Community Partnership for Patient Activation

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Community Partnership for Patient Activation

• Santa Cruz Experience
• Wells Shoemaker MD
• September 29, 2008

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3 Messages, Thinking 2015

• Flogging the usual suspects, the delivery
  system, will help for diabetes and heart disease
  and we will keep it upbut 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

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Bumper Sticker Wisdom

• Think Globally
• Act Locally
• andGet all the help you can!

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DIABETES PYRAMID
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Primary Care Workforce Crisis

• New entrants now ltlt 50 of 1995
• New kids cant buy houses here
• Leaving CAhassles, regulations, no life. and
  seeking niches if they stay.
• Overwhelmed with WYODIsimpossible
• Disaffected, to say it politely
• Think FTEs, not headstheyre getting gray,
  part time were in deep trouble

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What can be done?

• Expand capacity of each doctorpractice redesign,
  teams, community supports, information systems,
  outreach
• Respond to reimbursement disparity, including
  novel payment for chronic care
• Improve job satisfaction and personal life
  balancedelete stupid time waste

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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

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Two Grass Roots Collaboratives

• Health Improvement PartnershipExecutives of all
  health Usual Suspects
• Regional Diabetes CollaborativeWorker Bees in
  diabetes care, education, advocacy
• Diabetes Health Center

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Patient engagement resources

• Diabetes Health Centernon-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

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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

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Santa Cruz background

• Following slides for backgroundnot likely time
  for presentation 9/29

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Health Improvement Partnership

• Executive representation, monthly meetings
• Public Health Dept HSA
• 3 hospitals
• 2 private sector medical groups
• The AllianceMedi-Cal managed care
• Hospital staffs Medical Society
• ERs
• 3 Community Foundations
• Cabrillo Junior College

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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

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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 Centernon profit, ethnic
• Advocacy organizations Seniors
• CA Diabetes Program
• Cal State Monterey Bay, Cabrillo, UCSC

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Three Thrusts of RDC

• Clinical Care Improvement
• Patient educationmorph to self- management
  support, culturally appropriate, community
  focused
• Public information and Policy
• And liaison with related organizations, i.e.
  Pediatric Obesity, CCCN

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RDC Activities

• Quarterly general meetingsbest practices,
  education, networking
• Annual conference
• Health fairs
• Multiple local engagements
• Lawmaker outreach
• Public information speakers
• AHRQ grant conduit 2004-7
• Amplifier of messages

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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

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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