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Community Partnership for Patient Activation. Santa Cruz Experience Wells Shoemaker MD September 29, 2008. 3 Messages, Thinking 2015.

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community partnership for patient activation

Community Partnership for Patient Activation

Santa Cruz Experience

Wells Shoemaker MD

September 29, 2008

3 messages thinking 2015
3 Messages, Thinking 2015
  • Flogging the “usual suspects,” the delivery system, will help for diabetes and heart disease… and we will keep it up…but only help a little bit. (HEDIS is a narrow view.)
  • Public Health thinking and customized, broad community initiatives are essential.
  • Patient activation is the key to the garden… and we can turn it
bumper sticker wisdom
Bumper Sticker Wisdom
  • Think Globally
  • Act Locally
  • …and…Get all the help you can!
primary care workforce crisis
Primary Care Workforce Crisis
  • New entrants now << 50% of 1995
  • New kids can’t buy houses here
  • Leaving CA—hassles, regulations, no “life.” …and seeking niches if they stay.
  • Overwhelmed with “WYODI’s”—impossible
  • Disaffected, to say it politely
  • Think FTE’s, not “heads”—they’re getting gray, part time; we’re in deep trouble
what can be done
What can be done?
  • Expand capacity of each doctor—practice redesign, teams, community supports, information systems, outreach
  • Respond to reimbursement disparity, including novel payment for chronic care
  • Improve job satisfaction and personal life balance—delete stupid time waste
think local santa cruz county
Think Local: Santa Cruz County
  • Small county with natural geographic boundaries. Mix: urban, residential, ag
  • Population 260,000, fairly stable
  • Microcosm of Pacific Coast demographics, with ethnic clusters
  • University & Junior College
  • Liberal politics
  • Both collaboration and friction
  • Severe PCP recruitment handicaps
two grass roots collaboratives
Two Grass Roots Collaboratives
  • Health Improvement Partnership—Executives of all health “Usual Suspects”
  • Regional Diabetes Collaborative—”Worker Bees” in diabetes care, education, advocacy
    • Diabetes Health Center
patient engagement resources
Patient engagement resources
  • Diabetes Health Center—non-profit, local, ethnically attuned, community engaged… and struggling for nickels and dimes
  • Hospital based programs “pt education”
  • Group & clinic-based programs
  • Entrepreneurial programs “if you got the money, honey, I got the time”
what can plans do to help
What can Plans do to help?
  • Participate in regional collaboratives
  • Seek and pay for local patient activation services that work
  • Flexibility in criteria for vendors
  • Protect these in limited benefit products
  • Openness to novel chronic care reimbursement strategies
santa cruz background
Santa Cruz background
  • Following slides for background—not likely time for presentation 9/29
health improvement partnership
Health Improvement Partnership

Executive representation, monthly meetings:

  • Public Health Dept & HSA
  • 3 hospitals
  • 2 private sector medical groups
  • The Alliance—Medi-Cal managed care
  • Hospital staffs & Medical Society
  • ERs
  • 3 Community Foundations
  • Cabrillo Junior College
hip cross cutting targets
HIP: Cross-Cutting Targets
  • Healthy Kids launch
  • ER Frequent Users Program
  • Diabetes Program support
  • Students & health professions
  • Electronic connectivity
  • Area 99 injustice
  • Community forums & “United Nations”
  • Grant magnet
regional diabetes collaborative
Regional Diabetes Collaborative
  • Santa Cruz, Monterey, San Benito Counties
  • 800,000 people total
  • 7% diabetes prevalence  50,000 +
  • “Worker bee” professionals from
    • Public health, medical groups, Comm Clinics, Alliance
    • Hospitals (7) diabetes education staff
    • Diabetes Health Center—non profit, ethnic ++
    • Advocacy organizations & Seniors
    • CA Diabetes Program
    • Cal State Monterey Bay, Cabrillo, UCSC
three thrusts of rdc
Three Thrusts of RDC
  • Clinical Care Improvement
  • Patient education…morph to self- management support, culturally appropriate, community focused
  • Public information and Policy
  • And liaison with related organizations, i.e. Pediatric Obesity, CCCN
rdc activities
RDC Activities
  • Quarterly general meetings—best practices, education, networking
  • Annual conference
  • Health fairs
  • Multiple local engagements
  • Lawmaker outreach
  • Public information & speakers
  • AHRQ grant conduit 2004-7
  • Amplifier of messages
highlights
Highlights
  • HIP adopted diabetes formal goal 2003
  • IOM Presentation 2004
  • AHRQ grant Registry project 2004-7
  • Annual tri-county diabetes forum with “hot” speakers, lots of pub, political push
  • Expansion, solidification of RDC
  • Coordination with others
  • Still playing catch-up
take home
Take Home
  • Local resources potentially powerful
  • Can reach further than “medical” alone
  • Bake sale economics to start
  • Grant funding appealing but can be disruptive
  • High degree of customization needed
  • Leadership cultivation required
  • Costs real $ to launch and maintain
  • Easy to fall back to silo thinking