session 9 health and health disparitiespracticing medicine in the era of health reform session 9...
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Practicing Medicine in the Era of Health Reform
Session 9
Community Health and Health Disparities
Myechia Minter‐Jordan, MD, MBA
August 11, 2015
Tufts Health Care Institute
Goals for our discussion today To have an engaging discussion To promote an understanding of the role of CHCs in the health care system
To facilitate an understanding of Dimock and the work that we do
To understand the role of CHCs in reducing health care disparities
To understand emerging health center initiatives: integrated care, quality improvement and cost containment
To discuss Dimock’s approach to the “Triple Aim” To discuss and understand career pathways in health services admin
Health Centers in Massachusetts
• 49 community health centers • 285 sites reflect medical,
dental, behavioral health, school‐based and social services
• 800,000 patients• 800 board members
Who We AreHealth Centers Playing Major Role in State & National Health Reform
– Launch of early and massive outreach & enrollment campaigns for newly insured
− Recruitment of primary care providers to low‐income communities
– Expansion of primary/preventive care to thousands of previously uninsured state residents
– Nationally, community health centers are a cornerstone of the President’s plan to grow the nation’s primary care infrastructure
9/16/2015
Who We Are
Comprehensive and Responsive Care Model disease management programs
National “Medical Home” grant recipient Leading development of the
patient‐centered medical home model for ALL primary care practices across Massachusetts
Who We AreState‐of‐the‐Art
Facilities MA health centers have
received more than $164 million in federal funding to build new facilities, expand existing ones, upgrade technology and hire more staff
16 MA health centers will have brand new facilities within the next 2 years
Who We Are
Economic Impact 2009Health centers are both providers ofcare and economic engines in the lowincome communities they serve. Manyhealth center employees reflect therace, ethnicity, and socioeconomicstatus of their patients.
CHC Expenditures: $809 millionPayroll Expenditures: $566 millionEmployees: 12,200Additional Jobs Supported: 2,425Total Impact: $1.24 billion
Behavioral Health Child and Family Health Services
Detox Early Head Start Pedi
Outpatient addiction services
Head Start Adult
Adult/Pediatric MH Preschool Eye
Recovery Homes Early Intervention Dental
Shelter GED HIV
Residential Svcs OB GYN
Over 17,000 patients and 70,000 visits/yr
Defining Health Disparities
Many definitions and terms…
Health equity (related terms include healthcare inequality and healthcare disparities) refers to the study of differences in the quality of health and health care across different populations. This may include differences in the presence of disease, health outcomes, or access to health care across racial, ethnic, sexual orientation and socioeconomic groups.
Defining Health Disparities
More…
The Journal of the American Medical Association identifies race as a significant determinant in the level of quality of care, with ethnic minority groups receiving less intensive and lower quality care. Ethnic minorities receive less preventative care, are seen less by specialists, and have fewer expensive and technical procedures than non‐ethnic minorities.
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Defining Health Disparities
Massachusetts Health Center Patients
More than 67% percent belong to an ethnic, racial or linguistic minority group
Speak more than 40 languages Disproportionately low‐income, publicly insured or uninsured
At higher risk for developing serious chronic diseases like diabetes, hypertension and asthma
Have higher rates of smoking and obesity Limited experience with navigating the health care system
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Poverty and Health Status: Inextricably Linked
“The poor get sicker and the sicker get poorer.”
‐‐H. Jack Geiger, MD
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Poverty: A Key Determinant of Disparities
Community Health Centers were established to help break the vicious cycle of poverty & poor health status
• Health centers work to address underlying factors that determine and perpetuate poverty. Specifically, lack of:
– Educational opportunity – Economic opportunity/security – Social services and support systems
• Provide comprehensive, holistic and innovative care that recognizes the full spectrum of patients’ needs
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Poverty: A Key Determinant of Disparities
Educational Opportunity
• Many health centers provide GED preparation programs, computer courses and academic support and skill‐building classes that focus on preparing community residents for higher education opportunities.
