Grant will link
frequent ER users to physicians
PRESQUE ISLE — A $193,642 grant will allow The Aroostook Medical Center to start a new program aimed at driving down the number of Aroostook County residents who are frequent users of the emergency department.
The funding, from the Maine Health Access Foundation, will establish the Northern Maine Advanced Medical Home Collaborative. The initiative will identify, screen and enroll high cost patients who do not have a primary care physician (PCP) or are not engaged with a PCP and connect them with TAMC’s Family Practice and Internal Medicine.
“A significant number of folks in our community use the emergency department as their primary source of health care. This is clearly not in their best interest from a quality of care standpoint and/or cost utilization point of view,” said Dr. David Weed, who serves as the program’s medical director. “In the long run, these folks will be better served if they have an ongoing relationship with one of our primary care providers.”
According to Weed, the grant will enhance efforts already under way at TAMC which, through EMHS, is among 32 pioneer accountable care organizations (ACO) in the nation. That program is intended to improve the coordination, efficiency, effectiveness, quality and cost of health care.
While ACOs look to improve the care delivered to Medicare patients, the model is transforming the overall health care delivery system. Currently within EMHS, approximately 8,000 people, including nearly 3,000 Aroostook County residents, are participating. These people receive Medicare benefits and see primary care providers who are participating.
“We at TAMC have been working diligently to try to improve communication between our primary care providers and the emergency department, so as to minimize the repetitive and expensive use of our emergency department by members of our community,” said Weed. “We also continue to try to educate our patient population that utilizing the emergency department for their primary source of care is not in their best interest in either the short or long run. Lastly, we are working diligently to improve access to our primary care providers. This grant will help continue these efforts.”
According to the 2010 OneMaine Health Community Health Needs Assessment study, several indicators in Aroostook County point to a need for such a program. Emergency department visits are 68,196 per 100,000 residents compared to 47,665 statewide. Admission for patients with ambulatory care sensitive conditions, an accepted measure of access to appropriate primary care, are 1,510 per 100,000 residents compared to 967 statewide.
Aroostook County also has higher numbers than the state when it comes to individuals who cite they have no “usual source of care.” According to the OneMaine Health study, 20 percent of men and 9.1 percent of women in The County say they have no “usual source of care” compared to 18 and 8.3 percent, respectively, statewide.
The Northern Maine Advanced Medical Home Collaborative will prioritize engagement of individuals who have had multiple hospital admissions and those who have frequently utilized the emergency department with three or more admissions/visits in six months or five or more admissions/visits in 12 months.
The two primary objectives of the project are to develop an engaged provider/patient/community partnership to support current and future work at TAMC with the ACO development and to reduce emergency department and walk-in care utilization rates, and hospital admissions by patients with no PCP or limited primary care engagement, regardless of insurance coverage.
“It is our intention to establish a community-wide program which addresses the issue of high usage of the emergency department and walk-in clinic by patients without a primary care provider,” said Dottie Wheeler, director of primary care and the Patient Centered Medical Home at TAMC. “We will employ a medical home transition coordinator who will work closely with our transition of care coordination team to assist patients in establishing with a PCP. This person will also help direct patients to resources available through community based organization.”
The program will also incorporate a behavioral health component. When the medical home transition coordinator helps identify a provider, the staff will assess behavioral health needs and support the patient as needed. TAMC currently has a part-time social worker providing care at its North Street Healthcare facility and is working with Acadia Hospital in Bangor to establish a telepsych connection.
The TAMC grant is the only such award to a northern Maine health care organization and one of 11 awarded to Maine non-profits dedicated to overhauling health care delivery and payment approaches that reduce costs, maximize value, and deliver better health to Maine people.
“Maine is a nationally recognized leader in advancing new strategies to pay for health care delivery. We are pleased to continue our support for innovative Maine-based strategies that can improve quality while controlling costs,” said Dr. Wendy J. Wolf, MeHAF’s president and chief executive officer. “As Maine moves forward with implementation of the Affordable Care Act, controlling costs in ways that work for Maine people, businesses and health care systems, such as this innovative project at TAMC, will be critical.”
