“Building Collaborative Health Networks: Pat Terrell”

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

Building Regional, Collaborative Health Care Networks
Why?
Pressure will mount on local communities and governments to meet growing need
Publics can’t meet need alone
Providers motivated to come to the table to bring new ideas
National—and state--reform will require new delivery system models

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”

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.

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

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.)?

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.

Different Approaches to Determining Need

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”

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

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 doesn’t (and changing it) on an ongoing basis is critical

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

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

“Building Collaborative Health Networks: Pat Terrell”

by Health & Medicine Policy Research Group on Jun 26, 2009

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“Building Collaborative Health Networks: Pat Terrell” — Presentation Transcript