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What Haiti Can Teach the US about Providing Healthcare to the Uninsured Stan Shaffer, MD Founder, Healthy Mothers, Healthy Babies Kendra Wyatt Strategist, Community Access, Cerner. Session topics. Delivering Care in Haiti Medical Pathology – Social Pathology

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slide1

What Haiti Can Teach the US about Providing Healthcare to the UninsuredStan Shaffer, MDFounder, Healthy Mothers, Healthy BabiesKendra WyattStrategist, Community Access, Cerner

session topics
Session topics
  • Delivering Care in Haiti
    • Medical Pathology – Social Pathology
    • Community Focus – Community Engagement
    • Measuring Outcome – Measuring Impact
  • The Principles and Comparisons
    • Medical Home Theory
      • Kansas City, Missouri: Jackson Country Free Clinic
    • Lasso the Power of Community and Information Technology
      • Austin, Texas: Indigent Care Collaboration
      • JaxCare, Jacksonville, Florida
    • Health Banks- Privacy, Portability with Purpose
      • Live from the WHO Standards Meeting, Kenya
child mortality
Child Mortality

● = 5,000 child deaths / year

potential for basic interventions
Potential for Basic Interventions

Jones, Child Survival II, 2003; Lancet 362:65-71

  • Clean delivery, breast feeding, antibiotics

→ Sepsis deaths ↓94%

  • Prenatal tetanus vaccine

→ Tetanus deaths ↓81%

  • Malaria prevention

→ Low birth weight deaths ↓59%

  • Neonatal resuscitation

→ asphyxia deaths ↓39%

slide23
Why didn’t you go to the hospital?

1. Too far

2. Too expensive

3. Untrustworthy

Underlying Medical pathology

is Social pathology

Community Survey Results

slide26
Why didn’t you go to the hospital?

1. Too far → Community services

2. Too expensive →Free care

3. Untrustworthy → Quality

Consistency

Hospitality

The need

models of maternity care
Models of Maternity Care

Obstetricians

Nurse Midwives

Matrones

Hospital

Comprehensive

Expensive

Remote

Birthing Home

Home

Limited care

Inexpensive

Convenient

slide28
Pregnancy planning

Prenatal care and triage

Prevention of infections

Syphilis, HIV, Malaria

Safe birth

Clean delivery

Skilled birth attendants

Breast feeding support

Vaccinations

Nutrition and micro-nutrient supplementation

Child development

Road to Health

Continuity of Care

slide29

Health

Information

Technology

  • Outcome monitoring
  • Quality assurance
  • Performance improvement
  • Communication
  • Resource sharing
  • Health mapping
  • Community health atlas
slide32

Home visits

Santé Communautaire

Vit A

Education

HIV - DOT

slide33

Santé

Communautaire

Elimination of

Intestinal Parasites

slide37

Maison de Naissance

Primary Outcome Measures

slide39

Community Engagement

  • Employment
  • Mothers clubs
  • Community activism
  • Vaccination campaigns
  • Seeking water, housing, micro-loan programs
slide40

The value of a society is increased only as it cares for its most vulnerable.

John Rawls

not just for the countries with high child mortality,

but also for countries that could have changed the situation.

William Foege

Child survival…a measure of civilization…

childbirth in a haitian village
Childbirth in a Haitian Village

Implications for the

Un and Under-insured

in the States

partners in health healthcare as a right vs commodity

Partners In HealthHealthcare as a Right vs Commodity

“Anywhere you have extreme poverty and no national health insurance, no promise of health care regardless of social standing, that's where you see the sharp limitations of market-based health care.”

Paul Farmer

slide44

A medical home is defined as primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.  A medical home addresses how a primary health care professional works in partnership with the family/patient to assure that all of the medical and non-medical needs of the patient are met.  The physician should be known to the person/family and should be able to develop a partnership of mutual responsibility and trust with them.

