FROM HOSPITAL TO HOME ROOT CAUSE COALITION OCTOBER 2017

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Irma Farmer
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1 FROM HOSPITAL TO HOME ROOT CAUSE COALITION OCTOBER 2017

2 National Health Foundation History National Health Foundation was founded in 1973 by the Hospital Association of Southern California to conduct research and educational programs related to healthcare delivery, particularly in hospital settings. Mission To improve the health of individuals and under-resourced communities by taking action on the social determinants of health. Vision All people, regardless of who they are or where they live, can achieve their highest level of health.

3 SUMMARY OF SESSION Objectives How a program that originated as a safe discharge op4on for hospitals came to tackle one of our neighbors most basic social determinants of health: having a home. How Na4onal Health Founda4on iden4fied and created robust partnerships to design a program that met mul4ple stakeholder needs and is fully self- sustaining. The variety of challenges that have emerged over 10 years (e.g. marke4ng strategies for different stakeholders, divergence in partners program priori4es, increased local compe44on) and how Na4onal Health Founda4on has worked through them. How Na4onal Health Founda4on and the recupera4ve care program a small piece of the puzzle were integrated into the complex fabric of Los Angeles County s overall plan to solve homelessness.

PATHWAY RECUPERATIVE CARE Program Operations A staff of 15 individuals market, manage and care for 40 beds in Los Angeles County at two separate sites.

4 PATHWAY RECUPERATIVE CARE Program Operations A staff of 15 individuals market, manage and care for 40 beds in Los Angeles County at two separate sites. An additional 12 beds are offered in Ventura County under a different model. A new downtown site was recently leased and after renovations will open up with 60 beds. Program is funded 100% through hospital fee-for-service. NHF maintains letters of agreement with 60 private hospitals throughout the region. NHF responds to a hospital referral with six hours. Clients stay an average of 9 days. Bridge housing is available through 10 beds of those 40. Our Intake Coordinator giving a fast pitch to Hospital CEOs.

PATHWAY RECUPERATIVE CARE Output 945 unduplicated individuals have been safely discharged from the hospital to Pathway Recupera4ve Care last year 140 individuals moved from Recupera4ve Care to Bridge

5 PATHWAY RECUPERATIVE CARE Output 945 unduplicated individuals have been safely discharged from the hospital to Pathway Recupera4ve Care last year 140 individuals moved from Recupera4ve Care to Bridge Housing last year Impact 67% of program par4cipants discharged into housing According to our highest u4lizing hospital, only 4% of their pa4ents returned to the hospital within 30 days of their original discharge $11.5 million is saved each year through costs avoided to hospitals and health plans.

INITIAL PARTNERSHIP Launching Los Angeles Recuperative Care

tagged to facilitate collaborative between hospitals, health

recuperative care program A local provider of services for

relationships, contracts, payment structure, referrals,

6 INITIAL PARTNERSHIP Launching Los Angeles Recuperative Care Inappropriate discharges by local hospitals In 2007, NHF tagged to facilitate collaborative between hospitals, health plans, local foundations and funders; the result was a recuperative care program A local provider of services for the homeless operated the program and NHF managed hospital relationships, contracts, payment structure, referrals, evaluation Many lessons learned (produced 2012 report with those initial learnings)

PROGRAM EVOLUTION Upgrade: Los Angeles Recuperative Care In 2010, relaunched the program with a new service provider Semi-private rooms for more desirable healing space Pod model using motels to

7 PROGRAM EVOLUTION Upgrade: Los Angeles Recuperative Care In 2010, relaunched the program with a new service provider Semi-private rooms for more desirable healing space Pod model using motels to enable the program to be in multiple communities so that individuals experiencing homelessness could stay in their preferred neighborhood In 2014, The James Irvine Foundation recognized this partnership for its leadership in the field.

Continues marketing directly to hospitals and maintaining hospital agreements

8 PROGRAM EVOLUTION NHF Takes Program Operations In 2013, NHF takes full control of the program and hires staff to operate the program Contracts directly with motels Continues marketing directly to hospitals and maintaining hospital agreements Continues billing, database and evaluation In 2017, LABJ Safety Net Provider of the Year

9 WHAT THE FUTURE HOLDS Serving with Empathy Leasing new building; redesign of space More community engagement Taproot marketing makeover

10 FROM OUR CLIENTS For the first 4me in 10 years, I walked in and instead of being greeted with oh I m sorry we don t do that or oh I m sorry we do that but not for you or oh I m sorry we re out of funds I walked in and they said, okay what do you need? and they just started taking care of it. Steven

11 LET S PLAY: PATHWAY FAMILY FEUD!

12 PATHWAY FAMILY FEUD From the following 15 answers, which are the top three lessons learned from the ini4al Recupera4ve Care Pilot? 1. Anything is possible with a good glass of wine 2. Stop marke4ng once you reach full capacity 3. Loca4on, loca4on, loca4on 4. Do not carry a wai4ng list 5. Call your referring hospitals back within 48 hours 6. Have a database that can track your clients 7. Discharge to reputable housing op4ons 8. Accept anyone and everyone 9. Program models must be consistent 10. Provide regular feedback and pa4ent outcomes to the Hospitals 11. Have a quick and consistent eligibility determina4on process 12. Establish the length of stay with the hospital before the pa4ent is admifed. 13. An ongoing marke4ng and outreach program is necessary 14. Be upfront with the motel owner about what you are using the property for 15. Tell your board of directors you hate this idea

