EMERGING MODELS: Reaching the Hard to

Reach and UnderservedModerator:

Tyra Tomlin, Detroit Medical Center

Panelists

Andrea Boudreux, PsyD, MPH, MA, Catholic Health Initiatives

Diana Jackson-Davis, PhD, Parkview Health

Antionette Smith Epps, MHSA, Ferris State University

LaShannon Spencer, MPA, MHSA, Community Health Centers of Arkansas

EMERGING MODELS: Reaching the Hard to Reach and Underserved

The healthcare industry is ever changing. Fee for

service reimbursement and large tertiary facilities are

being replaced by more population based methods of

care compensation.

What are the new models that will prove to be

successful and add value to the organization and the

patient in this new age of healthcare?

EMERGING MODELS: Reaching the Hard to Reach and Underserved

Historically, minorities have been underserved,

received less access to care and experience poorer

health outcomes.

This session on emerging models of health care

delivery will explore specific populations that remain

hard to reach and examine emerging models that can

be adopted to better serve underserved community

members.

EMERGING MODELS:Reaching the Hard to Reach and Underserved

Participants will leave with an understanding of new models of healthcare delivery for the following populations:

African American males

The Elderly

Immigrant Populations

Rural Residents

Participants will understand how these models can be applied to provide care to other underserved populations and provide service in community based programs.

Participants will understand how the shift toward a value based system will impact their organizations and the importance of continuing to provide innovative care to vulnerable populations.

Cultural Issues with

Immigrants in Health Care

Diana Jackson-Davis, PhD,

Parkview Health

1. Understand the effects of current demographic trends

on U.S. healthcare

2. Understand the impact of health disparities on

prevalence of disease among immigrant populations

3. Learn why cultural education for healthcare providers

is an important method for addressing health

disparities

4. Learn practical methods for improving cultural

competence among members of an healthcare team

Learning Objectives

To create a more inclusive environment and

community

To establish dialogue and connections between

immigrant groups

To effectively advocate for immigrants and refugees

in the community

To encourage positive understanding about

immigrants

Why it is important to know about immigration

and how it impacts our community

African American Males and

Community Health Centers

LaShannon R. Spencer, MPA, MHSA

Chief Executive Officer

Community Health Centers of Arkansas/Arkansas Primary Care Association

What are Health Centers?

Community, Migrant, Homeless, Public Housing, and other Health Center Program grantees are non-profit, community directed providers that remove common barriers to care by serving communities who otherwise confront financial, geographic, language, cultural and other barriers.

Located in high-need areas identified as having elevated poverty, higher than average infant mortality, and where few physicians practice.

Tailor services to fit the special needs and priorities of their communities, and provide services in a linguistically and culturally appropriate manner.

Provide comprehensive primary and other health care services: medical, dental, mental health, and pharmacy.

Provide high quality care, reducing health disparities and improving patient outcomes.

Cost effective, reducing costly emergency, hospital, and specialty care, and saving the health care system $24 billion a year nationally.

And Community Health Centers are not FREE Clinics

Source: National Association Community Health Centers

Health Center

Population

United States

Population

Percent at or Below

100% of Poverty71% 15%

Percent Under 200% of

Poverty 92% 34%

Percent Uninsured 28% 10%

Percent Medicaid 47% 19%

Percent Medicare 9% 13%

Percent Hispanic/Latino 34% 17%

Percent African

American 20% 13%

Percent Asian/Pacific

Islander4% 6%

Percent American

Indian/Alaska Native 1% 1%

Percent White 57% 77%

CHCA

Community Health Centers of Arkansas, Inc.ARKANSAS PRIMARY CARE ASSOCIATION

StatewideLookat Arkansas CommunityHealth Centers

Southside

Batesville

5

Fayettevil

le

Bee

Branch

FQHC Legend

1st Choice Healthcare, Inc. ARcare

Boston Mountain Rural Health Center, Inc.

CABUN Rural Health Services, Inc.

Community Clinic

East Arkansas Family Health Center, Inc.

Healthy Connections, Inc.

Jefferson Comprehensive Care System, Inc.

Lee County Cooperative Clinic, Inc.

Mainline Health Systems, Inc.

Mid-Delta Health Systems, Inc.

River Valley Primary Care Services, Inc.

Source: 2014

UDS

Diabetes Health Statistics - (UDS

2013 - 2015)

