Ellenton Health Clinic Colquitt County Archway Partnership Cost-analysis, Economic Evaluation and Quality Improvement Project Barbara Gaston Master of Public Health Candidate Health Policy and Management College of Public Health The University of Georgia Summer 2011

This presentation is a brief overview of what I have been working on over the course of my internship. Please take one of the handouts. If you would like to receive on electronic version of my final paper, please put your name and on the sign in sheet. Enjoy your breakfast!

Why was I here? To complete the required internship for my program of study. The Archway Partnership Program is a part of the University of Georgia’s mission of outreach to the state. Ms. Cynthia Hernandez requested a Public Health student come to the Ellenton Clinic.

Why Colquitt County? Colquitt County Rankings Georgia County Health Rankings University of Wisconsin, Population Health Institute 100/ /156 98/ / /156 69/ / /156

Georgia County Guide Publication Colquitt County Statistics ratio of persons to physicians, 710 (2008) total number of physicians, 63 (2008) rate of family practice physicians, 26.8/ 100,000 (2008) rate of pediatricians, 6.7/ 100,000 (2008) total rate of all STDs, 364.1/ 100,000 (2009) percent uninsured, <65 Yrs of Age, at all Income Levels, 22.8% (2007) Emergency Room visits in general hospitals, 26,995 (2009)…higher in 2010! …..and much collected data does not even include much of the populations that you all serve here.

Why Quality Improvement? It’s supposed to be done….P&P If the best are not focusing on constant improvement, they will soon not be the best. A “systems thinking” approach

Who is being served?

When is the clinic most busy?

SWOT Analysis Internal, Organizational Factors StrengthsWeaknesses Staff that understands the patient population and is culturally competent Ability of staff to be flexible: in outreach, clinic operating hours, etc. Ability to provide primary care On site pharmacy Relationships with Emory Nursing and the University of Georgia, College of Public Health, Archway Partnership Not much community participation or donations (can also be an opportunity) Some disorganization in outreach efforts No employee wellness program Sometimes the Public Health and Community Health Policies and Procedures contradict each other External, Environmental Factors OpportunitiesThreats Growing recognition of need for preventative care, case management and patient education A position is open for a second Nurse Practitioner at the Clinic Future expansion of the Summer Project Initiative Pre-natal care classes to begin soon (response to end of Babies Born Healthy program) Limited funding or possible budget cuts State of Georgia legislation relevant to undocumented farm workers Many patients cannot pay in full or at all for services at the time that they are provided Some community members view the Clinic as a “Mexican” clinic and do not understand all that they do

What about the money? “Without health, it is difficult to work, learn, and participate in the community. An ineffective health care system results in underserved populations accessing the most expensive and least consistent health care – the emergency departments. One way or another, we all pay for health care for the poor (Georgia Health Policy Center, 2006).”

Why should CRMC care? How many patients in total visited the ER? - 28,760 An estimate of how many of those were non- emergent – 12.4% (2009) ->3,566 What is the current percent of ER visitors that are “self-pay” (almost always means not insured)? - 28% -> 8,052 Provided $17,650,804 in uncompensated care

The Ellenton Clinic potentially saved CRMC ~ $.5 Million if half of the clinical encounters went without screening or untreated and ended up in the ER Based on simply the operating costs for the ER to function ~ $170/ patient These would actually be much higher values, because this is not including physician’s charges and mal-practice insurance!!!!!

How is Ellenton helping? The Ellenton Clinic potentially saved the patients it served last year ~ $ 2 Million if half of the clinical encounters went without screening or untreated and ended up in the ER Based on hospital charging on average $1000 per ER visit $.5 Million Select primary diagnosis: Diabetes, hypertension, dental and foot problems Not including medication costs, or monies from QALYs saved or illness averted!!!!!

How should we move forward? Everyone try to adopt a “systems thinking” approach to everything that you do for the clinic Bring another intern in to take this project further Present ideas to the Archway Partnership for other projects Always be willing to educate and be patient with community members who are not knowledgeable about all that you do

Thank you for your time and support! I have had a wonderful time here getting to know all of you and learn from you. Any questions? Please feel free to contact me: Group picture!