Vertically Integrated

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• Vertically Integrated
• Rural/Suburban Health Networks
• to Address Community Health Needs
• Greg Dent
• Chair Crawford County Commission
• Founding Board Member
• Shannon T. Harvey, CEO
• sharvey_at_chwg.org
• 1-478-994-1914

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• Issues of Health.
• Why Should Counties Care?
• Healthy constituents are happier constituents
• Linked to educational and economic vitality

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• Whats the big deal about being uninsured, why
  should counties care?
• Most uninsured families are headed by a full
  time, full year worker
• miss twice as many days of work as insured
• live sicker and die younger
• kids miss 4.5 times as much school
• Uninsured typically delay care and are sicker
  when they get it episodic at the most expensive
  sites

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• Uncompensated care is expensive and has to be
  paid for
• Costs borne by
• Providers
• People who buy private insurance
• Taxpayers

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• Counties invest in health infrastructure
• EMS
• Public health
• Hospital
• Makes sense to reduce burden on safety net
  investment

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• But how?
• Through the power of partnership
• Can it really be done?
• Absolutely yes!

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• The Proof of the Yes
• Since 2001
• Garnered 3.2 million in new investment
• Recovered 1 million in lost Medicaid/Medicare
• Coordinated care of almost 2000 multiply
  diagnosed, chronically ill uninsured across 9
  central Georgia counties
• Posted 348,505 in annual savings to health
  system

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• Our evaluator states
• The news is good and only going to get better.
  70 of ER visits and 66 of hospitalizations
  occur within the first six months of care
  management.

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• Bottom lines
• This is a win for counties!
• Be part of the solution!
• How?

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Health Care Central Georgia. Inc. D/B/A Community
Health Works Region
CATOOSA
RABUN
FANNIN
TOWNS
DADE
UNION
MURRAY
WHITFIELD
GILMER
WALKER
HABERSHAM
WHITE
LUMPKIN
STEPHENS
CHATTOOGA
GORDON
PICKENS
FRANKLIN
DAWSON
HART
HALL
BANKS
FORSYTH
BARTOW
CHEROKEE
FLOYD
ELBERT
JACKSON
MADISON
POLK
BARROW
COBB
OGLETHORPE
CLARKE
GWINNETT
PAULDING
OCONEE
HARALSON
WILKES
WALTON
LINCOLN
DEKALB
DOUGLAS
FULTON
GREENE
TALIAFERRO
CLAYTON
ROCKDALE
COLUMBIA
CARROLL
MORGAN
MCDUFFIE
NEWTON
HENRY
FAYETTE
WARREN
RICHMOND
JASPER
PUTNAM
COWETA
HEARD
HANCOCK
GLASCOCK
BUTTS
SPALDING
JEFFERSON
MERIWETHER
BURKE
BALDWIN
PIKE
JONES
LAMAR
MONROE
TROUP
WASHINGTON
UPSON
JENKINS
WILKINSON
BIBB
SCREVEN
JOHNSON
HARRIS
CRAWFORD
TWIGGS
TALBOT
EMANUEL
LAURENS
PEACH
TAYLOR
MUSCOGEE
BULLOCH
EFFINGHAM
BLECKLEY
HOUSTON
MARION
TREUTLEN
CANDLER
MACON
CHATTAHOOCHEE
MONTGOMERY
SCHLEY
PULASKI
DODGE
EVANS
DOOLY
BRYAN
WHEELER
CHATHAM
WEBSTER
STEWART
TOOMBS
TATTNALL
SUMTER
WILCOX
TELFAIR
CRISP
LIBERTY
QUITMAN
LEE
LONG
JEFF DAVIS
TERRELL
BEN HILL
APPLING
TURNER
RANDOLPH
WAYNE
IRWIN
MCINTOSH
BACON
COFFEE
CLAY
WORTH
DOUGHERTY
CALHOUN
TIFT
PIERCE
EARLY
BAKER
ATKINSON
GLYNN
BERRIEN
BRANTLEY
WARE
COLQUITT
MITCHELL
MILLER
COOK
LANIER
CAMDEN
SEMINOLE
CLINCH
CHARLTON
DECATUR
GRADY
THOMAS
BROOKS
LOWNDES
ECHOLS
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A region of great need Rural Minority Poor
Un- or Publicly Insured, Underserved by a
Fraying Service System Disabled and Dying
Preventable Deaths
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Out of Great Need. . Possibility How
can we better, together, serve the uninsured than
weve been doing separately?
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• Step one
• A neutral convening leader
• With relational pull
• With perseverance
• Could that be YOU?
• To frame the common need and interest question

