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The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon
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The Palmetto Project: Putting Innovative Ideas to Work in South Carolina-Steve Skardon

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Steve Skardon Safety Net Summit Presentation, September 23, 2009

Steve Skardon Safety Net Summit Presentation, September 23, 2009

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  • We have been building a statistical data warehouse for the State of SC.
  • Transcript

    • 1. The Palmetto ProjectThe Palmetto Project Putting Innovative IdeasPutting Innovative Ideas to Work in South Carolinato Work in South Carolina Steve Skardon, Executive Director
    • 2. South Carolina Immunization Partnership Communicare AccessNET Provider Collaborative & Patient Navigator Network
    • 3. South Carolina Immunization Partnership February 1993 – May 1994 Objective Make S.C a national leader in childhood immunization Partners S.C. Department of Health & Human Services Palmetto Project Alliance for South Carolina’s Children Blue Cross Blue Shield of SC S.C. Press Association Rotary & Lions Clubs
    • 4. 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
    • 5. Communicare 1993 – present Objective Improve access and coordination of health care services for the uninsured and underinsured Partners S.C. Medical Association S.C. Hospital Association S.C. Pharmacy Association Six National Pharmaceutical Companies Smith Kline Beecham Labs
    • 6. 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)
    • 7. AccessNET Provider Collaborative & Patient Navigator Network 2005 – present Objective Improve health care outcomes and reduce cost of care for the uninsured with chronic disease through enhanced provider coordination and patient- centered navigation Partners Medical University of South Carolina (Women’s Health Initiative) Medical University of South Carolina (Children’s Hospital) Two Federally Qualified Community Health Centers Three Local Free Clinics Charleston Dorchester Mental Health Association SC Department of Health & Environmental Control SC Office of Research & Statistics
    • 8. 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,screening, monitoring, life style modification, $ disease self-management for navigatedmonitoring, life style modification, $ disease self-management for navigated patientspatients
    • 9. 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
    • 10. 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
    • 11. Y’all com beck, y’hare?Y’all com beck, y’hare?
    • 12. “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
    • 13. Where are we headed? (and who’s doing the driving?)
    • 14. Regional Networks of Care We can’t solve problems by using the same kind of thinking we used when we created them.” Albert Einstein
    • 15. Regional Networks of CareRegional Networks of Care PopulationPopulation 703,505703,505 Nearly 45% of population is uninsured or does not have sufficient coverage to meet its needs.
    • 16. Regional Networks of Care Continuum of Care Provider collaborative reduces administrative duplication & streamlines access to primary, diagnostic, & specialty care Access & Care Coordination New navigator network increases access & care coordination Education & Prevention 149 Heart & Soul sites provide outreach & ongoing health education Data Collection & Management Providers create single data management system
    • 17. Regional Networks of Care Medical Outcomes & Patient Centered Care
    • 18. 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
    • 19. 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
    • 20. Regional Networks of Care Medical Outcomes & Patient Centered Care Data Management & Electronic Records
    • 21. 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
    • 22. Data Management & Electronic RecordsData Management & Electronic Records  Web-based database system designed and implemented by the SCWeb-based database system designed and implemented by the SC Office of Research and Statistics (ORS),Office of Research and Statistics (ORS),  System integrations and coordination utilizes the state’s HIPAASystem integrations and coordination utilizes the state’s HIPAA compliant secure Data Warehouse and Client Information System.compliant secure Data Warehouse and Client Information System.  Accessible to all collaborative members for information storage andAccessible to all collaborative members for information storage and retrieval, referral of clients, and meeting reporting requirements.retrieval, referral of clients, and meeting reporting requirements.  PNs use the AIMS individual client records as basic clientPNs use the AIMS individual client records as basic client information---scheduled appointments, language, pharmacy andinformation---scheduled appointments, language, pharmacy and transportation needs are viewed up to date, in real time.transportation needs are viewed up to date, in real time.  Database allows for maintaining information about the client; trackingDatabase allows for maintaining information about the client; tracking and maintaining client appointments, assessments, and referrals;and maintaining client appointments, assessments, and referrals; recording information about community outreach activities and healthrecording information about community outreach activities and health education.education.
