Galveston County Community Health Access Program

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Galveston County Community Health Access Program
A Health Partnership with the Community
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Galveston County Community Health Access Program

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Galveston County Community Health Access Program
Mission
The Galveston Community Health Access Program
Coalition (GCHAP) will expand access to health
care to all individuals in our community,
improving their quality of life and productivity.
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What We Did!

• The County Medical Society convened a work group
  (for the second time in a decade) to deal with
  the issue of indigent health care.
• The Community Access Coalition came together to
  submit a HRSA Community Access Program grant.
• The University of Texas Medical Branch hosted
  Phyllis Busansky to speak on the impact of
  indigent health care upon health policy.
• The County Commissioners Court responded to the
  Medical Societys request by charging a public
  Task Force on Indigent Health Care to study the
  issue and to formulate solutions.
• The Task Force (composed of over 40 people)
  formed study groups on issues of governance,
  health plan composition, financing and education.
• The issue gained the support from local media.
• Dr. Marilyn Gaston and her staff presented a
  community leadership program (Pacing Event) in
  November, 2000, and set about a movement of
  community cooperation and change that had not
  previously existed.

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June 27, 2000
Mobilizing Community Political Will
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Faith-Based Partners
Community Outreach
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When Galveston County Judge Jim Yarbrough bet
us that 100 people were not interested in
indigent health care, he was right. 100 were
not --- over 800 showed up to ask the County to
dedicate more resources to the countys health
issues.
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Communication PlanningWeekly GCHAP Coalition
Meetings
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GCHAP Model Health PlanReforming the Health
Delivery System

• GCHAP brought together community partners
• Health Care Providers
• Hospitals
• Clinics
• Practitioners
• Faith Based Organizations
• Social Services / Advocacy Groups
• Government (local, state and federal)

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Community Education
Prevention Program
UTMB
The Jesse Tree
Chamber Of Commerce
Patients Families
Transportation
Telehealth
GCMS
4 Cs
MMC
MHMR
Other Community Partners
24 Hour Phone Triage
Infrastructure Systems
Case Management
Resource Coordination
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Model Health Plan
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Integrated Primary CareCommunity Based Health
System
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Transportation Contracts the GCHAP Coalition
UTMB-CONNECT VAN CONTRACT 1. Provide
Transportation between Mainland and Islandin
support of CAP coalition to improve access
tomedical services. Service provided upon call
from a CAP coordinator making a reservation. 2.
Increased frequency of shuttle van service
between Mainland and Island medical
facilities. 3. Purchase of tokens for Island
Transit Bus service and Tickets for ADA Van
service between points on The Island. To be
distributed to CAP Coalition Participants who
agree to accountability protocol.
UTMB-ISLAND TRANSIT CONTRACT1. Provide public
transportation on the Island for UTMB staff and
patients with appointments at UTMB clinics. 2.
UTMB ID card or letter confirming an appointment
for a free ride to and from UTMB
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WebCare supports collaborative work among
multiple agencies and types of services on behalf
of clients WebCare reduces administrative
overhead by sharing information and record
keeping functions. WebCare is built on a security
system capable of protecting the privacy and
confidentiality of client data and detailed
tracking of users actions. WebCare can provide
different agencies the ability to track their own
clients while sharing information and referrals
with other participating agencies.
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Leverage Community Assets

• IMMUNIZATION COALITION
• Create repository for community
• Data entry
• Well-established network of participants
• Health Equipment Loan Program
• Create bank of used equipment to respond to
  needs of uninsured
• Save Our Sisters (SOS) Breast Cancer Coalition
• Parish Nursing
• Promote teamwork rather than independent
  programs
• Telephone Helpline/Bilingual Services
• Community-wide Data Collection from diverse
  networks
• Cultural awareness An Art Exhibit
• VISTA Volunteers
• Friday Food Fair

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Galveston Community Health Access Program
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The Friday Food Fair

• Use of available resources
• Promote better nutrition
• Reward patient/client adherence
• Maximize screening opportunity
• Create community event
• Create a systemic change

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Galveston County Health Access Program Medical
Resources
JT
JT
Medical Care Management
Linked Health Care Sites
Regional Maternal-Child Health

• Jesse Tree (JT)

• Medical Transportation
• Connect Van
• Island Transit

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GCHAP Outcome Measures

• Improvement of access
• Reduction of health disparity
• Establishment of a medical home
• Increased patient adherence
• Consistent holistic referrals
• Reduction of ER visits
• Reduction of hospitalizations
• Increased quality of life / productivity

