A Journey to Community Integrated Health

With the increasing emphasis and investment in prevention, Population Health, value-based health care and health equity, it will take a full continuum of services to “move the needle”. This session will discuss the journey of one community based organization in becoming part of the broad continuum of health care delivery and access, in particular to vulnerable populations, using collaboration as the catalyst.

Transcript

1. Steve Tarver A Journey to Community Integrated Health
2. A JOURNEY TO INTEGRATED HEALTH Empower 2017
3. A JOURNEY TO INTEGRATED HEALTH Empower 2017
5. “If I could do one thing to improve the health of the community, do you know what it would be?” Dr. Troutman commented. . .
7. HEALTH • “The presence of physical, psychological, social, economic and spiritual well being not merely the absence of disease or infirmity” • “The maintenance of a harmonious balance of mind, body and spirit” – Community and individual
8. EQUITY • Justice according to natural law or right • Freedom from bias or favoritism
9. HEALTH EQUITY • “The absence of unfair and avoidable or remediable differences in health among social groups” (The Commission ) • A value position supported by an evidence base • There is and will be political opposition to the core value of health equity
10. HEALTH INEQUITIES Systemic, avoidable, unfair and unjust differences in health status and mortality rates and in the distribution of disease and illness across population groups. They are sustained over time and generations and beyond the control of individuals.
11. SOCIAL JUSTICE • The application of principles of justice to the broadest definition of society • Implies – Equity – Equal access to societal power, goods and services • Universal respect for human and civil rights
12. How Do We Improve Health?
15. The choices people make are the choices people have.
16. Impacting INDIVIDUALS Impacting ORGANIZATIONS Impacting COMMUNITIES Impacting SOCIETY Impacting FAMILIES © 2012 YMCA of the USA. All rights reserved. Childhood Obesity Group Exercise Falls Prevention Cancer Survivorship Family Camp Employee Wellness Benefits Wellness Centers Adventure Guides Youth Sports Swim Lessons Smoking Cessation Policies Promoting Healthy Eating Policies Promoting Physical Activity Diabetes Control Built Environment Access to Fresh Fruits & Veggies P.E. in Schools Economic Incentives and Disincentives (taxation or subsidies) Smoke-free Environments Diabetes Prevention Cardiac Rehab Arthritis Treatment To PROMOTE WELLNESS (Primary) To RECLAIM HEALTH (Tertiary) To REDUCE RISK (Secondary) COMMUNITY HEALTH EXAMPLES Personal Training
17. The Courier-Journal Sunday, November 6, 2016
21. THIS IS NOT YOUR GREAT GREAT GREAT GRANDFATHER’S YMCA
22. Anthony Bowen founded the first African American YMCA in 1853.
23. OUR REACH
24. Healthy Living Improving the Nation’s Health and Well-being Critical Social Issues Affecting Our Communities: • High rates of chronic disease and obesity (child and adult) • Needs associated with an aging population • Health inequities among people of different backgrounds Our Shared Intent: To improve lifestyle health and health outcomes in the U.S., the Y will help lead the transformation of health and health care from a system largely focused on treatment of illnesses to a collaborative community approach that elevates well-being, prevention and health maintenance. Our Desired Outcomes: People achieve their personal health and well-being goals People reduce the common risk factors associated with chronic disease The healthy choice is the easy, accessible and affordable choice, especially in communities with the greatest health disparities Ys emphasize prevention for all people, whether they are healthy, at-risk or reclaiming their health Ys partner with the key stakeholders who influence health and well-being
25. The opportunity in a changing healthcare landscape Acute Health Care System • High quality acute care • Accountable care systems • Shared financial risk • Case management and preventive care systems • Population-based quality and cost performance • Population-based health outcomes • Care System integration with community health resources Source: http://innovation.cms.gov/resources/State-Innovation-Models-Initiative-Overview-for-State-Officials.html Past
26. The opportunity in a changing healthcare landscape Acute Health Care System • High quality acute care • Accountable care systems • Shared financial risk • Case management and preventive care systems • Population-based quality and cost performance • Population-based health outcomes • Care System integration with community health resources Coordinated Seamless Health are System • High quality acute care • Accountable care systems • Shared financial risk • Case management and preventive care systems • Population-based quality and cost performance • Population-based health outcomes • Care System integration with community health resources Source: http://innovation.cms.gov/resources/State-Innovation-Models-Initiative-Overview-for-State-Officials.html Past Present
27. The opportunity in a changing healthcare landscape Acute Health Care System • High quality acute care • Accountable care systems • Shared financial risk • Case management and preventive care systems • Population-based quality and cost performance • Population-based health outcomes • Care System integration with community health resources Coordinated Seamless Health are System • High quality acute care • Accountable care systems • Shared financial risk • Case management and preventive care systems • Population-based quality and cost performance • Population-based health outcomes • Care System integration with community health resources Community Integrated Health Care System • High quality acute care • Accountable care systems • Shared financial risk • Case management and Preventive care systems • Population-based quality and cost performance • Population-based health outcomes • Care System integration with community health resources Source: http://innovation.cms.gov/resources/State-Innovation-Models-Initiative-Overview-for-State-Officials.html Past Present Future
