Enrique Enguidanos

Background

About Enrique Enguidanos

As a doctor with more than 25 years of clinical experience in Emergency Medicine, I’ve seen communities struggle to serve patients who are resistant to typical health care solutions. As a result, they utilize more health care resources and often fail to achieve long-term quality health outcomes, thus driving up costs across the system. After spending years in emergency departments watching the same individuals come to us for care that would have been better managed outside of the ED, I founded CBCS to help achieve a goal shared by all of us working across the health care industry: improve health outcomes and realize cost savings. CBCS is a service organization that addresses the needs of complex care patients. We typically contract with a payer and/or at-risk entity (e.g, insurer, health system, managed care organization or health foundation) to support improved service delivery for the cohort of difficult to manage and/or high-cost clients (“high utilizers”). These high utilizers are typically identified by one or more of the following criteria: • Frequency of ED visits or hospitalizations over a period of time;• Top 1-2 percent of cost of members within a community; and/or,• Identified by a community resource as a high utilizer of their services.High utilizers account for 18 percent of ED visits nationwide, at an annual cost of $11.2 billion. This group also has hospitalizations that last 60 percent longer than the general public, and they have a mortality rate three-times higher than the general public. Most high utilizers of our health care system have unique medical conditions, often impacted by social circumstances, such as homelessness, substance use disorders, and behavioral health issues, making them resistant to typical care coordination services. While most have some sort of assigned care coordination, standard telephonic or off-site care coordination practices tend to fail with this group. The unique circumstances surrounding these individuals make them best served by staff available within the community, familiar with their unique needs and who have an intimate knowledge of community resources. CBCS successfully helps payers and providers improve health outcomes and control costs among high utilizers by staying focused on a few core priorities: • We find and engage clients where they are. • We coordinate with existing community resources.• We provide 24/7/365 availability to clients.