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The Path Forward

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June 25, 2020

Published in: Healthcare
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The Path Forward

  1. 1. The Path Forward Health Care is a Right, Not a Privilege. 16/24/20
  2. 2. Healthcare: A Turning Point A Divided System of Care The pandemic is shining a light on the healthcare system’s failings and underscores that there remains two systems of care and that those who are historically disenfranchised because of race, ethnicity, gender, orientation and poverty continue to suffer and be ignored. Our challenge at Community Health Center, Inc. is to create a new system of care out of the chaos, one that brings meaningful reform and empowerment to our communities, patients and providers. 2
  3. 3. Building a Foundation A New Path Forward Four Teams: Team 1: • Look at how our “crisis“ delivery model is functioning • Determine steps to improve current model Team 2: • Assess changes happening within the neighborhoods we serve • Understand how the healthcare landscape is reacting Team 3: • Lay practical and conceptual foundation for new delivery model Team 4: • Prepare through our national affiliates to share, learn and grow 3
  4. 4. Team 1: Survive Focus: Clinical and Operational performance of the temporary model that we stood up within days of the pandemic's arrival in Connecticut, primarily through remote work and telehealth. Team 1 worked to ensure the delivery of quality patient care and to support our workforce in functioning safely and efficiently. Steps: 1. Identify challenges to the sustainability of this new environment and to provide recommendations for improvement 2. Develop comprehensive work plan to make short term improvements with specific goals and timelines across departments and disciplines 3. Rapid implementation of temporary set-up with the knowledge that ongoing improvement would be needed in the future 4
  5. 5. Team 2: Assess Focus: All health care is local. Substantive Health Care Redesign has for too long ignored the social determinants of health; racial inequity, income disparity, legal status, food insecurity, educational opportunity and digital capacity. All of the social systems underlying social determinants are experiencing disruption and have advocates with similar energy to ours who are helping reshape that landscape into a new and responsive health system. . 5 Steps: 1. Review changes in the behavior of the health system 2. Gain understanding of the changes going on for those we serve in the neighborhoods they live 3. Factor in disruptions of social systems underlying social determinants 4. Embrace advocates with similar energy 5. Help shape the landscape of a redesign for a new and responsive health system
  6. 6. Team 3: Build Focus: Understand how we can fundamentally transform the way that primary care is delivered, with the goal of improved clinical outcomes and increased community empowerment. 6 Steps: 1. Gain understanding and act on patient and employee satisfaction 2. Embrace a heightened commitment to eradicating health disparities for those historically disenfranchised 3. Ensure regulatory relief on the use of telehealth technology 4. Address the digital divide 5. Explore home health technologies
  7. 7. Team 4: Spread Focus: The current health system was defined by institutions that don’t represent the communities most impacted. We have new tools to deploy to engage patients beyond the walls of our clinics. And we need pragmatic research to help guide us and ensure that what we are doing is actually beneficial. . 7 Steps: 1. Develop content with specific focus areas and solutions 2. Spread content beyond our health center 3. Incorporate diverse views 4. Ensure we experience the full advantage of the knowledge and opportunity for collaboration presented
  8. 8. We didn’t get here on our own. We can’t move forward alone. There has never been a time like this when collectively we have the opportunity to build a better delivery system. Join us in this exciting opportunity – let’s look to each other and bring about a brighter future. 8
  9. 9. We didn’t get here on our own. We can’t move forward alone. We will walk you through the details of our work to date. We want to engage with your feedback. 9
  10. 10. Please Submit Your Questions 10
  11. 11. Staying True to Mission While Adapting to Crisis Changing care delivery without skipping a beatbeat Addressing necessary steps to ensure continuous quality care for CT’s most vulnerable populations 1. Existing Foundation 2. Rapid Implementation 3. Refining Process 11
