1. Research to Reform : Achieving Health System Change September 13-16, 2009 Research to Reform : Achieving Health System Change AHRQ 2009 Annual Conference September 13-16, 2009 Progress of a Learning Network: Working to Reduce Disparities by Improving Access to Care Monday, September 14, 2009 Sherry E. Gray, M.A. Director: Rural and Urban Access to Health St. Vincent Health

2. Focusing on Outcomes Confirm Evidence Based Intervention Id entify Individual at Risk Measure Outcome Health and Cost Savings 1 2 3 = + The Pathway Model

3. The Pathways Model Identify areas of greatest need geomapping, analyzing existing databases, needs assessments Establish a community hub centralized community group: communication; data collection; tracks services provided by community health workers Develop Pathways - start with “agreed upon” outcome; build steps from desired end- point; capture steps to completion; capture barriers and successes for intervention/ problem-solving -connect funding mechanisms to outcomes vs. activity-based reimbursement Identify and train community health workers Implement established Pathways until the outcome is accomplished Conduct ongoing quality assurance and evaluation monitor the progress and outcomes

4. “Oh no…another program!” Pathways are NOT: → Part of a “canned program” → Simple and quick solutions to complex problems → Built/developed in a “silo” and then “introduced” to other agencies, providers, programs, funders, for adoption and implementation → A fad Pathways ARE: A proven care coordination model A proven care coordination model Community based Community based Adaptable to a variety of “at-risk” populations Adaptable to a variety of “at-risk” populations Evidence-based interventions at the grassroots level Evidence-based interventions at the grassroots level Used to create outcome -based accountability and reimbursement vs. activity-based reimbursement Used to create outcome -based accountability and reimbursement vs. activity-based reimbursement

5. The Learning Network and Pathways The Learning Network and Pathways

6. RUAH History RUAH Partnership initiated: 2000 RUAH Partnership initiated: 2000 – – SV Health In patient, Out patient, Community Based Care – – Indiana Health Centers, Inc. Federally Qualified Health Care Center (FQHC) – – Health and Hospital Corporation of Marion County County Health Department – – ADVANTAGE Health Plans, Inc. Insurance Provider (public and private plans) – – Butler College of Pharmacy, later added PharmD students Pharmaceutical Assistance Program (PAP) Consultation Project Management/Oversight – – Community Interface Groups: local partner groups responsible for program implementation. health centers, health departments, physician offices, civic groups, and health, human and social service agencies Funded by HRSA, Ascension Health from 2001-2005 Sustained through local hospital funding and captured reimbursement through enrollment efforts

7. Current Service Areas: Clinton County Clinton County – St.Vincent Frankfort * Howard County * Howard County * – St. Joseph Hospital Madison County Madison County – St. Vincent Mercy * – Saint John’s Health System Randolph County * Randolph County * – St.Vincent Randolph Clay County Clay County – St.Vincent Clay Jennings County Jennings County – St.Vincent Jennings Fountain and Warren Counties Fountain and Warren Counties – St.Vincent Williamsport – * Original CAP grant program sites * Original CAP grant program sites * Original CAP grant program sites

8. RUAH Today Purpose: To connect our friends, family, and neighbors to a comprehensive, integrated delivery network of health, human and social services resulting in improved access and removal of barriers to needed resources. Meaning and Mission: The word ruah, in yiddish means “Breath of Life”. The Goal? The Goal? …to breathe new life into a dying health care system trying to serve our most vulnerable community members

9. Focus Areas: Health Access Workers–client advocates & system navigators Health Access Workers–client advocates & system navigators Pharmacy – access to low or no cost drugs through Medication Pharmacy – access to low or no cost drugs through Medication Access Workers (MAC’s) Access Workers (MAC’s) Creation of “Medical Homes” for the underserved Creation of “Medical Homes” for the underserved Access to Specialty Care for the underserved Access to Specialty Care for the underserved Program enrollment (financial resource review Program enrollment (financial resource review and application assistance) and application assistance) Reduction of inappropriate Emergency Room utilization Reduction of inappropriate Emergency Room utilization Assistance with supportive social services Assistance with supportive social services (“wrap around”) (“wrap around”) Diversity – translation of core documents, medical Diversity – translation of core documents, medical interpretation, key signage, development of diversity interpretation, key signage, development of diversity councils, LEP Assessment councils, LEP Assessment Sustainability Sustainability

10. Program Outcomes: (November ‘02 – June ‘09) Four community programs expand to Eight community programs Four community programs expand to Eight community programs Additional private sector funding obtained Additional private sector funding obtained – Anthem Foundation 29,767 client encounters 29,767 client encounters 59,081 referrals, including 59,081 referrals, including – Medical Home appointments – Government program applications (Medicaid & SCHIP, etc.) $18.2 million worth of low/no cost drugs provided $18.2 million worth of low/no cost drugs provided 800+ HIP applications = $ 2+ million captured reimbursement 800+ HIP applications = $ 2+ million captured reimbursement

11. Sound Good? RUAH produces good work RUAH produces good work ↑ interaction ↑ interaction (patients, clients, providers) ↑ connectivity/integration (community agencies and acute care facilities/providers ) ↑ activity (doing lots of things “to and for” people) ↑ access (primary care home assignments/specialty care) ↑ reimbursement (received funding not previously captured)

12. So? Did any of it work? Did any of it work? – Intuitively it appears that it does How do we know? How do we know? – Did the activities produce: Lower A1C values for Diabetics? Lower A1C values for Diabetics? Better birth outcomes for high risk pregnancies? Better birth outcomes for high risk pregnancies? Lower blood pressure and decreased cardiac risks? Lower blood pressure and decreased cardiac risks? Manage asthma symptoms and decrease ER visits and hospitalizations? Manage asthma symptoms and decrease ER visits and hospitalizations? 1. The answer? We don’t know. 2.The question: How do we find out? Find a way to connect the work to measurable outcomes that is both simple and real…

13. Pathway Implementation (our “beta site”) Work with Madison County Madison County and Saint John’s Hospital

14. Process: Maintain all current RUAH access work Maintain all current RUAH access work Build a local CKF Coalition Build a local CKF Coalition Host a high level Stakeholder meeting Host a high level Stakeholder meeting Develop “behind the scene” infrastructure support: IT, agreements, etc. Develop “behind the scene” infrastructure support: IT, agreements, etc. Hold the initial Madison County Community HUB Pathway development summit Hold the initial Madison County Community HUB Pathway development summit Implement the Pathways developed by the HUB Implement the Pathways developed by the HUB Evaluation and “Fine tuning” Evaluation and “Fine tuning”

15. How’s it going? ‘Stay tuned…we are still on the pathway