2013 2014 2015

Health Center

Total # of

Patients

# of Patients

with Diabetes

% Patients

with Diabetes

Total # of

Patients

# of Patients

with Diabetes

% Patients

with Diabetes

Total # of

Patients

# of Patients

with Diabetes

% Patients

with Diabetes

ArCare 40,442 3,392 8.4% 47,241 3,977 8.4% 51,421 4,487 8.7%

Boston Mtn 14,967 1,137 7.6% 15,404 1,413 9.2% 13,991 1,170 8.4%

CABUN 8,234 932 11.3% 7,801 910 11.7% 7,448 879 11.8%

Community Clinic 27,238 1,590 5.8% 31,562 1,936 6.1% 35,244 2,098 6.0%

1st Choice 13,465 1,117 8.3% 14,101 1,273 9.0% 15,010 1,345 9.0%

East Arkansas 12,596 1,569 12.5% 13,174 1,931 14.7% 14,221 2,075 14.6%

Healthy Connections 5,384 503 9.3% 6,780 651 9.6% 7,938 721 9.1%

Jefferson 11,414 1,058 9.3% 10,186 1,046 10.3% 8,409 890 10.6%

Lee County 4,427 544 12.3% 3,801 539 14.2% 3,418 502 14.7%

Mainline 8,755 757 8.6% 9,675 764 7.9% 10,791 768 7.1%

Mid-Delta 3,318 351 10.6% 2,985 278 9.3% 2,930 284 9.7%

River Valley 13,557 1,167 8.6% 14,507 1,272 8.8% 15,370 1,455 9.5%

Network 163,797 14,117 8.6% 177,217 15,990 9.0% 186,191 16,674 9.0%

CHCA: Diabetes Health Statistics

"To improve the health of African-American men, we must consider addressing why

they lack trust in the health-care system and its providers and social determinants

that prohibits access.”

Service Challenges in Rural

and Aging Populations

Antionette Smith Epps, MHSA

Assistant Professor Health Administration

Ferris State University

Learning Objectives

1. Understand the demographics of rural and aged

populations in the United States.

2. Understand the issues associated with

providing services to rural and aged

populations.

3. Present two models of service provision that

can be used to address the needs of these

populations.

4. Examine data on the effectiveness of these

models.

Community Health Worker Model

Definition:

A community health worker is a frontline public health

worker who is a trusted member of and/or has an

unusually close understanding of the community and

serves as a liaison/link/intermediary between

health/social services and the community to facilitate

access to services and improve the quality and cultural

competence of service delivery.

American Public Health Association

Community Health Workers Section

Community Health Worker Model

Research has documented improvements

Appropriate health care utilization

Health behaviors

Health outcomes

Care navigation

Problem solving

Self management skills

Goal setting and monitoring

Care coordination

Verhagen, I., Steunenberg, B., De Wit, N., & Ros, W. (2014). Community health worker interventions to improve access to

health care services for older adults from ethnic minorities: A systematic review. BMC Health Services Research, 14(1), BMC

Health Services Research, 2014, Vol.14(1)

Core Health Program Spectrum Health of Michigan

Free, home based program at two SH

locations 12 month program with monthly in home visits

Urban site in Grand Rapids, Michigan

Rural site in Greenville, Michigan

Targets diabetes & heart failure patients who

must be willing to make life style changes to

improve health

Encouraging results first year in Greenville 2015 full year of data

2016 ½ year of data

Core Health Program Spectrum Health of Michigan

Heart Failure Outcomes

Measure Pre Core Health Post Core Health

ED Utilization 75% 25%

Hospitalizations 62.5% 12.5%

HF in zone green 87.5% 100%

BP↓ 130/80 50% 62.5%

Annual Dental Visit 28.6% 42.9%

PAM Score >67.0 60% 100%

Spectrum Health Core Health Quality Outcomes Report, June 2016

Core Health Program Spectrum Health of Michigan

Diabetes Outcomes

Measure Pre Core Health Post Core Health

ED Utilization 52.2% 45.7%

Hospitalizations 41.3% 21.7%

Weekly Physical

Activity2.2 4.2

BP↓ 130/80 32.6% 54.3

HbA1c < 7% 34.1% 26.1%

PAM Score >67.0 48.7% 94.9%

Spectrum Health Core Health Quality Outcomes Report, June 2016

The shift from Volume to Value

and the importance of Primary

Care

Andrea J. Boudreaux, PsyD, MPH, MA

Associate Administrator

Catholic Health Initiatives

Shifting to Value: A Journey

Fee for Service

Sustainable Growth Rates

Bundled Payments

MACRA

APM

MIPS

Timeline 2017

2022

Implications to Health Systems

Clinically Integrated Networks versus

Physician Hospital Organizations

Develop road maps now to prepare for

measurements in 2017

Data analytics

Quadruple Aim

Triple Aim shortcomings

Provider Burnout

Why Primary Care Matters

Care in the appropriate place

Sickness versus Health industry

Value based reimbursement

Integrated care

Integrated Model

Psychology (Behavioral Health)

Care Teams

Advanced Practice Clinicians

Sample Case

Dr. X – value based reimbursement

Dr. Y – fee for service reimbursement

EMERGING MODELS

QUESTIONS?

EMERGING MODELS

Andrea Boudreux, PsyD, MPH, MA, Catholic

Health Initiatives AndreaBoudreaux@catholichealth.net

Diana Jackson-Davis, PhD, Parkview Health Diana.Jackson@parkview.com

Antionette Smith Epps, MHSA, Ferris State

University eppsa1@ferris.edu

LaShannon Spencer, MPA, MHSA,

Community Health Centers of Arkansas lashannon_sadie@yahoo.com