the palmetto project: putting innovative ideas to work in south carolina-steve skardon
DESCRIPTION
Steve Skardon Safety Net Summit Presentation, September 23, 2009TRANSCRIPT
The Palmetto The Palmetto ProjectProject
Putting Innovative Ideas Putting Innovative Ideas to Work in South Carolinato Work in South Carolina
Steve Skardon, Executive Director
South Carolina Immunization Partnership
Communicare
AccessNET Provider Collaborative & Patient Navigator Network
South Carolina Immunization PartnershipFebruary 1993 – May 1994
ObjectiveMake S.C a national leader in childhood immunization
PartnersS.C. Department of Health & Human ServicesPalmetto ProjectAlliance for South Carolina’s ChildrenBlue Cross Blue Shield of SCS.C. Press AssociationRotary & Lions Clubs
South Carolina Immunization Partnership(continued)
Methods
Political campaign techniques identify, educate, & motivate parents
Community partnerships among business and civic leaders create local strategies in 13 public health districts
Broadcast and print media partners in each health district
Outcomes
Increased immunization rates statewide from 53% to 90%
Ranked by CDC as 1st in the nation in 1994
Communicare 1993 – present
ObjectiveImprove access and coordination of health care services for the uninsured and underinsured
PartnersS.C. Medical AssociationS.C. Hospital AssociationS.C. Pharmacy AssociationSix National Pharmaceutical CompaniesSmith Kline Beecham Labs
Communicare (continued)
Methods
Care coordinator at statewide toll-free call center arranges for…
free visit for any uninsured caller to one of 2,000 providers
free pharmaceuticals from formulary of six participating drug companies,
overnight stays at one of 30 participating hospitals
Outcomes
53% of 8,000 clients provided medical home
Central fill pharmacy provides 1000 free prescriptions daily at an estimated value of more than $70 million annually (Welvista)
Faith-based Initiative in African American health reduces disparity in cardiovascular mortality among males by 50%. (Heart & Soul)
AccessNET Provider Collaborative & Patient Navigator Network 2005 – present
ObjectiveImprove health care outcomes and reduce cost of care for the uninsured with chronic disease through enhanced provider coordination and patient-centered navigation
PartnersMedical University of South Carolina (Women’s Health Initiative)Medical University of South Carolina (Children’s Hospital)Two Federally Qualified Community Health CentersThree Local Free ClinicsCharleston Dorchester Mental Health AssociationSC Department of Health & Environmental ControlSC Office of Research & Statistics
AccessNET(continued)
Methods
Providers standardize records into single data management system (AIMS), implement procedures for patient referral & medical follow up, & refer patients to health education and disease management programs
Navigators assess needs of new patients, address barriers to care, develop plan for care including referral to primary & specialty care and pharmacy assistance,
Outreach specialists implement health education and disease prevention programming in at-risk communities, conduct ongoing screening, monitoring, life style modification, $ disease self-screening, monitoring, life style modification, $ disease self-management for navigated patientsmanagement for navigated patients
AccessNET(continued)
Outcomes
100% of 2,000 clients provided medical home and access to patient navigation services
AIMS system becomes statewide platform for statewide medical records locator and health information exchange for 4.4 million South Carolinians
Cost of care for navigated patients declines by 27%
A 66 percent reduction in emergency room utilization by navigated patients with diabetes
An 83 percent reduction in ER utilization by navigated patients with cardiovascular disease
Lessons Learned
Clearly perceived need & limited objective
Opportunity
Plan
Needs assessment of every collaborating partner
Management of Collaborative: Democratic versus direction from lead partner?
Signs of early success
Y’all com beck, y’hare?Y’all com beck, y’hare?
“To every person there comes in life that special moment when one is tapped on the shoulder and offered the chance to do one very special thing. What a tragedy if that
moment finds you unprepared or unqualified for the work which would be
your finest hour.”“
Winston Churchill
Where are we headed?(and who’s doing the driving?)
Regional Networks of Care
We can’t solve problems by using the same kind of thinking we used when we created
them.”
Albert Einstein
Regional Networks of CareRegional Networks of Care
Population Population
703,505703,505
Nearly 45% of population is uninsured
or does not have sufficient coverage
to meet its needs.