  12. 12. Crisis SWOT Analysis Focus: Clinical and Operational performance of the temporary model that we stood up within days of the pandemic's arrival in Connecticut, primarily through remote work and telehealth. Team 1 worked to ensure the delivery of quality patient care and to support our workforce in functioning safely and efficiently. 12 • Engaged and involved leadership • Strong IT and BI Teams • Mission oriented staff • Improvement-oriented Culture • Existing Infrastructure Strengths Weaknesses Opportunities Threats • No existing robust telehealth platform • Fee for service relying on In-Person visits • Changes in documentation, coding, and billing • TB Model of Care focused on facility co-location • Unknown access to home internet for all workforce groups • Many “unknowns” in the landscape • Build a Telehealth Model of Care Delivery • Develop Virtual Team- Based (TB) Care • Increase access to health care • Remove the barrier of exam room space • Retention of staff related to additional flexibility from remote work • State regulations • Federal/CMS regulations • Access to PPE • Financial sustainability • Large non-revenue generating, but valuable workforce to maintain • Active COVID-19 community spread and disproportionate regional impacts
  13. 13. Existing Foundation Focus: Clinical and Operational performance of the temporary model that we stood up within days of the pandemic's arrival in Connecticut, primarily through remote work and telehealth. Team 1 worked to ensure the delivery of quality patient care and to support our workforce in functioning safely and efficiently. 13 • Organizational culture of health care being a right for all • Expectation of excellence • Flexibility of staff • National and statewide presence Culture/Values Technology Policies Centralization • Existing state wide and national communication platform (Zoom) • Texting Capabilities • Existing IT • Equipment/ • Infrastructure • Business Intelligence Team • Data Warehouse • Remote Worker’s Policy • Emergency Preparedness Plan • Planned Care • Standing Orders • Templated Visits • Centralized Infection Control Committee • Centralized Support Systems • Triage Line for business hours and after hours
  14. 14. Rapid Implementation 14 1. Regulatory Advocacy 2. Mobilizing Current Staff/Patients 3. Redeployment of Staff 4. Continuation of Care 5. Patient Specific Delivery 6. Internal/External Communications
  15. 15. Refining the Process 15 1. Ongoing Assessments of Current State 2. Tracking Data 3. Continuous Internal Communication 4. Proactive Patient Outreach 5. Re-evaluating Goals
  16. 16. Refining the Process: Monitor, Respond & Re-evaluate Focus: Clinical and Operational performance of the temporary model that we stood up within days of the pandemic's arrival in Connecticut, primarily through remote work and telehealth. Team 1 worked to ensure the delivery of quality patient care and to support our workforce in functioning safely and efficiently. 16
  17. 17. Refining the Process: Monitor, Respond & Re-evaluate 17
  18. 18. Refining the Process: Monitor, Respond & Re-evaluate Focus: Clinical and Operational performance of the temporary model that we stood up within days of the pandemic's arrival in Connecticut, primarily through remote work and telehealth. Team 1 worked to ensure the delivery of quality patient care and to support our workforce in functioning safely and efficiently. 18
  19. 19. More Work To Do 19 1. Addressing Integrated Model 2. Solidifying Logistics 3. Supporting Policies 4. Supporting Infrastructure 5. Continuing Communication 6. Road to new delivery model of care
  20. 20. Social Determinants of Health The Imperative to Create Equity in Health 20
  21. 21. COVID-19 Has Laid Bare a Harsh Truth People who are disenfranchised because of race, ethnicity, income, education, gender, environment etc. suffer inequity in health and life 21 FQHCs screen for, document, refer and, sometimes directly or indirectly, address SDOH . . . . BUT WE HAVE NOT DONE ENOUGH TO SOLVE FOR THEM AT SCALE COVID-19 Deaths Per 100,000 people Whites 26.2 Latinx 28.2 Indigenous Americans 36.0 Blacks 61.6
  22. 22. Social Determinants of Health The Facts Poverty is the Key Driver (millions) • Live at or below poverty 41,000,000 • Live at or below 150% poverty 90,000,000 • Live at or below 200% poverty 134,000,000 Race and Ethnicity Adjusted Life Expectancy (at age 40) 22 • Income/Poverty • Housing • FoodInsecurity • Isolation • Transportation • Education • Gender/SexualPreference Environment/Safety(violence) Women Men Top 1% 88.9 87.3 Bottom 1% 78.8 72.7 Life expectancy (U.S.) 2001-2014 60% of health outcomes can be attributed to SDOH
