Return on Community Investment (ROCI):
A High Impact Institute

Pre-Conference Data Collection
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Return on Community Investment Survey Responses

Respondent Name:

Anita Lee

E-Mail Address:

alee3seung@aol.com

Organization Name:

New York Presbyterian Hospital

Phone:

(914) 793-5524   Ext.

Fax:

(914) 793-5524

Address:

622 West 168 Street   room PH 1-46

City, State, Zip:

New York, NY    10032
Category: Your Community

What is the service area of your initiative (counties, city, etc.)?

Northern Manhattan and South Bronx

What is the total population in your service area?

1.8 million

What percentage of the total population lives below the federal poverty level?

30%

What percentage of the total population is uninsured?

25%
Category: Your Program Initiative

Indicate which of the following categories your initiative falls in:

Outreach and navigation
Securing public and private insurance coverage
Primary care capacity and access
Emergency room usage reduction
Case management of chronic disease
Access to affordable pharmaceuticals

Describe the purpose of your initiative (in one sentence, if possible):

We provide insurance enrollment, care coordination, case/disease management, connecting to medical home, and pharmaceutical access of uninsured clients in the community and in the emergency room.

Describe the scale of your initiative in terms of budget, capacity, etc.:

Annual budget of $1, 200, 000.

Describe the operational components of your initiative:

Facilitate enrollment program, referral center, pharmacy assistance program, diabetes management program, and C.A.R.E. Program.

Describe your initiative's staffing level:

One director, two care coordinators, one case manager, two program coordinators, 1 pharmacy community liaison, 6 outreach workers.

If applicable, please describe your strategic use of an information system:

Identify patient who visited the emergency department three or more times in the past six months. MIS is an event monitor that has a broad capability of “finding” patients who meet any defined criteria.

Please list the major, time-framed, measurable objectives your initiative is designed to achieve:

1) to reduce emergency room utilization of individuals who used the ED for preventable, non-urgent, primary care treatable conditions, 2) improve target population’s knowledge in navigating the health care system 3) eliminate the access barriers by targeting case management
Category: Measurable Results

Which of the following results can be attributed to your program initiative? Please check all that apply.

Coordinated System of Care Savings
Reduction of ER usage for non-urgent care
Savings from operational improvements within integrated system
Qualifying people for government subsidized programs
Increasing awareness of programs and services
Pharmaceuticals acquired on behalf of clients
Increased reimbursements
Improved health status
Improved productivity
Social justice implications
Increased attendance at work
Increased attendance at school

Please list any other actual, measurable results of your initiative:

: 82% reduction in 3 months, 92% reduction in ED utilization in 6 months, and 95% reduction in ED utilization in 9 months. Increase in primary care and specialty care access, increase in referral for insurance enrollment.
Category: Your ROCI Strategy

How do you define ROCI?

The ability to demonstrate that the combination of benefit to society, public health, and the bottom line of the health care entity and health care systems exceeded the cost of the intervention.

Describe your ROCI objectives and strategy:

The program intervention should be able to impact on a critical mass of individuals that can potentially use a lot of health care resources. The ROCI strategy is to demonstrate reduction of health care expenditure and improvement in the quality of life in a quantifiable way such as reducing sick days. The strategy is to educate patient in how to navigate the system, eliminate life stressors and access barriers, and facilitate and coordinate services so that appropriate intervention and disease management is provided promptly.

Describe the players involved in the ROCI conversation (by title and/or function):

New York Presbyterian Hospital, Community Premier Plus (a Medicaid managed care plan) and New York Presbyterian Community Health Plan (a Medicaid Managed care plan)

List the milestones in your ROCI strategy that pertain to deal making (a prospective approach):

Reduction in recidivism

List the milestones in your ROCI strategy that are tied to outcomes (a retrospective approach):

Identify new applications for the technology and the skills that were we acquired, this lead to the discussion with HMOs.

List the milestones in your ROCI strategy that are linked to sustainability:

Hospital invested in sustaining the program because of the reduction in Ed visits. Managed care organizations interested in contracting with the program to streamline their case management process.
Category: Your ROCI Methodology

Describe the analytic or economic logic underlying your ROCI method:

In a community with a continuous influx of immigrants, there is a continuous need to provide assistance and support for underserved residents in linking them to services and navigating the system. By reaching out to patients who used the emergency room as a primary care source and diverting them a more appropriate setting saves health care dollars and reduces bad debt. The social benefit is more sustaining, by linking patients to a medical home and offering support in accessing other services such as insurance, pharmaceuticals, and disease management will ultimately produce a healthier community.

Is your method supported by scientific research? If yes, please describe:

No, there are certain conclusions that can be drawn from reduction of recidivism, which is based on scientific research.

Describe the measures that you used to define "returns" or value:

The measure of value to the community is more informed health care consumers and the result of a more practical and compassionate health care system that supports better quality of life and health status. The measure of value to the health care system is cost savings. The measure of value to the hospital is improve efficiency

Describe the measures that you used to define investments or costs:

The cost of maintaining the program includes staff salary and maintaining the technology.

Please briefly describe your data collection methods.

The access database captures patient demographics, before and after intervention utilization pattern, identified barriers, and interventions.
Category: ROCI Communication and Negotiation

Describe the conversations that define your ROCI process:

Discussion surrounds the challenges of the emergency room staff, providers and managed care organizations, the barriers expressed by the patients, the surveillance information and recommendation provided by the Health Priority Specialist. The conversations were reconnaissance in nature.

Describe how ROCI conversations are tailored to specific audiences:

The scope, the capability, and the reach of the program has expanded significantly as it evolves to tailored to the needs of the consumers (payer and patients)

Describe what enabled effective conversations to occur:

Presentation of data that directly responded to something that is important to the stakeholders, such as financial bottom line, image, effectiveness, and regulatory compliance.
Category: Results from the ROCI Process

Describe the outcomes, the successes of your ROCI strategy:

After implementing the program for over two years, the interventions provided by the Health Priority Specialists seems to be effective for at least 9 months post intervention. The reduction of ED utilization of the patients who have received intervention was 83% after 3 months, 95% after six months, and 97% after 9 months. The success story is that the Hospital recognizes the benefit of such a program in improving ED efficiency, increasing revenue, and positive image. It has continued to fund the program.
Category: Lessons

What do you see as the critical success factors that can guide others?

The understanding of what is important to the stakeholder and tailor the outcome to respond to their problem is a critical success factor. The other is to continue to explore new opportunities and new capabilities to address the next challenge that your stakeholder will have.

Do you believe that your results can be replicated successfully with other similar initiatives? Can you suggest how replication may be facilitated?

Yes, the model is very replicable. Replication can be facilitated by using an existing algorithm to assess the type of services are routinely provided in the emergency room. In other words, assess the cost of operating the ED and what kind of visits use the most resources.
Category: Share Your Resources

Resource Files you've shared with us:

Health Priority Survey Form.doc