Advancing Team-Based Care:Dissolving the Walls: Clinic Community Connections
Download as PPTX, PDF2 likes260 views
The National Cooperative Agreement on Clinical Workforce Development webinar, held on June 2, 2016, focused on improving clinic-community connections through a learning collaborative aimed at enhancing health services for underserved populations. Key objectives included understanding the relationship between patients and their communities, and implementing strategies such as hiring community staff to bridge gaps in care and address social determinants of health. The program, presented by experts from various health organizations, highlighted successful practices, challenges faced by community health centers, and emphasized the importance of engaging patients and leveraging community resources.
Advancing Team-Based Care:Dissolving the Walls: Clinic Community Connections
- 1. Welcome The National Cooperative Agreement on Clinical Workforce Development WEBINAR 8: Dissolving the Walls: Clinic Community Connections June 2nd, 2016 Presented by the the Community Health Center, Inc. & the MacColl Center for Health Care Innovation
- 2. Speakers From MacColl Center for Health Care Innovation, Group Health Research Institute: Ed Wagner, MD, MPH, Director Emeritus Brian Austin, Deputy Director Katie Coleman, MSPH, Research Associate From Access Community Health Network: Donna Thompson, RN, MS From Community Health Center, Inc.: Mark Masselli, CEO/President Margaret Flinter, APRN, PhD, Senior Vice President & Clinical Director Kerry Bamrick, MBA, Senior Program Manager
- 3. LEARNING COLLABORATIVE APPLICATIONS NOW OPEN! o Participation in the Learning Collaborative is FREE for health centers. o 9-month intensive learning collaborative provided by CHCI, it’s Weitzman Institute and partners o Team Based Care or Post-Graduate Residency Program How to apply? -Visit www.chc1.com/nca -PDF of the application is available on our website -Applications due June 10th
- 4. Learning Objectives: 1. Describe the relationship between understanding individual patients and understanding their community and culture. 2. Identify 3 ways they can better connect with their community to provide the services their patients need.
- 5. Get the Most Out of Your Zoom Experience • Send your questions using Q&A function in Zoom • Look for our polling questions • Live tweet us at @CHCworkforceNCA and #primarycareteams and #HRSAnca • Recording and slides are available after the presentation on our website within one week • CME approved activity; requires survey completion • Upcoming webinars: Register at www.chc1.com/nca
- 6. Dissolving the Walls: Clinic Community Connections Learning from Effective Ambulatory Practices MacColl Center for Health Care Innovation Group Health Research Institute June 2nd, 2016 Ed Wagner, Director Emeritus Katie Coleman, Research Associate | Brian Austin, Deputy Director
- 7. The Origins of Community Medicine • In mid-1940s, Sidney and Emily Kark establish a PC practice among the Zulu in Pholela, SA. Provided primary care but also surveyed the health needs of the population, and responded accordingly. • In 1957, a med student, Jack Geiger, spends 4 months in Pholela with the Karks. • In 1965, Geiger starts first U.S. community health centers in Mound Bayou, Mississippi, and Boston.
- 8. Delta Community Health Center Services • In addition to providing PC services, the Delta HC: developed the CHW role, established a farm coop to make healthy food more available, dug wells for clean water, provided education to adults that hadn’t completed high school, etc. • The first health centers: Hired staff from the community addressed the social determinants of health in their communities.
- 9. The three goals of clinic-community connections 1. Hire staff from important communities to increase cultural competence and reduce language barriers. 2. Connect patients with community resources that meet important needs. 3. Help address social determinants of health.
- 10. Why hiring staff from the communities served is viewed as critical by LEAP practice leaders • People are more likely to seek medical care staffed by folks like them. • Patients often are more willing to confide personal information with a peer. • Staff from the cultures and communities served provide valuable intelligence on community strengths and resources, as well as factors threatening population health and well-being. • Evidence suggests that patients receiving or reviewing information from culturally indigenous staff become better self-managers. • It helps the local economy.
- 11. Connect patients with community resources that meet important needs. • Most U.S. communities have a confusing array of potentially helpful resources and services. • Providers are often not aware of community agencies and resources that can benefit patients, or how to help patients access them. • LEAP practices often employ staff (lay workers, MAs, CHWs, etc.) who develop relationships with services or resources in the community and help patients connect with them.
- 12. Help address social determinants of health. What can busy, financially strapped community health centers do to improve the health and well-being of the communities they serve?
- 13. Action Steps 1. Hire staff representative of communities served. 2. Designate staff to coordinate community linkages. 3. Learn community strengths and weaknesses. 4. Develop relationships with key community organizations. a. Those providing key patient services. b. Potential partners in addressing social determinants. 5. Use the practice’s influence and resources to better the community.