  23. 23. Housing Homelessness: • 568,000 people homeless on a single night (2019) o For every 10,000 people: Whites – 11.5, Blacks – 55 Affordability & Evictions: • 75% of extreme-low-income renters spend >50% of income • Landlords given court approval to evict 1 in 50 renter households (1 in 9 in some cities) • 1 out of every 5 Black women evicted at least once as adult • 37 affordable rental units for every 100 needed – 7.2 million gap 23 Innovators/Disruptors: • Factory OS – Offsite construction (cheaper and faster) Ideas/New Models: • Exemption from prevailing wages for construction • Inclusionary zoning with buyout provisions
  24. 24. Food Insecurity Data: • 2018: 37+ million experience food insecurity (11 million children) o 1 in 9 individuals (11.5%), 1 in 7 children (15.2%) – in all 50 states o Impact on children: asthma, anxiety or depression, grades etc. o 33% of food insecure people do not qualify for assistance • Today (COVID): 54 million experience food insecurity (18 million children) 24 Innovators/Disruptors: • Propel – using technology to help people manage SNAP and extend benefits Ideas/New Models: • FQHCs partner w/ Farmers to Families Food Box Program or Farms to Schools programs • Expand community eligibility for free lunch; eliminating individual applications • Expand SNAP deliveries direct from store/online to home
  25. 25. A History of Innovation 25 Our Track Record Blood Pressure, Cancer A1Cs, Viral Loads Value-Based Care School-Based Care Social Determinants of Health Next Horizon
  26. 26. A 360 Assessment We are not alone in valuing the opportunity to care for our patients • Yesterday’s Minute Clinic (“You’re sick. We’re quick”) is today’s pharmacy-based “Doctor’s Office” in your neighborhood • As we have grown to care for 29 million people, others have recognized the opportunities brought by the expansion of Medicaid, ACA coverage and the closing of private practices • The transition to telehealth will benefit them as much as it benefits us • Both established corporations and start-ups see this move as a business opportunity—tied to shareholder value (MAVEN, American Well) • Our shareholders are our patients and neighborhoods. We are economic engines and we know our populations - but we have to better address SDOH as part of our strategy 26
  27. 27. Reimagining Healthcare Embracing an opportunity to improve clinical outcomes & increase community empowerment 27
  28. 28. Workforce Models 28 1. Fully on-site for in person care 2. Hybrid of on-site & telehealth 3. Telehealth from telehealth pods 4. Fully remote/Telehealth from home
  29. 29. Addressing the Physical Space 29
  30. 30. Patient Preferences Focus: Clinical and Operational performance of the temporary model that we stood up within days of the pandemic's arrival in Connecticut, primarily through remote work and teleheRoRrob’s alth. Team 1 worked to ensure the delivery of quality patient care and to support our workforce in functioning safely and efficiently. 30
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  32. 32. Explore Home Health Technologies 32 Embracing patient’s desire for remote healthcare while simultaneously collecting health data in the hopes of improving overall outcomes.
  33. 33. Commitment to Eradicating Health Disparities 33 Continuously putting the needs of our patients at the forefront of every action. Embracing a heightened commitment to eradicating health disparities for those historically disenfranchised. “Nothing about us without us”
  34. 34. Working Together on The Path Forward 34
  35. 35. Building with a QI Foundation • Strong Leadership • Quality Improvement Infrastructure • Data & Measurement • High Performing QI Teams • Empowering Staff • Implementation & Sustainability Plans • Change Management 35
  36. 36. Working together Learning together Improving together Next generation learning collaboratives Learning Collaborative Activity Session National Webinars 36
  37. 37. Working together Learning together Improving together Project ECHO Practice Transformation • Practice transformation specialists • Formal curriculum • “Case”-based discussion 37
  38. 38. Connect with the Medical Neighborhood Strengthen Primary Care • New tools to strengthen primary care • Increase what we can accomplish in our health centers • Engage patients in new ways 38
  39. 39. Training the Next Generation • Residents – medical (MD, DO, APRN), behavioral health, dental • Students – medical, nursing, medical assistants, public health • Administrators • Community Health Workers • Peer Support Specialists Train future healthcare staff to OUR model of care 39
  40. 40. Research/Evaluation Evaluation Methods • Process evaluation • Impact evaluation • Outcome evaluation • Summative evaluation • Organizational and systems evaluation • Rapid evaluation and assessment Research Approaches • Mixed methods • Implementation science • Community based participatory research • Experiments and field trials • Survey design • Focus groups • Secondary analysis 40
  41. 41. Join Us! We can’t do this alone. Join the conversation. 41

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