28. COMMUNITY INTEGRATED HEALTH
31. Chapter 1 1997-2002 Chapter 2 2005-2008 Chapter 3 2008-2010 Chapter 4 2010-2013 Chapter 5 2014-2016 THE YMCA’s DPP: A journey 20 years in the making Chapter 6 Community Integrated Health EFFICACY TRANSLATION VALIDATION SCALING NIH IU School of Medicine YMCA of Greater Indianapolis CDC YMCA of Greater Louisville Partnership with TPA allowed first 100 Ys to track participants and facilitate contracting with third party payors DISSEMINATION More than 250 Ys worked to serve more participants and understand how the health care landscape has evolved allowing for new opportunities for sustainability
32. Current Footprint of the YMCA’s DPP
34. YMCA DIABETES PREVENTION PROGRAM
35. YMCA DIABETES PREVENTION PROGRAM
36. YMCA DIABETES PREVENTION PROGRAM
37. YMCA DIABETES PREVENTION PROGRAM
38. In the news… When compared with similar beneficiaries not in the program, Medicare estimated savings of $2,650 for each enrollee in the Diabetes Prevention Program over a 15-month period, more than enough to cover the cost of the program.
39. Providers Delivery Systems “Shepherding” • Key messaging development • Referral Goal • Provider – recruitment & engagement • Screening • Patient permissions • Unused Capacity o Current number in classes o Current number of trainers • Building Class capacity • Barriers – identify and overcome • Comprehensive list of CDC approved programs • Survey of people with successful completion • Best practices from other CBOs delivering DPP • Reimbursement/payer o Insurers o Medicare expansion • Coding • Employers • EMR • Referrals beyond providers • Screening opportunities • Pilot test additional formats for specific employee populations. (added 9/2016) • Infrastructure • Scripts • Receiving referrals • Staff training – behavior change • Cost • Comparing best practices – other Ys • HIPAA training LOUISVILLE HEALTH ADVISORY BOARD DIABETES COMMITTEE – WORK GROUPS
40. One cause of savings…
41. Y-USA’s MSO: Capturing Opportunity Authorized plan for Y-USA to assume functions of a Management Services Organization (“MSO”) -- providing administrative, business, and technology services to local Ys to enable them to receive third party payment for the delivery of the YMCA’s DPP and other chronic disease prevention programs. Healthy Living Department MSO Employs staff for: • Payor Engagement • Contracting • Account Management • Technology support • Compliance • Reporting • Finance Contracts with vendors for: • Technology platform • Billing / revenue cycle management MSO Team MSO Vendor(s) Existing Structure New Additional Structure Local Ys • Program delivery • Track participant outcomes in technology system • Raise funds to assist with sustainability in absence of 3rd party payors. Chronic Disease Prevention Program Team • Train Ys to deliver DPP • Management and administration support • Coordinate with existing TPA for technology support • Provide reporting technical assistance to Ys for reporting to partners, CDC, etc. “Build” “Buy”
42. Clinical Pathways supporting evidence-based programs via Alternative Payment Models • Clinical Pathways that fully implement primary, secondary, and tertiary prevention are essential to success in APMs • Prevention efforts in community-based settings have increased adherence with sustained disease self-management impacts and are essential to a comprehensive population health strategy • Medicare Shared Savings ACO • Bundled Payment • Oncology Care Model • Medicaid Payment Reform
43. Evidence-Based Programs supporting APMs • Alternative Payment Models provide financial incentives to achieve cost savings and improve clinical outcomes • The APM model provides the ability to risk stratify the target population using clinical indicators and Medicare claims data • Targeted high-risk beneficiaries are referred to the appropriate primary or secondary prevention program • Evidence-based programs provide the capacity to implement preventive health strategies that are proven to drive improvement of clinical outcomes and reduction in overall healthcare expenditures
44. Supporting Y-to-Payor Relationships
46. All “held together” by CHARACTER & ETHICS HEALTH EDUCATION CONNECTING PEOPLE ACCESSIBILITY ASPIRATIONS
49. Trends 107 233 87 64 136 25 260 0 50 100 150 200 250 300
50. BRINGING TOGETHER EDUCATION & HEALTH
52. WEST LOUISVILLE THE FUNDAMENTAL VISION. . . Creating Community Integrated Health through the lens of Health Equity
62. Violence is a public health issue.
63. ANSWER: Burner, Blower Q UESTION?
64. ANSWER: “It’s as easy as waking up and saying, Good morning.” Q UESTION?
65. TRAINING? • Implicit Bias • Undoing Racism
66. UNIVERSITY OF LOUISVILLE SCHOOL OF PUBLIC HEALTH & INFORMATION SERVICES Youth Violence Prevention Research Center
69. It’s a Paradigm Shift. . .
71. OLD – Looking form the inside out
72. New – Looking from the outside in
73. REGARDLESS OF WHAT WE CALL IT. . . • Clinic to Community • Patient centered medical home • Population health We will not “treat” ourselves out of the health challenges in the USA
74. We are not in the business to build a better YMCA. We’re in the business to build a better community!
75. THANK YOU