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Expert Question: In terms of viability, would be interested to learn ideas to manage financial needs (while waiting for Medicaid) and plans to scale up?

In negotiation with the three local hospital partners, the hospitals agreed to pay 80% of the budget for medical respite for the first year. This includes all financial support for start-up fees associated with equipment and staffing costs for Catholic Charities’ Medical Respite program.  The contributing hospitals will meet with Catholic Charities to discuss criteria and measures that will be monitored during the first year to determine future year’s contributions and funding approaches.  Year 2 of operations will begin in January 2018. 

Currently, Catholic Charities is planning conversations with accounting to develop models where referral sources would be billed for services provided by Catholic Charities' medical resptie program.  The focus of this exercise is to determine the price to be billed per bed based on negotiations with hospitals to maintain covererage of 80% of costs or if reductions will be in place for future years.   We are able to generate some revenue for our behavior health services, but that revenue covers only a small percentage of our costs. Until Medicaid funding is secured, we need to continue to demonstrate the value of the program to raise funds.

Early in the program design of Catholic Charities' medical respite program, it was dertermined that there needed to be a governing body that managed the direction and outcomes of the program. The role of the  Medical Respite Steering Committee is to determine and maintain funding streams for the program, as well as determine best practices for the medical respite health care model. The steering committee is composed of health care leaders in the community, including representatives from the three hospital partners and Catholic Charities.   

I posed your question to our nurse coordinator at our medical respite program and her reply was that this question has been on her mind as of late and is very timely.  She is currently working with our accounting office to design out some different staffing models for medical respite.

One area of concern is that medical respite staff (nursing, mental health, community health worker) currently spend the majority of the day (anecdotally guessing >60%) doing administrative tasks.  To remedy this need, the program would like to increase capacity by hiring an administrative assistant to absorb these duties therefore freeing up staff in the following ways:

Nursing: health education, Diabetes care classes, spending time talking about health insurance and appropriate use of the health system, in death medication planning classes, how to use primary care to avoid ER visits;

Licensed therapist: therapy sessions, referrals, help finding a psychiatrist, administering depression/anxiety indices as appropriate; and

Community health worker: nutrition classes, help finding classes/hobbies in the community, helping making and keeping doctors appointments, gardening.

Another need is to hire a case manager who has worked with homeless adults in Ramsey County before. Their role would include: helping patients start to find housing, help obtain food and social security benefits (as appropriate), help gain access to medicaid (if not already done by the referring hospital), assist clients find case management services (Independent Life Skills worker< Mental Health worker, community medical care coordinator) in the community to continue care after discharge.

Expert Question: Are there other organizations you are currently partnering with or plan to partner with?

The medical respite program at Catholic Charities relies on partnerships with other organizations for not only funding, but to provide those services for clients which are outside the scope of the agency.  As mentioned before, Catholic Charities is in partnership with three local hospitals (Regions Hospital, St. Joseph's Hospital, and United Hospital) to work together to create the medical respite services at Higher Ground Saint Paul.  The organizations have planned to fund a percentage of the first year of medical respite operations. Catholic Charities will provide data that includes total patient days by referring hospital. Each hospital’s contribution for the second half of the first year of operation will be in proportion to the total patient days that resulted from its referrals during the first half of the first year of operation. The contributing hospitals will meet with Catholic Charities to discuss criteria and measures that will be monitored during the first year to determine future year’s contributions and funding approaches.

An idea that is still in its infancy is increased interaction with community partners (Healthcare for the Homeless, United Family Medicine and Radius Health) to provide their respective clients through the referral system to gain access to Catholic Charities' medical respite beds.  These agencies are trying to anticipate thier client's needs before hospitaltization is needed or an Emerency Department visit.  Catholic Charities is currently having conversations with our partners on creative solutions to their requests.  What is known is that community partners are noticing the benefits of this program and how medical respite will improve their lives and health of thier clients.

In looking at partnerships, Catholic Charities would like to expand our knowledge on best practice and performance of other medical respite programs throughout the United States.  Ideally, it would be beneficial to have staff visit 2-3 medical respite programs to learn about their models of care, wraparound services, community partnerships, funding plans, and staffing models.  Catholic Charities could then take the information learned and incorporate these best practices.