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Who We Are Public/private partnership of
providers, community leaders and county
governments with common mission of improving
communities physical and fiscal
health Originally born from a convening intent
to more effectively address common problem of
uncompensated care
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• Our Board Leadership
• 5 Hospital CEOs
• 1 District Health Director
• 2 Behavioral Health System CEOs
• 2 Primary Care Physicians
• 2 Specialty Physicians
• 1 Foundation CEO
• 1 Medical School Dean
• 1 Volunteers in Medicine Clinic Chairman
• County Commissioners from 4 Counties
• (2 Chairmen)
• 1 Family Connection Regional Coordinator
• 1 Twiggs County Community Leader

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Step Two Follow the Data and Plan to
Evaluate What are my regions health
needs? What will we do? How will we know if
were successful? How will we measure that?
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• Our experience.
• Enrollment based program
• Adults 19-64 years old with incomes under 235
  FPL and either hypertension, heart disease,
  diabetes or depression
• Three components
• Access to continuum of primary and specialty
  care, labs/diagnostics, life-sustaining
  pharmaceuticals and hospital services
• Disease management
• Holistic care management

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• Our Current Network
• 80 physicians,
• 2 clinics,
• 23 pharmacies, and
• 6 hospitals
• 2 behavioral health providers
• 8 health departments
• across nine counties

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• Member Picture
• Average Education
• 11th Grade
• Average Income
• 4949.30/yr
• Average Number Diseases/Member 2
• Average Meds/Member 5

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Overall Comparison

• C H W
• Rates Per Member
• Discharges .193
• ER Visits .33

• MEPS
• Rates Per Member
• Discharges .24
• ER Visits .52

Extra Annual Discharges at MEPS rates
303,000 Extra Annual Costs if ER Visits at MEPS
rates 45,505 August 2003 data
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Trends over Time

• For those with more than 6 months of membership
  (58 of total members)
• 70 of ER visits occur in first 6 months of
  membership
• 66 of hospitalizations occur in first 6 months
  of membership
• August 2003 data

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• How have we been successful?
• Leadership Vision and Intent
• Board and managerial toward true partnership for
  health
• Patient focused processes and protocols
• Information Technology
• Web-based screening, eligibility, enrollment,
  assessment, care planning, care management,
  provider and pharmacy assignment across the
  continuum, care tracking by ICD9, CPT, costs and
  revenue streams
• Georgia Health Policy Center knowledge of
  financing and evaluation

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• A Different Frame.
• How can the crisis be used as an opportunity to
• Align payor and provider incentives?
• Use healthcare spending to fuel economic
  development in communities?
• Harness the power of communities to improve
  health?

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• A political win
• Bi-partisan
• Locals reinvest in community health. Moving to a
  culture of health investment will be increasingly
  important as US grays
• Aligns incentives so that local, state, national
  working together
• Harness the power of communities to change health
  and save
• Releases money over time - from existing system
  to improve the health of citizens as community
  capacity is built and culture is changed
• Economic engine for communities local
  infrastructure capacity so important in era of
  devolution

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• As leaders
• Our job is not
• to fix the past.
• Our job is
• to create the future.

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• Leaders make things possible.
• Great leaders
• make them inevitable.