AHRQ Annual Conference Progress of a Learning Network: Working to Reduce Disparities by Improving Access to Care Bethesda, Maryland September 14, 2009 Jim Walton, DO, MBA Baylor Health Care System - PowerPoint PPT Presentation

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AHRQ Annual Conference Progress of a Learning Network: Working to Reduce Disparities by Improving Access to Care Bethesda, Maryland September 14, 2009 Jim Walton, DO, MBA Baylor Health Care System

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Title: Improving Quality of Health Care Equity at Baylor Health Care System Author: James Walton Last modified by: Rasa Created Date: 10/12/2007 7:18:59 AM – PowerPoint PPT presentation

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Title: AHRQ Annual Conference Progress of a Learning Network: Working to Reduce Disparities by Improving Access to Care Bethesda, Maryland September 14, 2009 Jim Walton, DO, MBA Baylor Health Care System


1
AHRQ Annual Conference Progress of a Learning
Network Working to Reduce Disparities by
Improving Access to Care Bethesda,
Maryland September 14, 2009 Jim Walton, DO,
MBA Baylor Health Care System Dallas, TX
2
Baylor Health Care System Overview
  • Baylor Health Care System (BHCS)
  • Dallas-Ft. Worth metropolitan area of N. Texas
  • 15 owned, leased, or affiliated hospitals and 6
    short-stay hospitals
  • Affiliated physician organization, Health Texas
    Provider Network, has 450 physicians in 110
    practices in the region
  • Baylors flagship hospital, Baylor University
    Medical Center, is a 1000-bed inner city hospital
    with Level 1 trauma designation

3
Addressing Disparities BHCS Office of Health
Equity
  • The BHCS Office of Health Equity
  • Responsible for the identification, measurement,
    and elimination of health disparities within the
    Baylor Health Care System and the communities it
    serves

BHCS Equity Triangle
  • Health Care Access
  • Insuring Equal Access to Care Decreasing
    Unnecessary Utilization
  • Health Care Delivery
  • Insuring Equal Quality of Care Decreasing
    Adverse Events
  • Health Care Outcomes
  • Improving Health Outcomes Decreasing Mortality
    and Morbidity

Equity in Healthcare
Health Care Delivery
Health Care Access
Health Care Outcomes
4
Disparities in DFW Limited Access to Health Care
  • The Problem
  • Approximately 23.6 of the population in the
    Dallas-Ft. Worth metropolitan area are without
    health insurance coverage.
  • Translates to 1.3 million individuals with
    limited access to care1.
  • That number increases when you consider the
    number of Medicare and Medicaid patients
    struggling to access care.
  • BHCS facilities bear much of the burden of
    uncompensated care in our community.

1Parkland Health Hospital System, 2006 Estimates
5
Office of Health Equity Health Care Access Goals
Primary Objective By increasing access to needed
health services in community and home-based
settings, underserved patients will experience
less health disparities and require less frequent
utilization of hospital services (ED and
admissions), resulting in decreased uncompensated
care for BHCS facilities.
  • Health Care Access Strategies
  • Facilitate access to medical services (Medical
    Home, Ancillary, and Specialty Care)
  • Facilitate access to affordable prescription
    medications
  • Care coordination to overcome barriers (i.e. low
    SES, language, health literacy)

6
Care Coordination Pathways An
Adaptive Model
  • Leveraging Baylors infrastructure Physicians
  • Adjunctive support - Community Health Workers
  • Pathways model Care protocols to ensure
    connection with and delivery of evidence-based
    care
  • BHCS has adapted the CCC model over the past
    eight years to improve
  • Access to primary care
  • Health outcomes
  • Financial savings
  • Innovation in care delivery

7
Care Coordination-First Steps Community Health
Navigation
  • A collaboration with Project Access Dallas
  • A network of volunteer providers across Dallas
    Co. organized to provide care to uninsured
    working poor
  • Community Health Navigation was created to help
    patients overcome barriers to care
  • Translation, Transportation, Medication
    assistance
  • Health Education to improve patient knowledge and
    behaviors
  • Coordination of referrals within the PAD program

8
Adapting Care Coordination 1. BHCS Vulnerable
Patient Network
  • A unique house-calls program utilizing a
    multi-disciplinary team to provide home-based
    primary care services to underserved patients
    with complex medical and social conditions
  • Neuro-trauma and Heart Failure
  • Specially-trained CHW supports the care team with
    physicians and nurse practitioners
  • CHWs have medical assistant training
  • Utilize clinical and social Equity care-path
    tools
  • Serve as a single point-of-contact for home-bound
    patients

9
47.8 Reduction
36.4 Reduction
58.3 Reduction
10
72.6 Reduction
71.2 Reduction
29.6 Reduction
11
Adapting Care Coordination 2. Community Diabetes
Education (CoDE)
  • Use of Community Health Workers to provide
    chronic disease education and self-management
    training to underserved diabetics within
    charitable health clinics across Dallas County
  • Conduct one-on-one counseling with patients
  • CHW is bilingual/bi-cultural
  • Contextualizes diabetes curriculum messages
  • Advocates for diabetics families (meds,
    referrals, etc.)
  • Additional point-of-contact for patient/families

12
Community Diabetes Education (CoDE) Clinical
Outcomes
13
Care Coordination-Next Steps 3. Ambulatory Care
Coordination
  • Supporting the move toward NCQA certification -
    Patient-Centered Medical Home (PCMH)
  • Multi-disciplinary teams
  • 2007 - The AAFP, AAP, ACP, and AOA publish the
    Joint Principles of the Patient-Centered Medical
    Home with 7 Core Features
  • Ambulatory Care Coordination (HT-ACC)
  • Using non-physician staff to navigate patient
    care
  • Coordinating care/follow-up for patients
    (in-patient out-patient)
  • Addressing barriers, assessing progress and
    utilizing care paths for care management
  • Generating reminders for preventive care
  • Implementing evidence-based guidelines for
    disease management


Sources Joint Principles of the
Patient-Centered Medical Home available at
http//www.aafp.org/online/etc/medial
ib/aafp_org/documents/policy/fed/jointprinciplespc
mh0207.Par.0001.File. tmp/022107medicalhome.pdf
14
Summary
  • Community Care Coordination and the Pathways
    model has been successfully adapted to provide a
    wide range of services to underserved patients
  • Navigation clinical and social support chronic
    disease education
  • The model has produced
  • Improved clinical outcomes
  • Decrease in avoidable hospital utilization
  • Positive financial impact for hospitals
  • The model will be applied in new efforts to
    achieve NCQA certification for PCMH
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