emerging models- reaching the hard to reach and underserved
TRANSCRIPT
EMERGING MODELS: Reaching the Hard to
Reach and UnderservedModerator:
Tyra Tomlin, Detroit Medical Center
Panelists
Andrea Boudreux, PsyD, MPH, MA, Catholic Health Initiatives
Diana Jackson-Davis, PhD, Parkview Health
Antionette Smith Epps, MHSA, Ferris State University
LaShannon Spencer, MPA, MHSA, Community Health Centers of Arkansas
EMERGING MODELS: Reaching the Hard to Reach and Underserved
The healthcare industry is ever changing. Fee for
service reimbursement and large tertiary facilities are
being replaced by more population based methods of
care compensation.
What are the new models that will prove to be
successful and add value to the organization and the
patient in this new age of healthcare?
EMERGING MODELS: Reaching the Hard to Reach and Underserved
Historically, minorities have been underserved,
received less access to care and experience poorer
health outcomes.
This session on emerging models of health care
delivery will explore specific populations that remain
hard to reach and examine emerging models that can
be adopted to better serve underserved community
members.
EMERGING MODELS:Reaching the Hard to Reach and Underserved
Participants will leave with an understanding of new models of healthcare delivery for the following populations:
African American males
The Elderly
Immigrant Populations
Rural Residents
Participants will understand how these models can be applied to provide care to other underserved populations and provide service in community based programs.
Participants will understand how the shift toward a value based system will impact their organizations and the importance of continuing to provide innovative care to vulnerable populations.
Cultural Issues with
Immigrants in Health Care
Diana Jackson-Davis, PhD,
Parkview Health
1. Understand the effects of current demographic trends
on U.S. healthcare
2. Understand the impact of health disparities on
prevalence of disease among immigrant populations
3. Learn why cultural education for healthcare providers
is an important method for addressing health
disparities
4. Learn practical methods for improving cultural
competence among members of an healthcare team
Learning Objectives
To create a more inclusive environment and
community
To establish dialogue and connections between
immigrant groups
To effectively advocate for immigrants and refugees
in the community
To encourage positive understanding about
immigrants
Why it is important to know about immigration
and how it impacts our community
African American Males and
Community Health Centers
LaShannon R. Spencer, MPA, MHSA
Chief Executive Officer
Community Health Centers of Arkansas/Arkansas Primary Care Association
What are Health Centers?
Community, Migrant, Homeless, Public Housing, and other Health Center Program grantees are non-profit, community directed providers that remove common barriers to care by serving communities who otherwise confront financial, geographic, language, cultural and other barriers.
Located in high-need areas identified as having elevated poverty, higher than average infant mortality, and where few physicians practice.
Tailor services to fit the special needs and priorities of their communities, and provide services in a linguistically and culturally appropriate manner.
Provide comprehensive primary and other health care services: medical, dental, mental health, and pharmacy.
Provide high quality care, reducing health disparities and improving patient outcomes.
Cost effective, reducing costly emergency, hospital, and specialty care, and saving the health care system $24 billion a year nationally.
And Community Health Centers are not FREE Clinics
Source: National Association Community Health Centers
Health Center
Population
United States
Population
Percent at or Below
100% of Poverty71% 15%
Percent Under 200% of
Poverty 92% 34%
Percent Uninsured 28% 10%
Percent Medicaid 47% 19%
Percent Medicare 9% 13%
Percent Hispanic/Latino 34% 17%
Percent African
American 20% 13%
Percent Asian/Pacific
Islander4% 6%
Percent American
Indian/Alaska Native 1% 1%
Percent White 57% 77%
CHCA
Community Health Centers of Arkansas, Inc.ARKANSAS PRIMARY CARE ASSOCIATION
StatewideLookat Arkansas CommunityHealth Centers
Southside
Batesville
5
Fayettevil
le
Bee
Branch
FQHC Legend
1st Choice Healthcare, Inc. ARcare
Boston Mountain Rural Health Center, Inc.
CABUN Rural Health Services, Inc.
Community Clinic
East Arkansas Family Health Center, Inc.
Healthy Connections, Inc.
Jefferson Comprehensive Care System, Inc.
Lee County Cooperative Clinic, Inc.
Mainline Health Systems, Inc.
Mid-Delta Health Systems, Inc.
River Valley Primary Care Services, Inc.