• Innovation Spotlight: The Dimock Center offers a GED program that highlights a STEM curriculum. This program is offered to the community and is funded through grants. We have many success stories of students that graduated our program and became employed at Dimock.
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Poverty: A Key Determinant of Disparities
Economic Opportunity• In addition to employing more than 12,000 individuals, health centers also provide critical entry level jobs and training and career building opportunities right in the communities they serve.
• Innovation Spotlight: Dimock is the largest single employer in Roxbury. Dimock currently employs over 400 members from the community.
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Poverty: A Key Determinant of Disparities
Social Services, Support Systems
• Because poverty creates a unique and profound set of social stressors, many of our patients require a broad range of services that help facilitate health care and provide them with better means for pursuing healthier lifestyles:
– Outreach
– Insurance enrollment
– On‐site translation services
Poverty: A Key Determinant of Disparities
Social Services, Support Systems
– Housing: Help both with locating a place to live and for addressing housing conditions linked to illnesses like asthma
– Health education ranging from chronic disease management to nutrition
– Domestic violence prevention; support for victims of violence
– Transportation services
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Poverty: A Key Determinant of Disparities
Social Services, Support Systems
– Teen peer leadership
– Early childhood development and WIC programs
– On‐site healthy cooking classes for diabetics and other patient groups
– Patient support groups for people living with chronic disease
– Child care
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Poverty: A Key Determinant of Disparities
Social Services, Support Systems
• Innovation Spotlight: Several health centers across the state have partnered with local farmers’ markets to bring fresh produce to inner city and rurally isolated communities.
• Innovation Spotlight: Dimock maintains raised bed gardens in conjunction with the Food Project for its Head Start and Early Head Start programs. The families receive the vegetables for free and can participate in free cooking classes.
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Poverty: A Key Determinant of Disparities
Comprehensive, culturally competent care is key to addressing disparities
Community health centers have long operated within a patient‐centered care model, employing comprehensive care teams that include physicians, nurse practitioners, nurse health educators, behavioral health counselors, language interpreters and community health workers who proactively plan care with patients.
Health centers offer a comprehensive approach for a range of critical health services, including: behavioral health; substance abuse; oral health; pharmacy; and vision services.
The IHI Triple AimThe IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which is called the “Triple Aim”:
Improving the patient experience of care (including quality and satisfaction);
Improving the health of populations; and Reducing the per capita cost of health care.
Source: www.IHI.org
The Dimock Experience
Behavioral Health Pediatric Integrated Program (BHPIP) – In the first full year after integration, BHPIP has shown both operational and financial improvements compared to our previous model of separate BH and primary care services:
1. A 40% increase in BH appointment capacity and a 10% increase in unique patients receiving BH services, due to increased provider productivity related to operational efficiencies
2. Shorter time from referral to intake (from 3 months down to 1 week)3. Increased compliance with initial BH visit (from 30% to 67%)
*attributable to the warm handoff process from pediatricians to BH providers and to the licensed clinician/integrated care manager
4. A 48% decrease in staffing needs due to operational efficiencies, which represent $100,000 in savings without sacrificing patient access to services
5. A 7.3% decrease in bad debt
The Dimock Difference‐ Clinical Quality
2014 Clinical Performance
Dimock Surpasses State and National Measures on 9 of 13 clinical quality measures
The Dimock Difference‐ cost per patient vs other Massachusetts health care entities
Career Pathways
How does a physician become a President/CEO?
MPH vs. MBAPhysician Leadership Opportunities
To have an engaging discussion To promote an understanding of the role of CHCs in the health care system
To facilitate an understanding of Dimock and the work that we do
To understand the role of CHCs in reducing health care disparities
To understand emerging health center initiatives: integrated care, cost containment, and quality improvement
To discuss Dimock’s approach to the “Triple Aim” To discuss and understand career pathways in health services admin
Goals revisited: Did we get to where we set out to go?