Definition: Medical Home

slide45

Maison de Naissance

Providing a Physical Birth Home

Virtual Consults

Outreach

Via Football

Clubs

Virtual Consults

Data Center

Drinking Water

Waste

Management

Faith Partnerships

Agriculture

Productivity

Community

Health

Workers

MN Health Bank

Haitian School

of Midwifery

MN

Baby,Mama,

Family

Home

Cement Floor

Tile Roof

Government

Education

(BTI)Business

Technology

Institute

Les Cayes

Hospital

Cell Phone

Connectivity

Power

Entrepreneurism

Midwives

the mother of them all indigent care collaboration austin texas
AUSTIN/TRAVIS COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT

AUSTIN TRAVIS COUNTY MENTAL HEALTH MENTAL RETARDATION CENTER (ATCMHMR)

AUSTIN WOMEN'S HOSPITAL

CENTRAL TEXAS MEDICAL CENTER

CITY OF AUSTIN COMMUNITY CARE SERVICES DEPARTMENT

JOHNS COMMUNITY HOSPITAL

LONE STAR CIRCLE OF CARE

PEOPLE'S COMMUNITY CLINIC

PLANNED PARENTHOOD OF THE TEXAS CAPITAL REGION

ROUND ROCK HEALTH CLINIC

ST. DAVID'S HEALTH CARE

SETON FAMILY OF HOSPITALS

TRAVIS COUNTY HEALTHCARE DISTRICT

TRAVIS COUNTY MEDICAL SOCIETY

UT SCHOOL OF NURSING

VOLUNTEER HEALTHCARE CLINIC

WILLIAMSON COUNTY AND CITIES HEALTH DISTRICT

All Members of the Safety Net Community Participate

Community Health Record

Community Health Workers

The Mother of them all….Indigent Care Collaboration, Austin Texas
virtual medical home framework
Virtual Medical Home Framework

Community

Foundation

Philanthropy

Health Plan

Government

Faith

Health Ministry

Employer

Public Health

Birth Center

Education

Hospice

Affordable Housing

Appropriate Clothing

Environment

Person

Family

Specialist

Mobile

Clinic

Medical Home

FQHC, Safety Net

Nutrition

Community

Health Worker

Community Center

Hospital

Health System

Pharmacy

Grandmothers

Sports Clubs

jacksonville health information network community health record a virtual medical home

Shands

Jacksonville

McKesson

Duval County

Health Department

Med

Claims

Baptist Health System

SMS

Cerner

JaxCare

Claims

Mayo Clinic Hospital

Cerner

St. Vincent’s

Medical Center

IDX

.csv Files

Cerner

Memorial

Hospital

MediTech

  • Community Electronic Health Record

HL7 Interfaces,

Data Extracts

University of

Florida

IDX

AllScripts

.M. Sulzbacher

(FQHC)

Med Mgr

Brooks Rehabilitation

Hospital

MediTech

Jacksonville Health Information Network

Accessible via a secure internet site (SSL 128-bit encryption)

Jacksonville Health Information Network Community Health RecordA Virtual Medical Home

HMS

Duval County

Health Department

a new healthcare transaction health banks h r 2991 independent health record trust act of 2007
A New Healthcare Transaction: Health BanksH.R.2991Independent Health Record Trust Act of 2007

Saving money and lives using non-centric, consumer-driven independent health record banks

Charter for not-for-profit, cooperative institutions with member-owned accounts

IHRBs could save money and lives

  • Sale of data with revenue considered tax-free income
  • Gives providers access to data in emergencies

Vision for a “New Transaction”

Dennis Moore

U.S. Rep, D-Kan

Paul Ryan

U.S. Rep, R-Wis

  • "By offering member-owned accounts, independent health record banks have one focus—the patient.”
  • - U.S. Sen. Sam Brownback, R-Kan.
live from kenya the who
Live From Kenya & the WHO
  • Speaker will update attendees on results of the WHO Health Information Standards Conference Held December 4-7, 2007
finance health medical homes not sickcare information technology is like clean water global lessons

Finance Health & Medical Homes Not Sickcare Information Technology is like Clean WaterGlobal Lessons

resources
Stan Shaffer, MD

Maison de Nassaince

www.maisondenaissance.com

shaffers@umkc.edu

Kendra Wyatt

Cerner Corporation

www.cerner.com

kwyatt@cerner.com

Partners In Health

PIH.org

Bridget McCandless, Medical Director, Jackson County Free Clinic

bmmcca@comcast.net

Ann Kitchen, Executive Director, Indigent Care Collaboration

akitchen@icc-centex.org

Rhonda Poirier, Executive Director, JAXCARE

rpoirier@jaxcare.org

Resources