13 PATHWAY FAMILY FEUD From the following 15 answers, which are the top three lessons learned from the ini4al Recupera4ve Care Pilot? 1. Anything is possible with a good glass of wine 2. Stop marke4ng once you reach full capacity 3. Loca4on, loca4on, loca4on 4. Do not carry a wai4ng list 5. Call your referring hospitals back within 48 hours 6. Have a database that can track your clients 7. Discharge to reputable housing op4ons 8. Accept anyone and everyone 9. Program models must be consistent 10. Provide regular feedback and pa4ent outcomes to the Hospitals 11. Have a quick and consistent eligibility determina4on process 12. Establish the length of stay with the hospital before the pa4ent is admifed. 13. An ongoing marke4ng and outreach program is necessary 14. Be upfront with the motel owner about what you are using the property for 15. Tell your board of directors you hate this idea

14 PATHWAY FAMILY FEUD From the following 15 answers, which top three issues did Na4onal Health Founda4on face when taking over site opera4ons of Pathway Recupera4ve Care? 1. New kid on the block amongst other providers 2. Our office music playlist played too much New Kids on the Block and other boy bands 3. Discharge to reputable housing op4ons 4. Staffing 5. Providing regular feedback and pa4ent outcomes to the hospitals 6. Working with hotel owner/maintenance issues 7. Collec4ons (hospital fees) 8. The motel owner did not like us 9. The clients did not want to come to our facility because they didn t know us 10. Hospitals did not like that we did both opera4ons, finance and evalua4on 11. We had to adjust our mission and long- term strategy 12. Our staff thought it was a bad idea 13. It gave us a new perspec4ve on the work we were doing 14. We needed to open staff mee4ngs up to include a conference line for off- site staff 15. Our board of directors did not want to support this change

15 PATHWAY FAMILY FEUD From the following 15 answers, which top three issues did Na4onal Health Founda4on face when taking over site opera4ons of Pathway Recupera4ve Care? 1. New kid on the block amongst other providers 2. Our office music playlist played too much New Kids on the Block and other boy bands 3. Discharge to reputable housing op4ons 4. Staffing 5. Providing regular feedback and pa4ent outcomes to the hospitals 6. Working with hotel owner/maintenance issues 7. Collec4ons (hospital fees) 8. The motel owner did not like us 9. The clients did not want to come to our facility because they didn t know us 10. Hospitals did not like that we did both opera4ons, finance and evalua4on 11. We had to adjust our mission and long- term strategy 12. Our staff thought it was a bad idea 13. It gave us a new perspec4ve on the work we were doing 14. We needed to open staff mee4ngs up to include a conference line for off- site staff 15. Our board of directors did not want to support this change

16 PATHWAY FAMILY FEUD From these 10 answers, which top three issues does Na4onal Health Founda4on face in trying to maintain a census of 30? 1. Not requiring a minimum length of stay 2. Providing regular feedback and pa4ent outcomes to the hospitals 3. Excessive denials 4. Data base limita4ons 5. Our board of directors had a hard 4me coun4ng that high 6. Hospitals could not remember our phone number to submit referrals 7. Facility limita4ons 8. There were not enough homeless to fill the beds 9. Lack of a comprehensive Marke4ng strategy 10. We kept housing clients too quickly

17 PATHWAY FAMILY FEUD From these 10 answers, which top three issues does Na4onal Health Founda4on face in trying to maintain a census of 30? 1. Not requiring a minimum length of stay 2. Providing regular feedback and pa4ent outcomes to the hospitals 3. Excessive denials 4. Data base limita4ons 5. Our board of directors had a hard 4me coun4ng that high 6. Hospitals could not remember our phone number to submit referrals 7. Facility limita4ons 8. There were not enough homeless to fill the beds 9. Lack of a comprehensive marke4ng strategy 10. We kept housing clients too quickly

18 PATHWAY FAMILY FEUD Measure H is expected to generate an es5mated $355 million annually for services to combat homelessness through a local sales tax. From these 10 answers, which top three issues did Na4onal Health Founda4on face when Los Angeles County passed Proposi4on Measure H? 1. New regula4ons on county subcontractors 2. Shil in staff s day- to- day priori4es 3. New compe44on in the recupera4ve care market 4. NIMBY 5. Timing of funding due to Bond measure restraints 6. Zoning and permiong restric4ons 7. Finding Partners 8. SB 2 9. Amount of money available 10. It would not fund purchases of chocolate SB 2; an ordinance that says by right homeless shelters can only have 30 beds.

19 PATHWAY FAMILY FEUD Measure H is expected to generate an es5mated $355 million annually for services to combat homelessness through a local sales tax. From these 10 answers, which top three issues did Na4onal Health Founda4on face when Los Angeles County passed Proposi4on Measure H? 1. New regula4ons on county subcontractors 2. Shil in staff s day- to- day priori4es 3. New compe44on in the recupera4ve care market 4. NIMBY 5. Timing of funding due to Bond measure restraints 6. Zoning and permiong restric4ons 7. Finding Partners 8. SB 2 9. Amount of money available 10. It would not fund purchases of chocolate SB 2; an ordinance that says by right homeless shelters can only have 30 beds.

20 AND THE WINNER IS.

21 CHALLENGES REMAIN Increasingly Compe44ve Environment Staff Turnover Maintaining Balance in the Organiza4on Los Angeles Poli4cs Crea4ng Quality in an Unlicensed Environment Short Stay at Odds with Housing Marke4ng to Hospitals Accessing County Resources Marke4ng to Hospitals But we have hope and will stay motivated!

Kelly Bruno, President and CEO kbruno@nhfca.

22 Kelly Bruno, President and CEO Danielle Cameron, Chief Strategy Officer Follow us! Facebook

Recuperative Care Center of Los Angeles

Recuperative Care Center of Los Angeles Presented by National Health Foundation Elizabeth Yang, MA, Director Jeannine Pugliese, BSW, Coordinator October 26, 2012 Learning Objectives Define the benefits