Regional Networks of Care
Continuum of CareProvider collaborative reduces administrative duplication
& streamlines access to primary, diagnostic, & specialty care
Access & Care CoordinationNew navigator network increases access & care coordination
Education & Prevention149 Heart & Soul sites provide outreach & ongoing health
education
Data Collection & ManagementProviders create single data management system
Regional Networks of Care
Medical Outcomes & Patient Centered Care
Medical Outcomes & Patient Centered Care
Outcomes research seeks to understand the end results of particular health care practices and interventions. These include effects that people experience and care about, such as change in the ability to function. For individuals with chronic conditions, end results include quality of life as well as mortality. By linking the care people get to the outcomes they experience, outcomes research has become the key to developing better ways to monitor and improve the quality of care.
Agency for Healthcare Research and Quality
Medical Outcomes & Patient Centered Care
Patient centered care is that which is based on a partnership among practitioners, patients, & their families to ensure that decisions respect patient wants, needs, and preferences and that patients have the required education & support to make decisions and participate in their own care.
Institute of Medicine
Regional Networks of Care
Medical Outcomes & Patient Centered Care
Data Management & Electronic Records
Disabilities & Special Needs
Vocational Rehabilitation Law Enforcement
Health Department
Education
Outpatient Surgeries
State Employee Health Services
Emergency Room Visits
Hospitalizations
Environmental Conditions
Home Health Care
Medicaid Services
Social Services
Public Safety
Mental Health
Juvenile Justice
Free Clinic Visits
Alcohol & Drug Services
Child Care
Community Health Centers
Medicare
Disease Registries
Elder Services & Assessments
SC
Integrated
Data
System
Probation, Pardon & Parole
Corrections*
Legal/Safety Services
Social Services
Claims Systems
All Payer Health Care Databases
Behavioral Health
Health Department
Education
Other State Support Agencies
Disease Registries
LEGEND
Data Management & Electronic RecordsData Management & Electronic Records
Web-based database system designed and implemented by Web-based database system designed and implemented by the SC Office of Research and Statistics (ORS),the SC Office of Research and Statistics (ORS),
System integrations and coordination utilizes the state’s System integrations and coordination utilizes the state’s HIPAA compliant secure Data Warehouse and Client HIPAA compliant secure Data Warehouse and Client Information System. Information System.
Accessible to all collaborative members for information Accessible to all collaborative members for information storage and retrieval, referral of clients, and meeting storage and retrieval, referral of clients, and meeting reporting requirements. reporting requirements.
PNs use the AIMS individual client records as basic client PNs use the AIMS individual client records as basic client information---scheduled appointments, language, pharmacy information---scheduled appointments, language, pharmacy and transportation needs are viewed up to date, in real time. and transportation needs are viewed up to date, in real time.
Database allows for maintaining information about the client; Database allows for maintaining information about the client; tracking and maintaining client appointments, assessments, tracking and maintaining client appointments, assessments, and referrals; recording information about community and referrals; recording information about community outreach activities and health education.outreach activities and health education.
Regional Networks of Care
Medical Outcomes & Patient Centered Care
Data Management & Electronic Records
Communications
Communications
Last year 98,000 patients died as a result of medical errors.
According to the American Hospital Association, the leading cause of those errors was inadequate communication
among providers.
o
Communications
Evidence-based practices are specific clinical guidelines that help bridge the gaps between what researchers find to be effective treatment and what is implemented at the practice level. Their use is growing in all areas of health care in an effort to reduce errors and improve health.
According to the Institute of Medicine, only 50%-
60% of medical treatments are evidence-based.
Regional Networks of Care
Medical Outcomes & Patient Centered Care
Data Management & Electronic Records
Communications
New Programming under PNDP
New H&S Health
Education & Prevention
Sites
New Health Collaborativ
e Service Delivery
Sites
Health Conditions TargetedHealth Conditions Targeted
DiabetesDiabetesSC is 2SC is 2ndnd in the nation in the nation
Hypertension/CVDHypertension/CVDSC is 3SC is 3rdrd in the nation for high blood in the nation for high blood pressurepressure
StrokeStrokeSC is 2SC is 2ndnd highest in the nation for highest in the nation for stroke mortalitystroke mortality
Obesity Obesity SC is 3SC is 3rdrd in the nation for obesity in the nation for obesity
Disparities in Disparities in Cardiovascular DiseaseCardiovascular Disease
African Americans had a higher African Americans had a higher prevalence rate (15.4%) than prevalence rate (15.4%) than Caucasians (8.4%).Caucasians (8.4%).
