Deonza Thymes, MD was most recently an Emergency Medicine physician at Veterans Administration Hospital in Long Beach, CA. She is a co-founder and Vice President of Programs for Artemis Medical Society, a group of over 3,500 women physicians of color whose mission is to change healthcare by increasing physician diversity and diminishing healthcare disparities. Dr. Thymes not only serves as healthcare provider but a community leader, mentor, and role model. Before attending medical school, Dr. Thymes was a seventh and eighth grade math and science teacher at Foshay Learning Center in Los Angeles, CA. Dr. Thymes received her medical degree from Ohio State University College of Medicine, Columbus, OH and completed her emergency medicine residency at Martin Luther King, Jr. Drew Medical Center, Los Angeles, CA in 2006.
Deonza Thymes, MD, MPH
Emergency Medicine Specialist, Hollywood, CA
Design of a Pilot Care Coordination Model for Frequent Utilizers of the Emergency Department
Objective:
The objective of this project was to devise a protocol for coordinating care of high utilization emergency department patients using an innovative model focused on shifting patients from Medicaid to Commercial Insurance plans in an effort to increase access to care.
Background:
Frequent utilizers represent 5% of the Medicaid population. This 5% drives over 50% of Medicaid spending. These patients are more likely to overuse expensive medical services such as the Emergency Department and inpatient hospitalizations. Frequent utilizers tend to have a significant burden of disease and high illness acuity leading to urgent reasons for presentation to the ED. Unfortunately, the frequent utilizer population often has a complex mix of behavioral, medical and social needs that is not well managed by the current fragmented health care system. There are also issues of access to appropriate specialists. Medicaid patients have decreased access to specialty care when compared to privately insured patients. This is partly due to the preference of many specialists to accept commercial insurance versus Medicaid. Under the ACA, there is latitude for health systems to provide premium assistance to transition Medicaid patients with chronic conditions to commercial insurance. This is a tool to increase access to care and to improve outcomes for patients with high burden of chronic disease. Care coordination has been shown to decrease ED utilization and to improve management for complex patients.
Methods:
A review of literature was conducted related to frequent utilizers of the Emergency Department as well as care coordination models currently in practice. I interviewed executives and program directors at Centura to assess current resources and methods. I also interviewed emergency department directors to gain further insight into needs of their specific patient population.
Results:
My deliverable is a strategic document outlining components of a pilot program using a care coordination model for the newly commercially insured as a method to decrease ER utilization, hospitalization and increase linkage to community resources.
Future Direction:
It is our goal that this pilot intervention achieves the following:
1. Provides premium assistance to allow a shift of Medicaid patients to commercial insurance
2. Increases access to care through utilization of the care coordination program
3. Provides patients with support in navigating the health care system and social resources leading to a decrease in ED utilization and improved health outcomes
If successful, the pilot will be initiated throughout the Centura Health System.
Project Preceptor:
Preceptor: James Corbett, MDiv, JD
Assistant Preceptor: Catherine Bader, MPH
Others involved in project: Eliza Lanman, Executive Director of HealthSET
and Director of Centura Health LINKS and Nicole King, Community Health Manager
Sponsoring Agency:
Centura Health System in Denver