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Key GCHAP Components

• Transportation Services
• Eligibility / Screening Services
• Information Systems Infrastructure
• Social Services / Care Management
• Medical Health Care Services
• Acute and Chronic Health Care
• Case Management Services
• Pharmacy Access
• Health Education
• Mental Health and Substance Abuse Services
• Bilingual Diabetes Education Program

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www.galvestonchap.org
Website Contents

• Road map to access services
• Community resources
• Medical Treatment Guidelines
• Clinical Formulary

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Website Informationwww.galvestonchap.org

• For Patients
• Eligibility for services
• Locations of services
• Transportation
• Pharmacy Access
• Information

• For Providers
• Community support services
• Pharmacy access information
• Disease management guidelines
• Transportation
• Case management
• Referral services

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Return on Investment

• Better health status for all citizens
• Increased productivity in community
• Leveraged community assets
• VISTA Volunteers
• Case Management Programs
• Pharmacy Access Programs
• Volunteers (in general)
• Dollars from faith based community
• Food Distribution (Jesse Tree Food Fair)
• Medical Supplies and Equipment (DME)
• Appropriate use of health facilities

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We Cannot Give Up

• We are very much aware of the problems, but we
  dont throw in the towel because someone says
  no. We make them say no out loud and in
  public.
• Texas State Representative Patricia Gray
• Galveston County Daily News
• March 29, 2001
• Recipient, AMA Nathan Davis Award, 2002

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Future Goals

• Improve the demographic data on target population
• Use lessons learned from UTMBs Correctional
  Health Care to better manage the indigent /
  un-insured
• Focus community resources on improvement of
  access and elimination of health disparities
• Build on existing partnerships with community to
  improve individual health status

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Overhaul health System

• Curtail medical inflation
• Increase productivity
• Improve quality
• Decrease inappropriate and unsafe practices
• Hasten the application of health advances that
  are well grounded in science

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Requirements

• Electronic medical record for all patients
• Reliance on evidence-based guidelines
• Outcomes-driven support systems
• Practice reorganization
• Disease management programs
• Patient safety programs
• Internet-based knowledge-sharing paths
• Systematic measurement and disclosure of outcomes
• Better informed consumers
• Real time identification of effective diagnostic
  tools

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• Disease Management
• (Definitions)
• An intervention designed to manage or prevent a
  chronic condition using a systematic approach to
  care and potentially employing multiple treatment
  modalities.
• A multi-disciplinary approach to care for chronic
  disease that coordinates comprehensive care along
  a disease continuum across health care delivery
  systems.
• A population based approach to health care that
  identifies patients at risk, interventions with
  specific programs of care, and measures outcomes.

Weingarten, Scott R. et. At. BMJ 2000. Vol.
325, p 925
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• Interventions Key to Success
• Provider education
• Provider feedback
• Provider reminders
• Patient education
• Patient reminders
• Patient financial incentive

Weingarten, Scott R. et. At. BMJ 2000. Vol.
325, p 925
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• Successful Management Programs
• Depression
• Diabetes
• Asthma
• Hyperlipidemia
• Hypertension
• Renal disease

Weingarten, Scott R. et. At. BMJ 2000. Vol.
325, p 925
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• Typical Areas for Focus
• Arthritis
• Asthma
• Congestive heart failure
• Depression
• Diabetes
• Hemophilia
• HIV
• Hypertension

Gillespie, J.L.Disease Management Vol. 5, No 104,
2002
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• HMO Disease Management Programs
• Aetna US Healthcare www.aetnaushc.com
• Carefirst BC/BS www.qualityoncology.com
• CIGNA HealthCare www.cigna.com
• Kaiser Permanete www.kaiserpermanete.com
• UnitdHealth Group www.uhc.com

Gillespie, J.L.Disease Management Vol. 5, No 104,
2002
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• State Medicaid Disease Management Programs
• Florida
• New York
• Virginia
• West Virginia

Gillespie, J.L.Disease Management Vol. 5, No 104,
2002
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Share Knowledge

• Establish a Health Information Pathway based
  upon evidence-based guidelines
• Patients agree to follow pathways

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Incorporate information technology and health
science

• Establish an Institute for Medical Practice and
  Consumer Technology (IMPaCT)
• Standards for electronic health information
  content and transferability
• Evidence-based clinic practice guidelines
  development and technology assessments
• Outcomes measures

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Galveston County Health Optimization Plan
Management of vulnerable populations (county
contract, uninsured, underinsured, Medicaid, and
others) to assure optimum distribution and use
of resources to improve health outcomes, reduce
disparities, and control costs.

