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Research to Reform : Achieving Health System Change AHRQ 2009 Annual Conference September 13-16, 2009. Progress of a Learning Network: Working to Reduce Disparities by Improving Access to Care Monday, September 14, 2009 Sherry E. Gray, M.A. Director: Rural and Urban Access to Health

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Research to reform achieving health system change ahrq 2009 annual conference september 13 16 2009
Research to Reform : Achieving Health System ChangeAHRQ 2009 Annual ConferenceSeptember 13-16, 2009

Progress of a Learning Network:

Working to Reduce Disparities by Improving Access to Care

Monday, September 14, 2009

Sherry E. Gray, M.A.

Director: Rural and Urban Access to Health

St. Vincent Health


Focusing on outcomes
Focusing on Outcomes

1

3

+

2

=

Identify Individual

at Risk

Measure Outcome

Health and Cost Savings

Confirm Evidence

Based Intervention

The Pathway Model


The pathways model
The Pathways Model

Identify areas of greatest need

geomapping, analyzing existing databases, needs assessments

Establish a community hub

centralized community group: communication; data collection; tracks services provided by community health workers

Develop Pathways

- start with “agreed upon” outcome; build steps from desired end-point; capture steps to completion; capture barriers and successes for intervention/ problem-solving

-connect funding mechanisms to outcomes vs. activity-based reimbursement

Identify and train community health workers

Implement established Pathways until the outcome is accomplished

Conduct ongoing quality assurance and evaluation

monitor the progress and outcomes


Oh no another program

Pathways are NOT:

→ Part of a “canned program”

→ Simple and quick solutions to complex problems

→ Built/developed in a “silo” and then “introduced” to other agencies, providers, programs, funders, for adoption and implementation

→ A fad

Pathways ARE:

A proven care coordination model

Community based

Adaptable to a variety of “at-risk” populations

Evidence-based interventions at the grassroots level

Used to create outcome -based accountability and reimbursement vs. activity-based reimbursement

“Oh no…another program!”



Ruah history
RUAH History

  • RUAH Partnership initiated: 2000

    • SV Health

      • In patient, Out patient, Community Based Care

    • Indiana Health Centers, Inc.

      • Federally Qualified Health Care Center (FQHC)

    • Health and Hospital Corporation of Marion County

      • County Health Department

    • ADVANTAGE Health Plans, Inc.

      • Insurance Provider (public and private plans)

    • Butler College of Pharmacy, later added

      • PharmD students

      • Pharmaceutical Assistance Program (PAP) Consultation

      • Project Management/Oversight

    • Community Interface Groups: local partner groups responsible for program implementation.

      • health centers, health departments, physician offices, civic groups, and health, human and social service agencies

  • Funded by HRSA, Ascension Health from 2001-2005

  • Sustained through local hospital funding and captured reimbursement through enrollment efforts


Current service areas
Current Service Areas:

  • Clinton County

    • St.Vincent Frankfort *

  • Howard County *

    • St. Joseph Hospital

  • Madison County

    • St. Vincent Mercy *

    • Saint John’s Health System

  • Randolph County *

    • St.Vincent Randolph

  • Clay County

    • St.Vincent Clay

  • Jennings County

    • St.Vincent Jennings

  • Fountain and Warren Counties

    • St.Vincent Williamsport

    • * Original CAP grant program sites

      * Original CAP grant program sites


Ruah today
RUAH Today

Purpose:

To connect our friends, family, and neighbors to a comprehensive, integrated delivery network of health, human and social services resulting in improved access and removal of barriers to needed resources.

Meaning and Mission:

The word ruah, in yiddish

means “Breath of Life”.

The Goal?

…to breathe new life into a dying

health care system trying to serve our most vulnerable community members


Focus areas
Focus Areas:

  • Health Access Workers–client advocates & system navigators

  • Pharmacy – access to low or no cost drugs through Medication

  • Access Workers (MAC’s)

  • Creation of “Medical Homes” for the underserved

  • Access to Specialty Care for the underserved

  • Program enrollment (financial resource review

  • and application assistance)

  • Reduction of inappropriate Emergency Room utilization

  • Assistance with supportive social services

  • (“wrap around”)

  • Diversity – translation of core documents, medical

  • interpretation, key signage, development of diversity

  • councils, LEP Assessment

  • Sustainability


Program outcomes november 02 june 09
Program Outcomes:(November ‘02 – June ‘09)

  • Four community programs expand to Eight community programs

  • Additional private sector funding obtained

    • Anthem Foundation

  • 29,767 client encounters

  • 59,081 referrals, including

    • Medical Home appointments

    • Government program applications (Medicaid & SCHIP, etc.)

  • $18.2 million worth of low/no cost drugs provided

  • 800+ HIP applications = $ 2+ million captured reimbursement


Sound good
Sound Good?

  • RUAH produces good work

    ↑ interaction

    (patients, clients, providers)

    ↑ connectivity/integration

    (community agencies and acute care facilities/providers)

    ↑ activity

    (doing lots of things “to and for” people)

    ↑ access

    (primary care home assignments/specialty care)

    ↑ reimbursement

    (received funding not previously captured)


So?

  • Did any of it work?

    • Intuitively it appears that it does

  • How do we know?

    • Did the activities produce:

      • Lower A1C values for Diabetics?

      • Better birth outcomes for high risk pregnancies?

      • Lower blood pressure and decreased cardiac risks?

      • Manage asthma symptoms and decrease ER visits and hospitalizations?

  • 1. The answer? We don’t know.

  • The question: How do we find out? Find a way to connect the

  • work to measurable outcomes that is both simple and real…


Pathway implementation our beta site
Pathway Implementation(our “beta site”)

Work with

Madison County

and Saint John’s Hospital


Process
Process:

  • Maintain all current RUAH access work

  • Build a local CKF Coalition

  • Host a high level Stakeholder meeting

  • Develop “behind the scene” infrastructure support: IT, agreements, etc.

  • Hold the initial Madison County Community HUB Pathway development summit

  • Implement the Pathways developed by the HUB

  • Evaluation and “Fine tuning”


How s it going
How’s it going?

‘Stay tuned…we are still on the pathway


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