Annapolis community health partnership
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Annapolis Community Health Partnership. An Update for Community Health Resources Commission June 26, 2014. Core Goals of Year One: Complete. Increase access to primary care services capital improvements, hires, infrastructure doors opened October 2013

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Annapolis community health partnership

Annapolis Community Health Partnership

An Update for

Community Health Resources Commission

June 26, 2014


Core goals of year one complete

Core Goals of Year One: Complete

  • Increase access to primary care services

    capital improvements, hires, infrastructure

    doors opened October 2013

    453 unique patients served, 1,253 visits

  • Increase community health resources

    diabetic screening program implementationself-management and health literacy promotion

  • Promote cultural competency

    all staff trained


Challenges

Challenges

  • Being a guest and a host at the same time

  • Intercultural tensions

  • Insurance issues

  • Primary Care Medical Home versus agnostic and flexible Health Resource

  • Late entrants to care come to us in crisis

  • Change in Physician


Year 2 strategic plan and core goals

Year 2: Strategic Plan andCore Goals

  • GOAL ONE: Improve diabetes outcomes, measurable by 1/1/15

  • Strategies:

    • Screening program implemented

    • Patients enrolled in primary care

    • Population health management tools

    • Recruitment of additional patients


Year 2 strategic plan and core goals cont d

Year 2: Strategic Plan and Core Goals (cont’d)

  • GOAL TWO: Decrease preventable, costly, crisis-driven care

    • Objectives: Within 12 months:

      • Decrease medical 911 calls from Morris Blum by 30%

      • Decrease emergency room visits from Morris Blum by 30%

      • Decrease readmissions among Morris Blum residents by 30%


Goal two strategies

GOAL TWO Strategies

  • Promote site as a health resourcefor residents

  • Promote health literacy and knowledge regarding proper use of 911, ED.

  • Resident Health Advisor (HACA)

  • Care management, transitional services, apartment visits

  • Palliative care consultations, goals of care discussions


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