    • 23. Regional Networks of Care Medical Outcomes & Patient Centered Care Data Management & Electronic Records Communications
    • 24. 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
    • 25. 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.
    • 26. Regional Networks of Care Medical Outcomes & Patient Centered Care Data Management & Electronic Records Communications
    • 27. New Programming under PNDP New H&S Health Education & Prevention Sites New Health Collaborative Service Delivery Sites
    • 28. Health Conditions TargetedHealth Conditions Targeted  DiabetesDiabetes SC is 2SC is 2ndnd in the nationin the nation  Hypertension/CVDHypertension/CVD SC is 3SC is 3rdrd in the nation for high blood pressurein the nation for high blood pressure  StrokeStroke SC is 2SC is 2ndnd highest in the nation for stroke mortalityhighest in the nation for stroke mortality  ObesityObesity SC is 3SC is 3rdrd in the nation for obesityin the nation for obesity
    • 29. Disparities in Cardiovascular DiseaseDisparities in Cardiovascular Disease  African Americans had a higher prevalence rateAfrican Americans had a higher prevalence rate (15.4%) than Caucasians (8.4%).(15.4%) than Caucasians (8.4%).  African Americans were more likely to report aAfrican Americans were more likely to report a diagnosis of high blood pressure (36.4%) thandiagnosis of high blood pressure (36.4%) than Caucasians (29.5%).Caucasians (29.5%).  African American men in SC are likely to die fromAfrican American men in SC are likely to die from CVD 10 years before white men. Most will notCVD 10 years before white men. Most will not reach 65reach 65..
    • 30. Palmetto Project What does it take to provide health care to theWhat does it take to provide health care to the nearly 45% of South Carolinians withoutnearly 45% of South Carolinians without private health insurance?private health insurance?  Continuum of CareContinuum of Care  Access & Care CoordinationAccess & Care Coordination  Health Education & Disease PreventionHealth Education & Disease Prevention  Data Collection & ManagementData Collection & Management
    • 31. Target CountiesTarget Counties PopulationPopulation 703,505703,505 Nearly 45% of population are uninsured or do not have sufficient coverage to meet their needs.
    • 32. Disparities in StrokeDisparities in Stroke  Mortality from stroke among African Americans isMortality from stroke among African Americans is 24% higher than the national average.24% higher than the national average.  African Americans are 40 percent more likely to dieAfrican Americans are 40 percent more likely to die from stroke than Caucasians.from stroke than Caucasians.  Identifiable and treatable risk factors for CVD andIdentifiable and treatable risk factors for CVD and stroke nearly twice those of whitesstroke nearly twice those of whites  One in three African Americans has high blood pressureOne in three African Americans has high blood pressure  One in two is overweightOne in two is overweight  Two in three are physically inactive.Two in three are physically inactive.
    • 33. Disparities in Diabetes IIn 2005, estimated 280,000 state residents had beenn 2005, estimated 280,000 state residents had been diagnosed with diabetes, and another 140,000 havediagnosed with diabetes, and another 140,000 have diabetes but do not know itdiabetes but do not know it  African Americans had a higher prevalence rate forAfrican Americans had a higher prevalence rate for diabetes (15.4%) than Caucasians (8.4%).diabetes (15.4%) than Caucasians (8.4%).  Mortality rates for diabetes were three times higherMortality rates for diabetes were three times higher for non-whites as for whitfor non-whites as for whiteses  ER visits for diabetes were almost seven timesER visits for diabetes were almost seven times higher among African Americans than amonghigher among African Americans than among whites.whites.  In Dorchester County, diabetes resulted in more thanIn Dorchester County, diabetes resulted in more than three times as many ER visits for blacks than whites.three times as many ER visits for blacks than whites.
    • 34. 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 20103,000 navigated clients by August 2010
