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A large number of the beneficiaries present multiple complex chronic health conditions with a high coexistence of mental health conditions making the coordination of care more complex and inefficient.
Visibility into centralized accountable care organization (ACO) data across AICNY’s network from its population health vendor, HealthEC, revealed extraordinarily high emergency department utilization rates among the organization’s IDD patients living in certified residences. A substantial portion of that ED use was unnecessary or avoidable, but also had a high correlation to inpatient admissions.
“What we found is the doctors who were on-call after hours were covering IDD patients living in residences were family practice doctors who only had access to limited information on the present issue and thus struggled to triage patient care more effectively,” said Duane Schielke, executive director of the Alliance for Integrated Care of New York. “It resulted in high ER utilization which was also associated with limited access to alternative clinical support resources after hours and on weekends as many urgent care centers do not accept Medicaid.”