CARES Program Tackling ED Over Utilization in a Unique Way

Multi-agency collaboration in Colorado Springs is making big improvements in unnecessary emergency department visits – and in their community.

It costs the same amount of money to send a fire and ambulance response to handle a cardiac arrest as it does to help someone who has fallen out of a wheelchair and is unharmed. Our 9-1-1 emergency response system was set up to help people with life-threatening issues like fire, crime, seizures, strokes, heart attacks, etc. Yet today, it has become more of a helpline for both emergency and non-emergency issues. “The patient defines the emergency, thus defining the services,” says Administrator Steven Johnson, Colorado Springs Fire Department, Community and Public Health Division (CPH). “We needed a new way of thinking.”

Multi-Agency Collaboration

Community Assistance Referral and Education Services, or CARES, is a program within the Colorado Springs Fire Department that is a multi-agency collaboration. This collaboration includes hospitals, Community Health Centers, Homeless Missions, criminal justice and various behavioral health organizations.

The program required infrastructure and workflow changes, including referrals from hospital systems, 9-1-1 system changes, and new fire protocols. The over-arching goal is to better manage super utilizers, or those citizens who have had six or more 9-1-1 calls or ED visits within six months.

CARES takes a new approach to helping patients who really don’t need to rely on 9-1-1 to manage chronic conditions, behavioral health issues or minor issues. They will help patients with on-site behavioral health counseling or referrals, get prescriptions filled, assist with home safety concerns, give rides -- whatever it takes to help the patients in this program get healthier and avoid unnecessary ED visits. This program is funded in part by UCHealth and Centura Health along with the Colorado Springs Fire Department.

Patient Tracking Up to One Year

Patients in this program – who have signed a consent to join – are tracked by CARES for a period of 12 months – six of those are for an intensive intervention period where they are assigned to work with a behavioral health or medical navigator based on highest need and occasionally assigned to both teams.  The navigator works closely with the member, formulating an intervention plan and assisting with helping the member access the appropriate stream of care and knocking down barriers to appropriate treatment.  Once the member has met the 40% reduction in usage goal, they are placed in an observation phase for an additional six months to ensure they are accessing care properly and getting their needs met. 

The program has shown excellent results – the original goal of reducing ED/9-1-1 usage by 40% was well surpassed and in 2018, the overall reduction in usage was 70% for those actively engaged in navigation intervention.

Real-Time Alerts to Track Patients

CARES staff uses CORHIO Notifications, which are real-time alerts fed directly to their mobile integrated health software Julota, when a patient is admitted to a hospital or ED. “These live-time notifications allow immediate follow-up with the member to course correct, provide feedback about their choices, and facilitate discussion on additional assistance and behavior change,” says Dr. Victoria Allen-Sanchez, CARES supervisor, Community and Public Health Division.

CARES staff can find additional information, including detailed lab results, transcription notes, discharge planning, and medical history in CORHIO’s PatientCare 360, web-based portal. This information is integral in the intervention and care coordination process as it does not have to rely on the member’s reports to their navigator to drive treatment. 

The Community and Public Health Division also developed the CRT program (Community Response Team), a collaboration between a CSPD officer, a behavioral health clinician from AspenPointe, and a CPH paramedic that address the needs of those in Colorado Springs experiencing a mental health crisis.  This collaborative team directs patients into the right stream of care in a timely manner. Previous to CRT, when CSFD was called to a mental health crisis, 98% of the time the patient was transported to the emergency department. In contrast, with the expertise of this mobile team, the majority of patients can be treated in place with some transported to a crisis walk-in center, some receiving a direct admit to a local psychiatric hospital and only 13% needing transportation to the emergency department.