• Target area is Galveston County
• Service Network includes UTMB, 4 Cs, Mainland
  Medical Center, MHMR
• Key components are accessible medical home,
• disease management guidelines, standardized
  formulary, utilization review program,
  educational services, technology

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Galveston County Health Optimization Plan

• Key Success Factors
• County-wide partnership between providers
• Physician education/acceptance/advocacy
• Availability of support, i.e., guidelines,
  formulary
• Responsive Utilization Review System
• Case management personnel
• Patient Education
• Formulary

• Outcome Measures
• Lower utilization of ER by county indigent /
  uninsured
• Fewer hospital admissions
• Decreased mortality/morbidity rates
• Increased compliance with DMG and Chronic Care
  Strategies

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Galveston County Indigent Care FY 02
UTMB Charges for Galveston Co. Indigent Care
79.3 Million

• Galveston County expenditures for Public Health
  7 Million
• 2.2M Public Health Services
• 2.7M Primary Care Services
• 2.1M Secondary and Tertiary Care

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Galveston County Demographics
Total Est. 2003 Population 256,067 (Galveston
County is ranked 15th in TX for population)
Unemployment Rate (2002) 7.2
(TX6.1) Uninsured Rate (2000)
23 Pop Below Poverty All Ages (1999) 15.5
Pop Below Poverty lt age 18
21.5 Medicaid Enrollment (4/03)
23,318 (9) Medicaid Eligible (4/03)
30,000 Medicaid Enrollment agelt19 (4/03)
14,537 CHIP Enrollment
4,300 Medicaid Births (SFY 2003) 1,839
(49.3 GC) Enrolled in Co. Indigent Care Contract
_at_17 FPL (2003) 1200 monthly
avg. Total Active Registered 4 Cs Patients
121,176 Total 4 Cs Patients Receiving Services
(2002) 17,339
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Galveston County Demographics
Total Est. 2003 Population 256,067
Adolescent Motherslt age 18 (1999) 6.3 (TX
6.1) Unmarried Mothers (1999) 36.5 (TX
31.3) Low Birth Rate (1999) 7.6 (TX
7.4) Communicable Diseases rate/100,000
(1999-2000) Gonorrhea) 204.8 (TX
157.8) Chickenpox 41.5 (TX
37.3) Chlamydia 389.8 (TX 329.8) Deaths
from rates per/100,000 (1999-2000) Diseases of
the Heart 236.3 (TX 211.2) All Cancers
211.6 (TX 163.7) Diabetes 34.5 (TX
25.5) Unintentional Injuries 43.4 (TX
37.4) Chronic Lower Respiratory 39.1 (TX
35.8) Alzheimers Disease 18.7 (TX
15.6) Septicemia 13.9 (TX
9.6) Nephritis/nephrosis 13.3 (TX
8.7)
Source Galveston County Health District
Epidemology Summary 2002)
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Galveston County Immunization Coalition Immunizati
on Sites
Be Wise, Immunize . . Throughout Our Lives
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An internet web site that serves the purpose
of communicating information about the Galveston
County Health Access Program which is a Galveston
County collaboration developed to build a
comprehensive approach to develop a healthcare
delivery system for our underserved citizens.

• Pathways for Services (Clients)
• Resources for Providers (Formulary, Disease
  Management Guidelines)

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Integrated Health Plan

• Primary Health Care
• Specialty Health Care
• Hospital
• Laboratory
• Radiology
• Telemedicine
• Pharmacy Services

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Integrated Health Care Plan

• Indigent Health Care
• County Jail Health Care
• Psychiatry Services
• Case Management Services
• Pharmacy
• Lab / Radiology Access
• Telemedicine / IS
• Resource Coordination

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Top Diagnosis for Galveston County Contract
Patients

• Inpatient
• Chest pain
• Esophagitis, Gastroenteritis Misc Digest
  disorders Age gt17 w cc
• Cirrhosis Alcoholic hepatitis
• Major Joint and Limb Reattachment Procedures of
  Lower Extremity
• Uterine Adnexa Proc for Non-Malignancy w cc
• Esophagitis, Gastoentis 7 Misc Digestive
  Disorders
• Diabetes gt 35
• Atherosclerosis w cc
• Other Circulatory System Diagnoses w cc
• Major Small Large Bowel Procedures w cc
• Outpatient
• Other and unspecified disorders of the back
• Care involving use of rehabilitation procedures
• Other symptoms involving abdomen and pelvis
• General symptoms
• Viral hepatitis
• Other and unspecified disorders of soft tissues
• Symptoms involving respiratory system and other
  chest symptoms