16 th Annual International Summit on Improving Patient Care in the Office Practice and the Community. Monday, March 16, 2015

Transcription

1 Welcome 16 th Annual International Summit on Improving Patient Care in the Office Practice and the Community Monday, March 16, 2015 Antony Sheehan, President Jenny Bartlett-Prescott, Director of Integrated Health Services Church Health Center of Memphis

2 Today... 1) Who we are 2) What do we do 3) Taking community engagement to the next level 2

3 » If you don t know your community how can you know your Patients and Families? Question... 3

4 Welcome to Memphis 4

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6 This is where we live and work... Memphis/Shelby County Population = 653,450/927,644 Black or African American = 62% White = 31% Hispanic = 5% Asian = 1.7% West Tennessee 6 Memphis / Shelby County

7 Social Determinants of Health 7

8 Memphis... Last! First! 8

9 September 1, patients to 60,000 3 staff to 270+, plus more than 1,000 volunteers The intersection of Faith and Health in the Community 9

10 For every dollar spent on illness, at least $1 spent on wellness... 10

11 Our Values grateful service loving justice-seeking gentle humble faithful passionate collaborative welcoming respectful distinctive compassionate integrity inclusive joyful openness innovative brave 11

12 Our Brand At Church Health Center, we stand in the gap, but we do not stand still. Each day, we stand ready to care for people who are hurting but live within a system that has left them behind. Our neighbors come seeking help, yet what they find is much deeper and more healing. What they discover is hope for a better life. At Church Health Center, our work is fueled by faith and powered by love. It is this mindset that allows us to fundamentally rethink healthcare as we seek a more just world. To us, love creates a connection between medicine and true wellness, and it is the reason we care for one another, with one another. Church Health Center is a community of caregivers doctors, nurses, nutritionists and therapists, educators and faith leaders who, together, prove that acts of love can have profound outcomes. We were built for this. 12

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15 1. Serve & Heal We will integrate faith and health into accessible, comprehensive, high-quality services to serve more and serve better and improve the health of our community 2. Build & Collaborate We will build partnerships that extend our reach, support our Model for Healthy Living, and deliver improved health and well-being throughout our community. 3. Share & Learn We will both share and seek knowledge among the world s faith and health communities to improve healthcare and promote whole-person wellness. 4. Improve & Deliver We will improve the health of our population and enhance the service experience with stewardship of our resources and quality improvement strategies. Our Aims... 15

16 » Continuity of Care» Access to Services» Wrap-around care Patient Centered Medical Home 16

17 As healthcare reforms continue, we have the opportunity to advance integrated care: Share our Model for Healthy Living and integrate it fully into our care Prepare for new business models that complement shifts in the healthcare world The Model for Healthy Living 17

18 Live in Shelby County, Tennessee (broadly ) 12% (+) of the population uninsured People we care for earn very little, most live at or around the poverty level Some requirements apply for some aspects of our services Patient Eligibility who we serve 18

19 » Medical» Walk-in Medical» Dental» Eye Care» Nutrition» Physical Therapy» Behavioral Health Staffed Clinics 19

20 » Volunteers on and off site» Donated services 20

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22 MEMPHIS Plan participants Assigned to a volunteer primary care physician and local hospital. May access our volunteer network of specialists by referral of their PCP. Go to their assigned hospital for emergencies and surgical care when recommended by their PCP. The MEMPHIS Plan 22

23 MEMPHIS Plan Employers must: Be located in Tennessee. Have no more than 200 eligible employees. May only offer the MEMPHIS Plan to employees who are unable to afford the insurance provided through the employer or do not qualify. MEMPHIS Plan Employees must: Make no more than 200% of the poverty level, Work at least 20 hours a week. To participate in the MEMPHIS Plan 23