- 16. Resource Spotlight #2: Program and Services Brochure from 11th Street Family Health Services www.improvingprimarycare.org
- 17. Presented by: Donna Thompson CEO Access Community Health Network June 2, 2016 ‘Looking Beyond Our Walls’ Access Community Health Network
- 18. Key Objectives • Share ACCESS’ experience as a Federally Qualified Health Center (FQHC) serving the Chicago area • Discuss the role of the community in caring for our patients • Explore how we learn from patients about their needs ‘beyond our walls’ • Describe how ACCESS connects with existing resources and advocates for those resources that don’t exist
- 19. About ACCESS • ACCESS is one of the largest FQHC organizations in the country. • Accredited by The Joint Commission, ACCESS operates 36 health centers across Chicago and Cook and DuPage counties. • This year, ACCESS will serve more than 180,000 low-income individuals and families, including more than 30,000 uninsured patients with over 608,000 visits. • ACCESS is proud to be named a Level 3 Patient-Centered Medical Home (PCMH) Recognized Practice by NCQA.
- 20. Our Mission The mission of ACCESS is to provide outstanding preventive and primary health care, accessible to all in their own communities.
- 22. Challenges We Face • Newly insured population due to expansion of Affordable Care Act (ACA): many decades behind in maintaining their health • Many patients are experiencing first face-to-face with a provider since their last pediatric visit • New competitors are now emerging in what was once considered an undesirable market • More patient choice • Provider retention and recruitment • Volume to Value-base reimbursement (aggressive movement to risk contracts) • Addressing social determinants of health
- 23. The Quality Factor • The backbone of the ACA is prevention. • Huge paradigm change: from volume to value model • Must be at the core of every organization’s business and care model
- 24. Our Approach to Quality Improvement • Emphasis on quality outcomes (measureable) • Patient Centered Medical Home (PCMH) model (Level 3) • Strong technology investment • Ability to be nimble and rapidly adapt to this new health care environment
- 25. How We Impact Health Beyond Our Walls • Engage patients between visits through technology, including 24/7 patient access via a secure online patient portal • Screen patients for key social determinants that impact health (i.e. food insecurity, housing) and link patients to the resources they need to support their care and positively affect their health outcomes • Develop a team-based care model that is rooted in evidence-based practices • Engage our patients in their care plan through shared decision- making and meet them where they are • Invest in the right technology to give our providers access to real- time data that can impact patient care and outcomes
- 26. How We Impact Health Beyond Our Walls Role of the Community • Imbedded in our strategic focus • Stakeholders are within and outside our walls • Long history of cultivating collaborative relationships • Strategic community partnerships aren’t built with only those organizations that think like you • Intentional with creating a workforce reflective of the community at all levels of the organization • 51% of ACCESS’ Board of Directors are community representatives • Community has to feel they have power and ownership • Can influence change
- 27. How We Impact Health Beyond Our Walls How we learn from our patients about their needs • Build trust and non-judgmental relationships • Shared decision-making • Use of data from various sources to confirm/validate and bring clarity when discussing community issues • Advisory groups • Change the milieu of the health center – Comfort rooms – Design of the exam rooms – Group visits that create supportive environment • Centering programs
- 28. How We Impact Health Beyond Our Walls Connecting to existing resources • Things to consider: • Success is all about the detail • Understanding the assets in the community and staying current • Ideas that appear simple are usually more complex to execute • What’s it really going to take to make a resource valuable for the community • Community perception of resources can make or break an idea • Resources need to be aligned with how people navigate their daily lives
- 29. How We Impact Health Beyond Our Walls Advocating for resources that don’t exist • Things to consider: • Build a business case using data that supports the need and desired impact • Ideas that appear simple are usually more complex to execute • It’s better to seek resources with a group that has the same shared interests. Strong by numbers and influence • Explore non-traditional sources for advocacy or to build coalition • Patience and Focus - to build momentum and commitment may take years before outcome is realized
- 30. Questions? Learn More About ACCESS Donna Thompson, Chief Executive Officer Donna.Thompson@accesscommunityhealth.net • www.achn.net • ACCESS on social media: • http://Twitter.com/ACCESSHealth • http://Facebook.com/ACCESSCommunityHealth • https://www.LinkedIn.com/company/access- community-health-network
- 31. Community Health Center, Inc. Foundational Pillars 1. Clinical Excellence- fully Integrated teams, fully integrated EMR, PCMH Level 3 2. Research & Development- CHC’s Weitzman Institute is the home of formal research, quality improvement, and R&D 3. Training the Next Generation: Postgraduate training programs for nurse practitioners and postdoctoral clinical psychologists as well as training for all health professions students CHC Profile: •Founding Year - 1972 •203 delivery sites •145k patients
- 32. Community Health Center, Inc. Income Equality Starts with Us Solutions Need to be Scalable Build it, and They Will Come. Maybe.. Who Wants to be on the Bus? The Visit Starts with a Phone Call
- 33. Q & A, Discussion