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
- Establish ED care triage program for at-risk populations
- Participating EDs will establish partnerships to community primary care providers with an emphasis on those that are PCMHs and have open access scheduling.
- Achieve NCQA 2014 Level 3 Medical Home standards or NYS Advanced Primary Care Model standards by the end of DSRIP Year 3.
- Develop process and procedures to establish connectivity between the emergency department and community primary care providers.
- Ensure real time notification to a Health Home care manager as applicable
- For patients presenting with minor illnesses who do not have a primary care provider:
- 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.
- Patient navigator will assist the patient with identifying and accessing needed community support resources.
- Patient navigator will assist the member in receiving a timely appointment with that provider’s office (for patients with a primary care provider).
- 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.)
- 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.