Community and PopulationBased Health Care Delivery Systems:

1
Community- and Population-Based Health Care
Delivery Systems

• Building Collaborative Networks
• Regional Health Care Safety Net Summit
• Health and Medicine Policy Research Group
• Pat Terrell
• June, 2009

2
Building Regional, Collaborative Health Care
Networks

• Why?
• Pressure will mount on local communities and
  governments to meet growing need
• Publics cant meet need alone
• Providers motivated to come to the table to bring
  new ideas
• Nationaland state--reform will require new
  delivery system models

3
Local Communities Have Unique Opportunities

• Rising numbers of uninsured likely
• State is just trying to get through the day in
  face of growing deficits (Medicaid)
• Federal government will be immersed in reform
  deliberation (looking models for addressing both
  access and cost)
• Any new approach will require new delivery models
  (Coverage is not the same as Access)
• Local communities can become learning
  laboratories for new delivery systems with local
  government as honest broker

4
Elements of Developing Effective Delivery Systems

• Know the population.
• Understand need and current health utilization of
  all levels of care.
• Find gaps/duplications in continuum.
• Align mission, financial sustainability,
  competencies of individual providers.
• Create systems to manage network.

5
Who is the focus of a safety net system?
Hospitals?
Doctors?
Unions?
County Supervisors?
Population!
6
Targeting Population

• Underserved, not just uninsured
• Medicaid
• Multiple morbidities (including pysch)
• Geographically isolated
• Under-insured
• Immigration/cultural issues
• Where do they live now and where are they moving?
• What care are they getting now and from which
  providers (FQHCs, EDs, hospitals, doctors,
  nursing homes, etc.)?

7
Population What do they need?

• Must assume what demand should be, not just what
  is.
• Population focus to determine volume of
• Primary Care
• Specialty Outpatient Care
• Inpatient acute
• Lower levels of acute
• LTC
• Translate into provider requirements.

8
Different Approaches to Determining Need
9
Building a System Filling Gaps, Eliminating
Duplication

• After mapping out need and current resources,
  identify
• Current gaps and duplications
• Inappropriate utilization
• Project future concerns about delivery system
  ability to meet need.
• Begin fitting providers to system design, based
  on
• Individual institutional mission
• Financial rationality (i.e., primary care in
  FQHCs)
• Community benefit leverage
• Not wanting to be left out

10
Bringing Players to the Table

• Start with individual discussions (even if within
  public system only)
• Propose roles, assure that others are included
• Key issues predictability, sustainability,
  equitability
• Stress role of local government bodies as honest
  brokers
• Bring all together when there is general
  agreement to endorse broader plan

11
Managing the Network

• Network management will be key takes beyond a
  puzzle of different components
• IT, referral systems, common disease management
  approach are essential
• Connections with non-acute services
• Evaluating what works and what doesnt (and
  changing it) on an ongoing basis is critical

12
Formalizing the Network

• Can be internal system oversight or
  multi-provider governance
• Accountability of all elements of the system to
  each other is important
• Planning for continual changes in the patient
  population and service needs to be key function
• Resource sharing and cost-saving is a standing
  agenda item
• Coordinated advocacy at state and national level
  is a significant benefit

13
Network Development Focused on Underserved
Populations Examples

• California Counties (unique requirement for local
  responsibility for indigent care)
• - San Mateo
• - Orange
• New Orleans (4 parishes)
• Austin, Texas (greater Travis County)
• Chicago/South Suburbs (Comer Plan/CHNU)
• Miami/Dade County
• Cincinnati/Hamilton County Plan