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Community and PopulationBased Health Care Delivery Systems:

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Pressure will mount on local communities and governments to meet growing need ... California Counties (unique requirement for local responsibility for indigent care) ... – PowerPoint PPT presentation

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Title: Community and PopulationBased Health Care Delivery Systems:


1
Community- and Population-Based Health Care
Delivery Systems
  • Building Collaborative Networks
  • Regional Health Care Safety Net Summit
  • Health and Medicine Policy Research Group
  • Pat Terrell
  • June, 2009

2
Building Regional, Collaborative Health Care
Networks
  • Why?
  • Pressure will mount on local communities and
    governments to meet growing need
  • Publics cant meet need alone
  • Providers motivated to come to the table to bring
    new ideas
  • Nationaland state--reform will require new
    delivery system models

3
Local Communities Have Unique Opportunities
  • Rising numbers of uninsured likely
  • State is just trying to get through the day in
    face of growing deficits (Medicaid)
  • Federal government will be immersed in reform
    deliberation (looking models for addressing both
    access and cost)
  • Any new approach will require new delivery models
    (Coverage is not the same as Access)
  • Local communities can become learning
    laboratories for new delivery systems with local
    government as honest broker

4
Elements of Developing Effective Delivery Systems
  • Know the population.
  • Understand need and current health utilization of
    all levels of care.
  • Find gaps/duplications in continuum.
  • Align mission, financial sustainability,
    competencies of individual providers.
  • Create systems to manage network.

5
Who is the focus of a safety net system?
Hospitals?
Doctors?
Unions?
County Supervisors?
Population!
6
Targeting Population
  • Underserved, not just uninsured
  • Medicaid
  • Multiple morbidities (including pysch)
  • Geographically isolated
  • Under-insured
  • Immigration/cultural issues
  • Where do they live now and where are they moving?
  • What care are they getting now and from which
    providers (FQHCs, EDs, hospitals, doctors,
    nursing homes, etc.)?

7
Population What do they need?
  • Must assume what demand should be, not just what
    is.
  • Population focus to determine volume of
  • Primary Care
  • Specialty Outpatient Care
  • Inpatient acute
  • Lower levels of acute
  • LTC
  • Translate into provider requirements.

8
Different Approaches to Determining Need
9
Building a System Filling Gaps, Eliminating
Duplication
  • After mapping out need and current resources,
    identify
  • Current gaps and duplications
  • Inappropriate utilization
  • Project future concerns about delivery system
    ability to meet need.
  • Begin fitting providers to system design, based
    on
  • Individual institutional mission
  • Financial rationality (i.e., primary care in
    FQHCs)
  • Community benefit leverage
  • Not wanting to be left out

10
Bringing Players to the Table
  • Start with individual discussions (even if within
    public system only)
  • Propose roles, assure that others are included
  • Key issues predictability, sustainability,
    equitability
  • Stress role of local government bodies as honest
    brokers
  • Bring all together when there is general
    agreement to endorse broader plan

11
Managing the Network
  • Network management will be key takes beyond a
    puzzle of different components
  • IT, referral systems, common disease management
    approach are essential
  • Connections with non-acute services
  • Evaluating what works and what doesnt (and
    changing it) on an ongoing basis is critical

12
Formalizing the Network
  • Can be internal system oversight or
    multi-provider governance
  • Accountability of all elements of the system to
    each other is important
  • Planning for continual changes in the patient
    population and service needs to be key function
  • Resource sharing and cost-saving is a standing
    agenda item
  • Coordinated advocacy at state and national level
    is a significant benefit

13
Network Development Focused on Underserved
Populations Examples
  • California Counties (unique requirement for local
    responsibility for indigent care)
  • - San Mateo
  • - Orange
  • New Orleans (4 parishes)
  • Austin, Texas (greater Travis County)
  • Chicago/South Suburbs (Comer Plan/CHNU)
  • Miami/Dade County
  • Cincinnati/Hamilton County Plan
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