African Americans were more likely to African Americans were more likely to report a diagnosis of high blood report a diagnosis of high blood pressure (36.4%) than Caucasians pressure (36.4%) than Caucasians (29.5%).(29.5%).
African American men in SC are likely African American men in SC are likely to die from CVD 10 years before white to die from CVD 10 years before white men. Most will not reach 65men. Most will not reach 65..
Palmetto Project
What does it take to provide health What does it take to provide health care to the nearly 45% of South care to the nearly 45% of South
Carolinians without private health Carolinians without private health insurance?insurance?
Continuum of CareContinuum of Care Access & Care CoordinationAccess & Care Coordination Health Education & Disease Health Education & Disease
PreventionPrevention Data Collection & ManagementData Collection & Management
Target CountiesTarget Counties
Population Population 703,505 703,505
Nearly 45% of population
are uninsured or do not have
sufficient coverage to meet
their needs.
Disparities in StrokeDisparities in Stroke Mortality from stroke among African Mortality from stroke among African
Americans is 24% higher than the national Americans is 24% higher than the national average.average.
African Americans are 40 percent more African Americans are 40 percent more likely to die from stroke than Caucasians.likely to die from stroke than Caucasians.
Identifiable and treatable risk factors for Identifiable and treatable risk factors for CVD and stroke nearly twice those of whitesCVD and stroke nearly twice those of whites
One in three African Americans has high blood One in three African Americans has high blood pressure pressure
One in two is overweightOne in two is overweight Two in three are physically inactive.Two in three are physically inactive.
Disparities in Diabetes
IIn 2005, estimated 280,000 state residents had n 2005, estimated 280,000 state residents had been diagnosed with diabetes, and another been diagnosed with diabetes, and another 140,000 have diabetes but do not know it 140,000 have diabetes but do not know it
African Americans had a higher prevalence African Americans had a higher prevalence rate for diabetes (15.4%) than Caucasians rate for diabetes (15.4%) than Caucasians (8.4%).(8.4%).
Mortality rates for diabetes were three times Mortality rates for diabetes were three times higher for non-whites as for whithigher for non-whites as for whiteses
ER visits for diabetes were almost seven ER visits for diabetes were almost seven times higher among African Americans than times higher among African Americans than among whites.among whites.
In Dorchester County, diabetes resulted in more In Dorchester County, diabetes resulted in more than three times as many ER visits for blacks than than three times as many ER visits for blacks than whites.whites.
How Patients are IdentifiedHow Patients are Identified
Referrals by collaborative partnersReferrals by collaborative partners
Outreach & screeningOutreach & screening
CommunityCommunity
Target Capacity under PNDPTarget Capacity under PNDP
3,000 navigated clients by August 3,000 navigated clients by August 20102010
What are the What are the interventions?interventions?
Outreach to health disparities populationsOutreach to health disparities populations Prevention and early detectionPrevention and early detection
Education, screening, monitoring, life style Education, screening, monitoring, life style modificationmodification
Referral to primary careReferral to primary care Referral for diagnostic and specialty careReferral for diagnostic and specialty care Medication assistanceMedication assistance Reduction of BarriersReduction of Barriers Self-management goal settingSelf-management goal setting Facilitate involvement with community Facilitate involvement with community
organizationsorganizations Coordinate with relevant insurance/other Coordinate with relevant insurance/other
coveragecoverage
PNDP Navigated PatientsPNDP Navigated PatientsPN Actions by Patient ConditionPN Actions by Patient Condition Diabetes = 53Diabetes = 53 Ophthalmology scheduling = 21Ophthalmology scheduling = 21 Foot care scheduling = 4Foot care scheduling = 4 Hypertension = 186Hypertension = 186 Cardiology scheduling = 22Cardiology scheduling = 22 Cancer screening and treatment referrals Cancer screening and treatment referrals
= 41= 41 Women’s services/OB/GYN scheduling = Women’s services/OB/GYN scheduling =
9090 Pediatrics = 266Pediatrics = 266 Dental or oral health scheduling = 10Dental or oral health scheduling = 10 Mental health referrals = 11Mental health referrals = 11 Other specialty care scheduling = 148Other specialty care scheduling = 148
Arthritis (8) Neurology (12) Arthritis (8) Neurology (12) Pulmonology (6) Pulmonology (6)
GI (78)GI (78) Orthopedic (10) ENT (14) Orthopedic (10) ENT (14)
Dermatology (20)Dermatology (20)
