Reports Cites Importance of Coordinated Care in Hospitalizations, ER Use

Interesting story from Crain's New York's Health Pulse look at New Yorker's with developmental disabilities use of the emergency room and hospitalizations. As we move toward Medicaid Managed Points out the importance of coordinating care, especially having a discharge plan, before a person returns to his/her home. Pasting below because it requires a subscription.

A new report examines data on hospital and emergency department use among the developmentally disabled in New York state—a group that is relatively small but costly to the health system. The report, prepared by Welsh Analytics using 2013 SPARCS data and edited by the ArthurWebbGroup, documents how such special populations compare with general patients in their inpatient and emergency department utilization.

About 1.6% of inpatient hospitalizations involved a person with developmental disabilities, excluding epilepsy. Conditions include intellectual disabilities, cerebral palsy and autism-spectrum disorders.

The developmentally disabled population will be one of the last in the state to be enrolled in managed care when individuals begin to voluntarily enroll in October 2015. Health consultant Arthur Webb said he believes the report, online here, offers guidance to hospitals and policymakers on how to reduce unnecessary inpatient and ED visits.

“Unlike behavioral health, this is a population small enough that you can get your hands around it,” he said. “It lends itself to some real improvements.”

The developmentally disabled are more than twice as likely to be admitted to the hospital from the ED. Medicare or Medicaid was the primary payer for 80% of hospital visits, while dual eligibles accounted for 27.4% of inpatient discharges in the state.

Coordinating care between hospitals and the community-based providers who care for the developmentally disabled is key; only in about one-fifth of cases do these patients have a formal plan for home care, the report found.

“That shouldn’t happen,” Mr. Webb said. “Making sure there is a plan for discharge is a major area with room for improvement.”

In New York City, 1.4% of inpatient stays involved a person with developmental disabilities. That translates into about 14,000 inpatient discharges and 13,000 outpatient ED visits for that population.

The report identified the Rockaways, the Bronx, eastern Brooklyn and northern Staten Island as neighborhoods that showed “somewhat higher” rates of inpatient admissions for developmentally disabled residents.

“We can reach into these communities and see if we can’t improve the plan of care and improve their access to primary care,” said Mr. Webb. “It really lends itself to some very proactive approaches to managing care.”