Sutter Medical Center Sacramento - Triage, Transport and Treatment (T3)

Overview

Sutter Medical Center Sacramento (SMCS) is a founding partner of T3 (Triage, Transport and Treatment), a collaborative, pioneering program that provides services to a group of patients who frequently seek emergency department (ED) care for needs that could be best addressed through preventive measures and regular care in a community-based health care home. The program assists individuals who habitually use the ED for non-emergency care with a means of getting appropriate housing, benefits and social services, substance abuse treatment, mental health services, and primary health care services. Addressing patients’ immediate needs and shifting their care from the ED to a more appropriate care setting has been shown to improve patients’ health. It also reduces the wait time for those seeking care for medical emergencies and dramatically reduces costs to the health care system.

T3 clients have a very high rate (approximately 75 percent) of homelessness; about 95 percent have mental health issues, and 95 percent are using substances at the time they are accepted in the T3 program. Sutter’s partner and T3 co-founder is WellSpace Health, a federally qualified health center and behavioral health provider that provides social, psychological, and primary health care services to T3 clients. An eight-bed T3 house provides temporary housing for clients. This arrangement provides an opportunity for case managers and medical providers to build trust with clients while meeting their immediate needs. This also allows clients to be “wrapped” with services, including a medical home, insurance services, mental health resources and connection to permanent housing.

Impact

Since the T3 program began in 2007, nearly 1,000 patients have gone through the program. As a result, there has been a 60 percent reduction in ED visits among clients engaged in T3 for more than six months and a 35 percent reduction in inpatient bed-days. Sixty percent of the clients have been placed in permanent housing, and 80 percent stopped or significantly reduced substance use. T3 currently meets the needs of more than 230 active clients by ensuring that they are engaged in comprehensive health, behavioral health, and ancillary services in the community.

Challenges/success factors

• When clients first enter the T3 program, nearly half are uninsured. By the time clients leave the program, they all have some kind of health coverage.
• Seventy-five percent of the T3 target population is chronically homeless. To achieve success, Sutter needed to meet their immediate needs. T3 is not a primary care first model; case managers work to stabilize the clients before addressing their chronic health care conditions. (Often the first thing that case managers do is work with the client to resolve outstanding legal warrants.)
• The program needs to be incorporated into existing systems. Sutter has a Case Management tool that helps identify patients appropriate for the T3 program. When individuals that appear to be T3-type clients show up in the ED, The WellSpace case manager comes to the ED and connects with the client and Sutter staff.

Future direction/sustainability

Sutter continues to expand this important program, as T3 patient numbers grow in both Sacramento and Placer counties. The T3 Foothills (in Placer county) caseload has quadrupled from 15 active clients per quarter, to more than 60 clients in service or waiting for services, due to the referral network from the SRMC ED Navigator program. As a result, Sutter will continue to contract with WellSpace Health to provide this vital program to all who need it.

Contact: Holly Harper
Community Benefits
Telephone: 916-496-0971
E-mail: HarperH1@sutterhealth.org