Building Collaborative Health Networks: Pat Terrell”


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PPT on Building Collaborative Partnerships for the the Regional Health Care Safety Net in Northeastern Illinois. Presented at the Safety Net Summit, June 23, 2009, hosted by Health & Medicine Policy Research Group (HMPRG) and the U.S. Health Resources and Services Administration (HRSA)

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Building Collaborative Health Networks: Pat Terrell”

  1. 1. 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
  2. 2. Building Regional, Collaborative Health Care Networks <ul><li>Why? </li></ul><ul><ul><li>Pressure will mount on local communities and governments to meet growing need </li></ul></ul><ul><ul><li>Publics can’t meet need alone </li></ul></ul><ul><ul><li>Providers motivated to come to the table to bring new ideas </li></ul></ul><ul><ul><li>National—and state--reform will require new delivery system models </li></ul></ul>
  3. 3. Local Communities Have Unique Opportunities <ul><li>Rising numbers of uninsured likely </li></ul><ul><li>State is just trying to get through the day in face of growing deficits (Medicaid) </li></ul><ul><li>Federal government will be immersed in reform deliberation (looking models for addressing both access and cost) </li></ul><ul><li>Any new approach will require new delivery models (“Coverage” is not the same as “Access”) </li></ul><ul><li>Local communities can become learning laboratories for new delivery systems with local government as “honest broker” </li></ul>
  4. 4. Elements of Developing Effective Delivery Systems <ul><li>Know the population. </li></ul><ul><li>Understand need and current health utilization of all levels of care. </li></ul><ul><li>Find gaps/duplications in continuum. </li></ul><ul><li>Align mission, financial sustainability, competencies of individual providers. </li></ul><ul><li>Create systems to manage network. </li></ul>
  5. 5. Who is the focus of a safety net system? Hospitals? Doctors? Unions? County Supervisors? Population!
  6. 6. Targeting Population <ul><li>Underserved, not just uninsured </li></ul><ul><ul><li>Medicaid </li></ul></ul><ul><ul><li>Multiple morbidities (including pysch) </li></ul></ul><ul><ul><li>Geographically isolated </li></ul></ul><ul><ul><li>Under-insured </li></ul></ul><ul><ul><li>Immigration/cultural issues </li></ul></ul><ul><li>Where do they live now and where are they moving? </li></ul><ul><li>What care are they getting now and from which providers (FQHCs, EDs, hospitals, doctors, nursing homes, etc.)? </li></ul>
  7. 7. Population: What do they need? <ul><li>Must assume what demand should be, not just what is. </li></ul><ul><li>Population focus to determine volume of: </li></ul><ul><ul><li>Primary Care </li></ul></ul><ul><ul><li>Specialty Outpatient Care </li></ul></ul><ul><ul><li>Inpatient acute </li></ul></ul><ul><ul><li>Lower levels of acute </li></ul></ul><ul><ul><li>LTC </li></ul></ul><ul><li>Translate into provider requirements. </li></ul>
  8. 8. Different Approaches to Determining Need
  9. 9. Building a System: Filling Gaps, Eliminating Duplication <ul><li>After mapping out need and current resources, identify: </li></ul><ul><ul><li>Current gaps and duplications </li></ul></ul><ul><ul><li>Inappropriate utilization </li></ul></ul><ul><ul><li>Project future concerns about delivery system ability to meet need. </li></ul></ul><ul><li>Begin fitting providers to system design, based on: </li></ul><ul><ul><li>Individual institutional mission </li></ul></ul><ul><ul><li>Financial rationality (i.e., primary care in FQHCs) </li></ul></ul><ul><ul><li>Community benefit leverage </li></ul></ul><ul><ul><li>Not wanting to be “left out” </li></ul></ul>
  10. 10. Bringing Players to the Table <ul><li>Start with individual discussions (even if within public system only) </li></ul><ul><li>Propose roles, assure that others are included </li></ul><ul><li>Key issues: predictability, sustainability, equitability </li></ul><ul><li>Stress role of local government bodies as “honest brokers” </li></ul><ul><li>Bring all together when there is general agreement to endorse broader plan </li></ul>
  11. 11. Managing the Network <ul><li>Network management will be key – takes beyond a puzzle of different components </li></ul><ul><li>IT, referral systems, common disease management approach are essential </li></ul><ul><li>Connections with non-acute services </li></ul><ul><li>Evaluating what works and what doesn’t (and changing it) on an ongoing basis is critical </li></ul>
  12. 12. Formalizing the Network <ul><li>Can be internal system oversight or multi-provider “governance” </li></ul><ul><li>Accountability of all elements of the system to each other is important </li></ul><ul><li>Planning for continual changes in the patient population and service needs to be key function </li></ul><ul><li>Resource sharing and cost-saving is a standing agenda item </li></ul><ul><li>Coordinated advocacy at state and national level is a significant benefit </li></ul>
  13. 13. Network Development Focused on Underserved Populations: Examples <ul><li>California Counties (unique requirement for local responsibility for indigent care) </li></ul><ul><li>- San Mateo </li></ul><ul><li>- Orange </li></ul><ul><li>New Orleans (4 parishes) </li></ul><ul><li>Austin, Texas (greater Travis County) </li></ul><ul><li>Chicago/South Suburbs (Comer Plan/CHNU) </li></ul><ul><li>Miami/Dade County </li></ul><ul><li>Cincinnati/Hamilton County Plan </li></ul>