The following community health centers and hospitals were selected by Washington State DSHS as the locations for the CMS ER Diversion Pilot Projects.

Lourdes Medical Center, Pasco
Location: Largely rural, farming community, growing quickly, serves designated Health Professional Shortage Area (HPSA).
Target Population: Mothers and children who receive Medicaid benefits and those on Medicaid who are high utilizers of Emergency Department Services.
Plan:
1) Extend nurse triage line to 24hrs w/follow-up.
2) Locate Case Manager in ER.
3) Urgent Care clinic next door w/ Women and Children’s Center.
4) Add behavioral health counselor located at Community Health Center to assist PCP’s.
5) Promote medical home concept.
6) Community education initiative: Working with McDonald’s to create tray liners depicting appropriate ER use and resources and with local radio stations for public service announcements.

Note: Hospital is primary contractor; partnered with Miramar Health Center (Yakima Valley Farm Workers Clinic) and Community Health Center La Clinica.

Community Health Association of Spokane
Location: Largely urban, suburban, second largest city in WA, serves designated HPSA.
Target Population: Mothers and Children with Medicaid benefits, High Utilizers, High Utilizers with dental issues.
Plan:
1) 24-hour triage line using existing mid-level staff.
2) Add behavior health services and promote medical home concept.
3) Expand case management with ED Patient Liaison.
4) Enhance electronic connection with Holy Family Hospital.
5) Increase MCO enrollment.
6) Work with hospital to immediately schedule follow-up appointments at clinic.

Note: Proposed working with Community Health Plan of Washington to split saving; partnered with Holy Family Hospital.

HealthPoint, Auburn Clinic
Location: Urban Auburn plus surrounding rural communities; designated Medically Underserved Area.
Target Population: Mothers and children, Medicaid eligible persons, and other high utilizers of the Auburn Regional Medical Center ED.
Plan:
1) Expand clinic hours.
2) Expand case management and care coordination services.
3) 24-hour access to nurse triage line.
4) Assist MCO enrollment and reduce additional access barriers.
5) Promote medical home concept.
6) Continue culturally competency, quality initiatives.

Note: Health Literacy initiative for parents and education for special populations; partnered with Auburn Regional Medical Center.

Interfaith Community Health Center, Bellingham
Location: Rural with one small city. Designated HPSA with several Medically Underserved Areas.
Target Population: Uninsured, Medicaid managed care patients, Medicaid FFS, Medicare patients.
Plan:
1) 24-hour access to nurse triage services.
2) Expand service hours and promote medical home concept.
3) Add RN case manager, social worker/customer service representative.
4) ED Dental follow-up and urgent walk-in dental program.
5) Outreach/Education effort for new MCO clients (gift certificate for appointments made).
6) Increase behavioral health service hours.
7) Hire part-time access worker.

Note: Follow-up for all clients who do not make appointments; collaborating with St. Joseph’s hospital and with the Whatcom Alliance for Healthcare Access.

Additionally, all sites are working in collaboration with the Patient Review and Coordination Program at Washington State DSHS to provide additional support and intervention for particularly vulnerable patients who fall into the high utilizer category.