This document discusses population healthcare access and health status in a county in North Carolina. It notes that healthcare is a local phenomenon and health literacy varies locally and is culturally defined. It presents data on various health issues in the county such as cancer prevalence, cardiovascular disease, diabetes outcomes, chronic respiratory disease, STDs, crime rates, access to dental care, and substance abuse. It suggests that a solution is needed to better manage healthcare access and delivery through coordinated care, case management, and medical homes to improve health outcomes for the local population.

1. Population Healthcare Access and Health Status A single County example in North Carolina

2. Social Systems Include Human Resources, Governance Structures, Work Processes, Technology and Capital Healthcare is a local phenomenon Health literacy is a local characteristic Definition of health is largely cultural Question: Should our communities act locally in response to Federal and State standards through self definition?

3. Our Regional PartnershipOften regional partnerships may be created:If the politics do not interfere. Possible 8 county collaborative

4. Few US Citizens are familiar with the moral categories established by Adam Smith. Including those of nature: Propriety, Prudenceand Benevolence and Motive: Self-love, Reason and Sentiment. It is in this treatise that Smith first introduces the metaphor: 'The Invisible Hand' referring to society's self-regulation through channeling ambition to meet society's needs. Weal th High Low Where should the resources go?

5. 2009 Medicaid Eligibility Will now expand greatly under PSACA

6. There is a great distance between families and they travel farther for care

7. Travel farther and have fewer choices Co Our counties

8. Fewer choices for primary AND specialty care Note Specialty Care Deficit

9. Who are our RAC’s Where are our trauma centers Our RAC So do patients with severe trauma go

10. Where are they treated? Cross County Collaborative Residents Hospital Referrals

11. Unusually high hospital discharge rates for conditions that should be treated in ambulatory setting

12. How confusing can this get?Do we have a solution?

13. County Health Profile Not so good news Good News Ref NC CATCH 2006

14. Adolescent Health Ref NC CATCH 2006

15. Adolescent Health

16. Adolescent Health

17. Cancer Prevalence

18. Cancer Prevalence

19. Typical Rural Cancer In NC Low prevalence VERY Important Low incidence rate Cancer caught in late stage Due to lack of screening High mortality

20. Cancer in Sampson County

21. Cardiovascular Disease

22. Diabetes Outcomes Excessive mortality Excessive hospital days End Stage Renal Disease Excessive kidney failure

23. Chronic Respiratory Disease Smoking and Smoking

24. STDs Risky behavior

25. Murder, Rape and Property Crime Sampson County Crime Risk

26. Access to Dental Care Bad teeth = Bad Hearts

27. Disability Children at risk

28. Substance Abuse Accidents

29. 29 A Solution is needed to Manage the Supply Chain—Accessing Care Services based on Patient NeedsPlease do not forget rural America Targeted Patients with highly complex conditions (Top 1%) Case Management Targeted Patients with unstable chronic conditions, barriers to behavioral change and or multiple co-morbidities Extended Care Team Focus Care Coordination: Patient/Family Coaching & Care Coordination Scope, Intensity & Cost of Services Targeted Patients with uncomplicated chronic conditions and preventative care needs Medical Home contract established with population of focus Supported Self Management: Proactive Outreach & Monitoring Services Practice Focus Acute Care Only Informed Self Service : Education and Self Service Instructions Usual Care: Diagnosis & Treatment Services Distribution of Services across the Population 0% 100% Proprietary & Confidential

30. Untangled Health Thanks You Do not hesitate to contact us for references.