU Client

Jail Booking $357 $164 $193

Jail Housing $2,243 $673 $1,570

AmbulanceTransport

$4,031 $2,288 $1,743

Hospital EDVisits

$4,237 $1,895 $2,342

HospitalInpatient Days

$12,963 $6,741 $6,222

Annual Total PerClient

$23,831 $11,767 $12,070

Annual Totalfor 78 Clients

$1,858,818 $917,826 $940,992