Health Disparities Collaborative Moving Towards Transformation

1
Health Disparities CollaborativeMoving Towards
Transformation

• BPHC Goal That BPHCfunded Health Centers will
  be recognized as the model for quality primary
  health care in the United States for 16 million
  patients.
• Was initially a clinical care improvement model
  for patients with chronic diseases.
• Has with extensive use matured and undergone
  several changes transforming from a Chronic
  Disease Model to Planned Care.

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HDC Implementations

• Implementations of HDC have resulted in
  unintended, but positive consequences
• Most Centers realize that they cannot hope
• to optimize their clinical care to all
  patients unless they improve

• Access to care.
• Continuity of the care.
• Integration of care provided at center.

3
Process for Achieving Bureau Aim Using HDC as
Basis for Transformation

• The Vision
• A Health Center must understand the vision
  articulated by BPHC in terms of the impact on
  their center.
• Framework
• Centers and the communities they serve are so
  different that we must outline a general
  framework which includes
• The vision.
• Stepping stones to achieving the vision.
• End goals desired Outcomes for both centers and
  patients in terms of patients seen and healthcare
  outcomes.
• Keys to success.

4
Primary Considerations

• Primary considerations for transformation
• Process of engaging centers must change.
• Integration of initiatives.
• Considerations regarding equivalency.
• Effective national communications structure.
• Health center infrastructure.
• The business case.
• Support for teams and clients.

5
Process for Engaging Centers Must Change

• To reach 16 million, there must be focus on three
  critical areas
• Prework/Readiness for centers.
• Leadership engagement and training.
• Centers must understand the interrelationships
  between the learning models, model for
  improvement, chronic disease model and
  access/redesign.

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Process for Engaging Centers Must Change, cont.

• Prework/Readiness process must be more stringent
  change Health Disparities Operational
  Guidelines e.g.

• Require broadband access.
• Require e-mail availability for each team member.
• Require dedicated computers for staff and
  providers.

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Process for Engaging Centers Must Change, cont.

• Leadership
• Engaging center leadership is critical. We must
  identify what senior leadership needs to achieve
  understanding.
• Must have cluster staff identify and maintain
  relationships with senior leadership to support
  sustainability and spread.

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Process for Engaging Centers Must Change, cont.

• Access / Redesign A Paradigm Shift
• Old in order to protect today, we push work
  into tomorrow
• New In order to protect tomorrow, we pull work
  into today
• If we truly want to move centers into an
  integrated model of care and reach 16 million
  patients we must teach Access / Redesign in order
  to create high leverage changes for office
  efficiency at the center level.
• We must recognize that delay is the worst form of
  denial of access.

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Process for Engaging Centers Must Change, cont.

• The Learning Model
• Disease components (and their interrelationships)
  of the Care Model will require less effort and
  staff support.
• Must change certain administrative decisions made
  in the past to facilitate sustain and spread and
  lessen strain on staff e.g. teams repeating.

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Integration of Initiatives

• Centers are overwhelmed with applications for
  small amounts of money
• Mental Health
• Dental
• Medical Expansion
• New Start / New Access Point
• Must align Bureau funding sources to support goal
  of 16 million.

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Integration of Initiatives, cont.

• The expectation should be that
• Centers must attempt to meet as much of the
  demand in their area as possible.
• If they can meet more demand by moving to an
  integrated model of care, improve access and
  better continuity, then why not make funding
  decisions on the basis of components of an
  integrated model available through the center or
  allow the use of medical expansion to fund new
  vision.

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Considering Equivalency

• Disease management evolution from chronic
  conditions to include a focus on vital
  operational and financial aspects.
• Historical participation by CHCs in other
  initiatives.
• Alignment and support of HDC standards
  nationally, but best practices, learning and data
  collection must originate from the bottom up.

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State and Regional Collaboratives

• Restructure the current 13 month learning model
  to include state/regional sessions in
  implementation of HDC.
• Utilize cluster faculty in addition to national
  faculty and cluster staff.
• State/regional collaboratives will meet
  equivalency standards collaboratively established
  by national HDC leadership.
• Develop a sustainable strategy for outcomes
  measurement and reporting.

