# Presentation: 015159

## ICC:  Using Information to Link Providers and Patients in a Region

**Paul Gionfriddo         Executive Director**
**HCAP Meeting                January 2004****            **

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## Common Eligibility: 

**Medicaider/Case Tracker**

## Medicaider

- Common Eligibility Tool, Screens for Medical Assistance and Charitable Programs
- In use since August 2002
- 37,179 interviews of uninsured people completed by January 1, 2004
- Current average: 6,000 screens per month
- Average screening time: 3.1 minutes

## Medicaider Process

- Uninsured patient is screened anonymously by provider or service agency at the time of encounter.
- After screening, Medicaid/SCHIP eligible patients are asked to provide name and phone number to receive application assistance.
- Medicaider information is saved in Case Tracker.
- Insure-a-Kid outreach worker logs on to Case Tracker from central location and follows up with patient.

## Uninsured Patients Screened by Age thru 2003

## Eligibility of Uninsured Patients Screened through December 2003

## Impact: Medicaider and Case Tracker

**Since July 1, 2003, ICC members have been reducing the number of uninsured people in Central Texas by over 100 per month using Medicaider and Case Tracker. **

## Safety Net Provider Benefits from Medicaider (Cumulative)

## are

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## I-Care System Structure

- I-Care is a Master Patient Index (MPI) and Clinical Data Repository (CDR).
- ICC contracts with EPIC and Ascension ISD for software and ASP services.
- Electronic interfaces are constructed with existing safety net provider electronic databases to build a shared health record.
- Record includes encounter codes (ICD9, CPT), some pharmacy, and will have lab.
- No duplicate data entry.

## MPI/CDR Status: January 9, 2004

_**251,025 patients**_ in MPI/CDR (93% uninsured).
- 161,907 patients with at least one encounter.
- 29,586 patients with authorizations (18% of those with encounters).
_**491,311 visit encounters**_.
- 43,697 pharmacy encounters.

## MPI: Patient Mapping – System Wide and by Subgroups

**Source: ICC Master Patient Index, 2003**

## CDR 2003:  For What Do Uninsured People Use a System of Care?

- In 2003, The Top 50 Diagnoses Accounted for 57% of all Diagnoses.

- Women’s Reproductive Health, and Chronic Conditions, Dominated the Diagnoses List, with Acute Disease and Child Health Following.

## Flu Patients, Oct/Nov 2003, Seton Topfer Clinic v. Seton NW Hospital

**= Patient Using NW**

**Blue Star**** ****= Patient Using Topfer**

## Medical Home Analysis through November 2003

## CDR: Demonstrating Relationships between Clinic and Hospital Care

## Diabetes:  Documenting the Differing Trends in Diagnoses

## Mental Health: Measuring the Effects of Policy Changes

**2003 Mental Health Diagnoses, All Local Providers**

**State Cuts in MH Funding**

## Using the MPI/CDR To Evaluate Effectiveness of Interventions

**“****It is worth noting that the patient who reported going to the ED eleven times within the past 3 months, had actually ‘only’ been in the ED seven times between April and June 2003, according to the ICC’s MPI/CDR data warehouse.   However, the patient had been seen an additional 9 times since December 2002, for a total of 16 ED visits between December 2002 and June 2003.   This patient was referred into the EMerge program on June 23, 2003 and since that time, has only had one ED visit in August.”  **
- ICC Emerge Evaluation, 10/03

## MPI/CDR: Patient Histories Across Providers

_**Date of Service and Diagnosis:**_			_**Location:**_
**2/12/2003**
**	****780.79-OTHER MALAISE AND FATIGUE****	****SETON NORTHWEST**
**	****789.00-ABDOMINAL PAIN UNSPEC SITE****	****SETON NORTHWEST**
**5/18/2003**
**	****E968.2-ASSAULT-STRIKING W OBJ****	****	****SETON NORTHWEST**
**	****813.43-FX DISTAL ULNA-CLOSED****	****	****SETON NORTHWEST**

**1/14/2003**
**	****305.90-DRUG ABUSE NEC-UNSPEC****	****BRACKENRIDGE**
**	****311-DEPRESSIVE DISORDER NEC****	****BRACKENRIDGE**
**3/22/2003**
**	****305.90-DRUG ABUSE NEC-UNSPEC****	****BRACKENRIDGE**
**	****300.9-NEUROTIC DISORDER NOS****	****	****BRACKENRIDGE**
**	****311-DEPRESSIVE DISORDER NEC****	****BRACKENRIDGE**

## Building a Health Record through Merging Patient Encounters

**3/7/03****	****Contraceptive Management ****	****	****ATCOH**
**7/7/03****	****Abdominal Pain****	****	****	****ATCOH**
**7/10/03****	****Ovarian Cyst****	****	****	****	****Brack**
**7/21/03****	****Abdominal Pain, **
**	****	****	****Contraceptive Management****	****	****ATCOH**
**8/14/03****	****Administrative Encounter ****	****	****Brack**
**8/27/03****	****Ovarian Cyst ****	****	****	****	****SSW**
**9/15/03****	****Contraceptive Management, **
**	****	****	****Ovarian Cyst****	****	****	****	****ATCOH**
**9/23/03****	****Pain in Joint, **
**	****	****	****Abnormality of Gait ****	****	****	****St David’s**
**10/1/03****	****Plica Syndrome, **
**	****	****	****Ankylosis-Lower Leg****	****	****	****SNW**

## Predicting and Altering the Future?...

**12/31/02****	****  355.8 - Mononeuritis Leg NOS****	****	****Brackenridge Hospital**

**1/5/03     729.5 -  Pain in Limb****	****	****	****Brackenridge Hospital**

**1/15/03   355.2 -  Femoral Nerve Lesion****	****	****ATC Manor**

**1/16/03   728.9 -  Muscle/Ligament Dis NOS****	****Brackenridge Hospital**
**	**** ****719.70- Difficult Walk NOS****	**
**	**** ****355.9 -  Mononeuritis**

**2/14/03****	**** 355.9 -  Mononeuritis****	****	****	****ATC Manor**

**4/18/03****	**** 729.5 -  Pain in Limb****	****	****	****ATC Manor**

**4/30/03****	**** 977.8 -  Poisoning-Medicinal ****	****	****Brackenridge Hospital**
**	**** ****305.90- Drug Abuse NEC-Unspec****	**

**5/13/03   975.2 -   Poisoning-Skelet Muscle****	****	****Seton Medical Center**
**	**** ****E950.4- Suicide – Drug/Med NEC****	**

**...****..As of 2/2003, also an ATCMHMR Center Patient**

## MPI/CDR: What We’ve Learned

- Focus equally on technical, legal, and business operations.
- Don’t require duplicate data entry.
- It takes time and money to build clinical data repositories – but they can be built quickly.
- The system data are only as good as the data that are sent (maybe a little better).
- The system should have in it something useful (i.e., something they’ll pay for) for the customers who will eventually pay.