24 Key indicators were significantly lower for MEMPHIS Plan and Church Health Center patients MEMPHIS Plan (n=3474*) Controls (n=3240) Variable Mean (SD) Mean (SD) p-value LOS** 4.25 (4.2) 6.37 (10.5) <.001 Charges $5,162 ($15,646) $9,100 ($34,039) <.001 Direct cost $860 ($3,948) $1,777 ($7,648) <.001 Visits 3.9 (4.7) 8.4 (12.3) <.001 *Number of visits; **Number of inpatient stays Church Health Center = 248, Controls = 417. Data from Methodist University Hospital 24

25 Church Health Center Wellness 25

26 For every dollar spent on illness, at least $1 spent on wellness... 26

27 The Church Health Center... A variety of results demonstrating the effectiveness of Integrated Care 27

28 Healthy Living Program 18 month Wellness-based intervention for overweight diabetics 116 participants enrolled Average age of 52.4 years 81% of participants are female 81% African American 10.3% White 8.6% Hispanic $14,961 reported average income 28

29 Healthy Living Program 18 month Wellness-based intervention for overweight diabetics PROGRAM COMPONENTS 18 month family membership to Church Health Wellness Participant commitment to visit wellness facility 2 times per week for 12 months First 12 months: Completion of 4 session diabetes education class Monthly sessions with health coach Monthly sessions with dietician Weekly check-in with exercise coach Social work or counseling assistance, as needed 29

30 Healthy Living Program 18 month Wellness-based intervention for overweight diabetics Percent Change After Program Body Mass Index -2.1%** Max Oxygen Consumption 11.4%** HbA1c -8.4%** LDL Cholesterol -9.5%* *p<0.05; **p<

31 Healthy Living Program 18 month Wellness-based intervention for overweight diabetics Percent Change After Program Perceived Health +28.0%** Anxiety-Depression -23.0%** Overall Life Satisfaction +19.9%** Overall Feeling That Things +9.4%** In Life Are Worthwhile **p<

32 Staff Health 85% Involvement 32

33 Outreach in the Philippines 33

34 34,000 publications went around the world... CHReader.org 34

35 Church Health Scholars 35

36 Perea Preschool Fall of Scores at Entry Spring Scores at Exit Delayed/Very Delayed 62% Delayed/Very Delayed 10% Average/Advanced 38% Average/Advanced 90% The 2014 class improved by 74% in mastery of their academic skills! 36

37 Perea Preschool The first Contacted and collected information on 47% of students Collectively maintained a 3.03 GPA during their high school year. All of those students on track to graduate from high school. Over $1 million dollars in scholarships offers. 37

38 And, Ava s getting ready for her graduation early... 38

39 We had a Case Study published about us in

40 The British Medical Journal 40

41 Funding of the Center s work Sources of Revenue Contributions: Individual and Community Earned Income: Patients, Members, MEMPHIS Plan Donated Services: Volunteers, Hospitals, Clinics In-kind Donations: Medications, Medical Aids 41

42 Blessed... Jesus life was about healing the whole person body and spirit and the church is Jesus in the world. If we want to be faithful disciples, we will do what Jesus did, including healing. We have the opportunity to lead innovative, collaborative approaches to healthcare. 42

43 Business-like... Clarity about what we are trying to accomplish Accountability doing what we say we will do Data on outcomes that matter Data on costs Culture of innovation and improvement Our mission 43

44 It Works! 44

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47 Don t be poor Don t be born to a poor family Don t live in a poor area If you live in a hurricane-affected area, own a car Professor Ichiro Kawachi 47

48 So what s Leadership got to do with it? 48

49 Leadership Essentials Liberating Talent Profound Belief in Talent Purpose Beyond Self... All mediated through Respect 49

50 Wounded Healer of the Soul 50

51 Returning to the Social Determinants of Health 51

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54 Crosstown Concourse 54

55 Defining Ourselves... Who we will be... in Crosstown (partnership) in the City of Memphis (system) in the World (knowledge) 55

56 A steady hand --- and a long journey 56

57 Paul Tillich 57 The first duty of love is to listen

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