Using Data Analytics to Reduce Potentially Avoidable Emergency Department Utilization

Esperanza Health Centers is one of nine Chicago-area FQHCs and three health systems that owns the Medical Home Network (MHN), an accountable care organization with approximately 120,000 Medicaid members. MHN has a shared risk contractual arrangement for managing total cost of care. The health plan delegates complete care management responsibility to MHN which is performed by FQHC and other practice employed staff at the care team level. MHN care managers perform complete health risk assessments, create individualized care plans, and follow up on those care plans for moderate- and high-risk members, a subset of who are individuals who have made three or more emergency department (ED) visits in the previous six months. MHN receives admission, discharge, and transfer (ADT) alerts from 25 area hospitals so care managers are alerted as soon as their members register in the ED. MHN’s IT department combines those ADT alerts with complete medical and pharmacy claims data to create reports that can be used to provide insight and improve patient outcomes.