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Health Center Infrastructure

• Expansion to 16 million must include
  consideration of all aspects of CHC
  infrastructure
• Staffing infrastructure.
• Data Management and Information Systems.
• Expansion of team outreach.
• Senior leader engagement.

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The Business Case

• The Business Case has always been the largest
  problem with the HDC model.
• Outcome based care requires accurate data data
  capturing and data entry which in many cases is
  not available at centers, and integration with
  other data to show penetration e.g. CDC.
• Current data collection efforts hampered by
  quality, access and methodology.

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The Business Case, cont.

• Model requires an investment by center savings
  occur down stream to hospitals, Managed Care
  Plans, Medicaid, Medicare, and CHIP.
• Pressing need for a cost/benefit analysis.

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The Business Case, cont.

• Funding sources for centers must be coordinated
  to help centers understand and fund the change
• Bureau must recognize centers completing
  restructured collaborative as medical /
  behavioral health expansions and allow expansion
  funds to be used to fund the change.
• Bureau must move from funding mandated practices
  to funding excellence in outcomes.

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The Business Case, cont.

• Bureau must advocate changes in
  Medicaid/Medicare/CHIP to support approach.
• Expand definition of provider to reimburse
• LMSW-ASCP
• LPC
• LMFT
• Nurse that provides health education.
• Telephone support.

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The Business Case, cont.

• If Access/Redesign results in a center provider
  being able to increase their panel size, - why
  not reward with incentives resulting in more
  insured served without duplication of
  administrative costs?

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Support for Both Teams and Clients Is Critical

• Challenge of regular reporting to meet HDC
  requirements.
• Center staff turnover threatens sustain and
  spread efforts.
• Lack of recognition of the financial burden of
  spread and sustain at the center, cluster and
  national level.

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Support for Both Teams and Clients Is Critical,
cont.

• Current data collection and analysis process is
  inadequate.
• We must have the best data possible not only on
  patients in registry, but also penetration into
  the population with targeted diseases.
• Must expand to more sophisticated data collection
  methods such as GIS software, integration of
  other data sets available from the CDC or the
  U.S. Census Bureau.

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Support for Both Teams and Clients Is Critical,
cont.

• Teams
• Teams require on-going support such as
  E-learning.
• Tools to assist their development such as a CD
  developed by the Northeast.
• Support and learning for entire staff at the
  local level such as in CA.

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Support for Both Teams and Clients Is Critical,
cont.

• Clients require
• Education on chronic disease and its impact on
  the body and mind.
• Help with feeling of desperation.
• Health education specific to their disease.
• Materials at 4th grade level.
• After hours number they can call that can deal
  with
• Behavioral health support.
• Questions about their disease.
• Questions regarding their medications.

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Support for Both Teams and Clients Is Critical,
cont.

• Providers need training on
• Dealing in the new environment.
• Dealing with other types of providers (e.g.
  mental health).
• Nurses will be optimizing care need to train,
  upgrade and be reimbursed for their services.

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Support for Both Teams and Clients Is Critical,
cont.

• Staff need training on
• Model Why things are changing.
• Coding issues more complicated than normal
  medical setting.
• Appointment issues.

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Bureau Alignment With Other Entities

• Medicare/Medicaid
• Use of centers in their initiative.
• Prescription Cards and Medication for chronic
  diseases outreach from centers.
• Medicaid / CHIP reimbursement for comprehensive
  care.
• CDC money and data needed.
• Ability to use Medicare card with 340B.

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Model

Pharmacy
Dental
Social Work
Intervention Service Brief Intervention
Primary Care
Mental Health
Referral

• Patient Self Care
• Support
• Patient Education Materials
• Medical Co-Management
• Group Session
• Patient Education on Illness

• Ongoing Patient Support
• Wrap around 24 hour telephone service
• Specialized training for program staff
• Telephone treatment adherence program
• Patient education and self management tools
• Provider education and support tools