    • 35. What are the interventions?What are the interventions?  Outreach to health disparities populationsOutreach to health disparities populations  Prevention and early detectionPrevention and early detection  Education, screening, monitoring, life style modificationEducation, screening, monitoring, life style modification  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 communityFacilitate involvement with community organizationsorganizations  Coordinate with relevant insurance/other coverageCoordinate with relevant insurance/other coverage
    • 36. PNDP Navigated PatientsPNDP Navigated Patients PN 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 = 41Cancer screening and treatment referrals = 41  Women’s services/OB/GYN scheduling = 90Women’s services/OB/GYN scheduling = 90  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) Pulmonology (6)Arthritis (8) Neurology (12) Pulmonology (6) GI (78)GI (78) Orthopedic (10) ENT (14)Orthopedic (10) ENT (14) Dermatology (20)Dermatology (20) Non-Disease SpecificNon-Disease Specific PN ActivitiesPN Activities  Health coverageHealth coverage assistance = 28assistance = 28  Medication/PAPMedication/PAP assistance = 68assistance = 68 (ECCO PAP = 298)(ECCO PAP = 298)
    • 37. SC Data WarehouseSC Data Warehouse  Builds off of existing legacy systems from state agencies and private sectorBuilds off of existing legacy systems from state agencies and private 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 statistical dataIdentifiers are pulled off of the statistical data. Use only the statistical data  Data is always “owned” by originating agency. Permissions required to useData is always “owned” by originating agency. Permissions required to use and/or linkand/or link Using Data in the Data Warehouse Agencies & Other Entities can:Using Data in the Data Warehouse Agencies & Other Entities can:  Evaluate their programsEvaluate their programs  Look at OutcomesLook at Outcomes  Understand better how their programs interact with other agency & other entityUnderstand better how their programs interact with other agency & other entity programsprograms  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 ApplicationsPartner in the Development of Customized Software Applications
    • 38. The Client Information SystemThe Client Information System Web-based HIPAA compliant secure Client InformationWeb-based HIPAA compliant secure Client Information System tracks SC public sector clients and services acrossSystem tracks SC public sector clients and services across multiple agenciesmultiple agencies..  ForFor Treatment and OperationsTreatment and Operations  Designed to provide a 12-month rolling history of the client’s services.Designed to provide a 12-month rolling history of the client’s services.  Includes management and summary reports.Includes management and summary reports.  Medicaid clients served by the Dept. of Health and Human ServicesMedicaid clients served by the Dept. of Health and Human Services operational.  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 acrossEnd product will allow the tracking of SC public sector clients across multiple agencies to ensure better coordination and management.multiple agencies to ensure better coordination and management.
    • 39. AIMSAIMS  Web-based database system designed and implemented by the SC BudgetWeb-based database system designed and implemented by the SC Budget and Control Board’s Office of Research and Statistics (ORS),and Control Board’s Office of Research and Statistics (ORS),  System integrations and coordination utilizes the state’s HIPAASystem integrations and coordination utilizes the state’s HIPAA compliant secure Data Warehouse and Client Information System.compliant secure Data Warehouse and Client Information System.  Accessible to all collaborative members for information storage andAccessible to all collaborative members for information storage and retrieval, referral of clients, and meeting reporting requirements.retrieval, referral of clients, and meeting reporting requirements.  PNs use the AIMS individual client records as basic client information---PNs use the AIMS individual client records as basic client information--- scheduled appointments, language, pharmacy and transportation needsscheduled appointments, language, pharmacy and transportation needs are viewed up to date, in real time.are viewed up to date, in real time.  Database allows for maintaining information about the client; trackingDatabase allows for maintaining information about the client; tracking and maintaining client appointments, assessments, and referrals;and maintaining client appointments, assessments, and referrals; recording information about community outreach activities and healthrecording information about community outreach activities and health education.education.
    • 40. AccessNETAccessNET RHIO 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

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