Emergency Department Care Triage (Project 2.b.iii)

What do we hope to accomplish?

  • Reduce avoidable emergency department use by connecting patients to primary care and addressing the educational and cultural drivers of emergency department utilization

Who is our target population?

  • Patients presenting at the emergency department who would benefit from follow-up with primary care, specialty care and other outpatient specialty services

How will we do it?

  • Implement Patient Navigators in five Emergency Departments
  • Integrate culturally competent Patient Navigators into five NYP emergency department care teams who will ensure that obstacles to patient adherence are addressed and follow-up care is initiated. Activities include:
    • Meeting with high-risk patients to understand their issues with access to care and educating them regarding how best to utilize the health care system
    • Sharing updates with the health care team to inform the health care plan
    • Scheduling patients for primary care/specialty medical appointments through open access scheduling
    • Linking patients to financial assistance or other social services
    • Providing appointment reminders
    • Conducting post-appointment follow-up calls 
    • Matching patients without regular primary care providers to local Patient Centered Medical Homes within the Performing Provider System
    • Making referrals to Community Healthcare Workers, Social Workers and Care Managers to address complex, multidisciplinary medical needs

NY State Requirements

  1. Establish ED care triage program for at-risk populations
  2. Participating EDs will establish partnerships to community primary care providers with an emphasis on those that are PCMHs and have open access scheduling.
    1. Achieve NCQA 2014 Level 3 Medical Home standards or NYS Advanced Primary Care Model standards by the end of DSRIP Year 3.
    2. Develop process and procedures to establish connectivity between the emergency department and community primary care providers.
    3. Ensure real time notification to a Health Home care manager as applicable
  3. For patients presenting with minor illnesses who do not have a primary care provider:
    1. Patient navigators will assist the presenting patient to receive an immediate appointment with a primary care provider, after required medical screening examination, to validate a non-emergency need.
    2. Patient navigator will assist the patient with identifying and accessing needed community support resources.
    3. Patient navigator will assist the member in receiving a timely appointment with that provider’s office (for patients with a primary care provider).
  4. Established protocols allowing ED and first responders - under supervision of the ED practitioners - to transport patients with non- acute disorders to alternate care sites including the PCMH to receive more appropriate level of care. (This requirement is optional.)
  5. Use EHRs and other technical platforms to track all patients engaged in the project.

Scale and Speed

Metric: The number of participating patients presented at the ED and appropriately referred for medical screening examination and successfully redirected to PCP as demonstrated by a connection with their Health Home care manager or a scheduled appointment within 4 weeks of ED discharge.

Commitment: At the completion of Year 3, ED Care Triage will schedule follow-up appointments for 21,497 Medicaid beneficiaries annually.