Non-Disease Non-Disease Specific PN Specific PN ActivitiesActivities
Health coverage Health coverage assistance = 28assistance = 28
Medication/PAP Medication/PAP assistance = 68assistance = 68
(ECCO PAP = 298)(ECCO PAP = 298)
SC Data WarehouseSC Data Warehouse Builds off of existing legacy systems from state agencies and Builds off of existing legacy systems from state agencies and
private sectorprivate sector Creates a Unique ID (not related to any other number)Creates a Unique ID (not related to any other number) Identifiers are pulled off of the statistical data. Use only the Identifiers are pulled off of the statistical data. Use only the
statistical datastatistical data Data is always “owned” by originating agency. Permissions Data is always “owned” by originating agency. Permissions
required to use and/or linkrequired to use and/or link
Using Data in the Data Warehouse Agencies & Other Using Data in the Data Warehouse Agencies & Other Entities can:Entities can:
Evaluate their programsEvaluate their programs Look at OutcomesLook at Outcomes Understand better how their programs interact with other agency & Understand better how their programs interact with other agency &
other entity programsother entity programs Study Health, Human Service, Education, and Law Enforcement IssuesStudy Health, Human Service, Education, and Law Enforcement Issues Analyze Statistical – Aggregate InformationAnalyze Statistical – Aggregate Information Access Analytic Data CubesAccess Analytic Data Cubes Partner in the Development of Customized Software Applications Partner in the Development of Customized Software Applications
The Client Information The Client Information SystemSystem
Web-based HIPAA compliant secure Client Web-based HIPAA compliant secure Client Information System tracks SC public sector Information System tracks SC public sector clients and services across multiple clients and services across multiple
agenciesagencies. . For For Treatment and OperationsTreatment and Operations Designed to provide a 12-month rolling history of the client’s Designed to provide a 12-month rolling history of the client’s
services. services. Includes management and summary reports. Includes management and summary reports. Medicaid clients served by the Dept. of Health and Human Medicaid clients served by the Dept. of Health and Human
Services operational. Services operational. Discussions with two other state agenciesDiscussions with two other state agencies Legal teams involvedLegal teams involved End product will allow the tracking of SC public sector clients End product will allow the tracking of SC public sector clients
across multiple agencies to ensure better coordination and across multiple agencies to ensure better coordination and management. management.
AIMSAIMS
Web-based database system designed and implemented by the Web-based database system designed and implemented by the SC Budget and Control Board’s Office of Research and SC Budget and Control Board’s Office of Research and Statistics (ORS),Statistics (ORS),
System integrations and coordination utilizes the state’s System integrations and coordination utilizes the state’s HIPAA compliant secure Data Warehouse and Client HIPAA compliant secure Data Warehouse and Client Information System. Information System.
Accessible to all collaborative members for information Accessible to all collaborative members for information storage and retrieval, referral of clients, and meeting storage and retrieval, referral of clients, and meeting reporting requirements. reporting requirements.
PNs use the AIMS individual client records as basic client PNs use the AIMS individual client records as basic client information---scheduled appointments, language, pharmacy information---scheduled appointments, language, pharmacy and transportation needs are viewed up to date, in real time. and transportation needs are viewed up to date, in real time.
Database allows for maintaining information about the client; Database allows for maintaining information about the client; tracking and maintaining client appointments, assessments, tracking and maintaining client appointments, assessments, and referrals; recording information about community and referrals; recording information about community outreach activities and health education.outreach activities and health education.
AccessNETAccessNETRHIO HeadStartRHIO HeadStart
State Data Warehouse used to establish a Record Locator Service (RLS) for the region as well as longitudinal record for over 4 million residents of the state. Specifically, the data includes
• all Medicaid (including pharmacy and physician office visits)• State Health Plan claims • UB-92 inpatient, ambulatory surgery and ED claims• In summary, a secure “bus” to connect to.
As such, this warehouse will provide a nearly comprehensive record of all providers who have served a given patient or client since 1996
• Diagnoses• Procedures• Prescription History