Source: 2014
UDS
Diabetes Health Statistics - (UDS
2013 - 2015)
2013 2014 2015
Health Center
Total # of
Patients
# of Patients
with Diabetes
% Patients
with Diabetes
Total # of
Patients
# of Patients
with Diabetes
% Patients
with Diabetes
Total # of
Patients
# of Patients
with Diabetes
% Patients
with Diabetes
ArCare 40,442 3,392 8.4% 47,241 3,977 8.4% 51,421 4,487 8.7%
Boston Mtn 14,967 1,137 7.6% 15,404 1,413 9.2% 13,991 1,170 8.4%
CABUN 8,234 932 11.3% 7,801 910 11.7% 7,448 879 11.8%
Community Clinic 27,238 1,590 5.8% 31,562 1,936 6.1% 35,244 2,098 6.0%
1st Choice 13,465 1,117 8.3% 14,101 1,273 9.0% 15,010 1,345 9.0%
East Arkansas 12,596 1,569 12.5% 13,174 1,931 14.7% 14,221 2,075 14.6%
Healthy Connections 5,384 503 9.3% 6,780 651 9.6% 7,938 721 9.1%
Jefferson 11,414 1,058 9.3% 10,186 1,046 10.3% 8,409 890 10.6%
Lee County 4,427 544 12.3% 3,801 539 14.2% 3,418 502 14.7%
Mainline 8,755 757 8.6% 9,675 764 7.9% 10,791 768 7.1%
Mid-Delta 3,318 351 10.6% 2,985 278 9.3% 2,930 284 9.7%
River Valley 13,557 1,167 8.6% 14,507 1,272 8.8% 15,370 1,455 9.5%
Network 163,797 14,117 8.6% 177,217 15,990 9.0% 186,191 16,674 9.0%
CHCA: Diabetes Health Statistics
"To improve the health of African-American men, we must consider addressing why
they lack trust in the health-care system and its providers and social determinants
that prohibits access.”
Service Challenges in Rural
and Aging Populations
Antionette Smith Epps, MHSA
Assistant Professor Health Administration
Ferris State University
Learning Objectives
1. Understand the demographics of rural and aged
populations in the United States.
2. Understand the issues associated with
providing services to rural and aged
populations.
3. Present two models of service provision that
can be used to address the needs of these
populations.
4. Examine data on the effectiveness of these
models.
Community Health Worker Model
Definition:
A community health worker is a frontline public health
worker who is a trusted member of and/or has an
unusually close understanding of the community and
serves as a liaison/link/intermediary between
health/social services and the community to facilitate
access to services and improve the quality and cultural
competence of service delivery.
American Public Health Association
Community Health Workers Section
Community Health Worker Model
Research has documented improvements
Appropriate health care utilization
Health behaviors
Health outcomes
Care navigation
Problem solving
Self management skills
Goal setting and monitoring
Care coordination
Verhagen, I., Steunenberg, B., De Wit, N., & Ros, W. (2014). Community health worker interventions to improve access to
health care services for older adults from ethnic minorities: A systematic review. BMC Health Services Research, 14(1), BMC
Health Services Research, 2014, Vol.14(1)
Core Health Program Spectrum Health of Michigan
Free, home based program at two SH
locations 12 month program with monthly in home visits
Urban site in Grand Rapids, Michigan
Rural site in Greenville, Michigan
Targets diabetes & heart failure patients who
must be willing to make life style changes to
improve health
Encouraging results first year in Greenville 2015 full year of data
2016 ½ year of data
Core Health Program Spectrum Health of Michigan
Heart Failure Outcomes
Measure Pre Core Health Post Core Health
ED Utilization 75% 25%
Hospitalizations 62.5% 12.5%
HF in zone green 87.5% 100%
BP↓ 130/80 50% 62.5%
Annual Dental Visit 28.6% 42.9%
PAM Score >67.0 60% 100%
Spectrum Health Core Health Quality Outcomes Report, June 2016
Core Health Program Spectrum Health of Michigan
Diabetes Outcomes
Measure Pre Core Health Post Core Health
ED Utilization 52.2% 45.7%
Hospitalizations 41.3% 21.7%
Weekly Physical
Activity2.2 4.2
BP↓ 130/80 32.6% 54.3
HbA1c < 7% 34.1% 26.1%
PAM Score >67.0 48.7% 94.9%
Spectrum Health Core Health Quality Outcomes Report, June 2016
The shift from Volume to Value
and the importance of Primary
Care
Andrea J. Boudreaux, PsyD, MPH, MA
Associate Administrator
Catholic Health Initiatives
Shifting to Value: A Journey
Fee for Service
Sustainable Growth Rates
Bundled Payments
MACRA
APM
MIPS
Timeline 2017
2022
Implications to Health Systems
Clinically Integrated Networks versus
Physician Hospital Organizations
Develop road maps now to prepare for
measurements in 2017
Data analytics
Quadruple Aim
Triple Aim shortcomings
Provider Burnout
Why Primary Care Matters
Care in the appropriate place
Sickness versus Health industry
Value based reimbursement
Integrated care
Integrated Model
Psychology (Behavioral Health)
Care Teams
Advanced Practice Clinicians
Sample Case
Dr. X – value based reimbursement
Dr. Y – fee for service reimbursement
EMERGING MODELS
QUESTIONS?
EMERGING MODELS
Andrea Boudreux, PsyD, MPH, MA, Catholic
Health Initiatives [email protected]
Diana Jackson-Davis, PhD, Parkview Health [email protected]
Antionette Smith Epps, MHSA, Ferris State
University [email protected]
LaShannon Spencer, MPA, MHSA,
Community Health Centers of Arkansas [email protected]