Workshop IIIC: Helping the Un & Underinsured through the Public Health Maze
LATCH Local Access To Coordinated Healthcare
September 23, 2008
Susan D. Yaggy, Chief
Division of Community Health
Department of Community and Family Medicine
Duke University Medical Center
Duke Community Health
• Created as a Division of the Medical School in 1998 with a staff of 2
• Collaborative community-based services
• Programs created with extensive community input often a year in planning
• Multi disciplinary; multi-agency
Preceding LATCH
• 3 school-based clinics: 1 high school, 2 elementary
• Minority health careers• Primary care with FQHC for homebound:
diabetes, HTN, asthma• Dental van with Health Dept and schools• Large Medicaid care management programs:
– 10,500 enrollees (now 20,000) in Durham– Non-clinical staff– Deliver education, advocacy, follow-up on clinic care,
navigation in homes
LATCH History
• Launched: January 2002; Healthy Communities Access Program (HCAP) funding from US Health Resources and Services Administration (HRSA.)
• To improve access to health services
• Improve health status for Durham County’s growing uninsured/ underinsured Latino immigrants.
• Over 300 patients waiting on opening day.
Open to any:
• Durham County residents who is un/underinsured – no means testing
• Referred by local health and social service providers and self-referrals
• Since 2002, over 14,000 referrals and nearly 11,000 enrolled patients
Enrollee Demographics
• 41% Male, 59% Female
• Race/Ethnicity: Hispanic/Latino (>96%)
• Employed in low-wage industries (construction, landscaping, restaurants, housekeeping, childcare)
• Average <7 years in US
Barriers• No knowledge of health system• Do not speak (any/much)
English.• Some speak indigenous
languages • Lack of available childcare• Lack of reliable/available
transportation• Low/no literacy• No phone; 30 day phone• Cultural differences re: health
and prevention• Documentation status; fear
limits care-seeking and follow-up
What LATCH Brings:
• Individual/Family Approach
• Case management
• Patient navigation – health and social services
• Health education
• Community outreach - delivered in neighborhoods and at home
• Care managed (electronic information system)
• Culturally and Linguistically competent staff
• Primary outreach through El Centro Hispano, a trusted community resource
LATCH Services• Home Visits (program orientation, needs assessment
and risk stratification)• Health Services Orientation/Coordination (PCP/medical
home, urgent care, specialty, ER)• Referrals and Facilitation (appointments, directions,
accompaniment) • Medication Access and Compliance/education• Bills Assistance (Self-Pay Payment Plan, Medicaid and
Duke Charity Care applications)• Some Chronic Disease Management (asthma,
hypertension, diabetes, depression, pregnancy, etc.)• Prevention Education• Advocacy• Interpretation/Translation• Limited Transportation
Enrollment
• Medical and Social Service Providers
• Walk-in enrollment --El Centro Hispano
• Self-referrals• By fax, phone or in-
person• Fax Referral/Consent
Form with patient signature
A Working Consortium to Resolve Access Barriers• El Centro Hispano• Lincoln Community Health Center• Durham County Department of Social Services• Durham County Health Department• Planned Parenthood• Catholic Charities• Durham City Parks and Recreation• Center for Child and Family Health• Immaculate Conception Church• Duke University Medical Center and Health System• Duke Private Diagnostic Clinic• Duke University Hospital: Latino Health Project• Durham Regional Hospital
Some Recent Consortium Successes• HIPPA firewall blocking
Emergency Medicaid enrollment
• Billing and payment plan services not in Spanish
• Health Dept. pregnancy confirmation requirement by MD
• Literacy level on patient payment materials
• Transportation system issues with DSS
• Birth certificate—father’s ID
Program Support
• Funding: HRSA funding ended in April ’06. LATCH now supported by DUHS
• FY09 budget: $299K• LATCH staff:
– Program Coordinator– SW (DSS contract)– .5 health educator– 3 CHW’s– .5 secretary– And administrative support from Division of
Community Health
LATCH outcomes
• Phone survey (n=225) in summer 2005 (225 of 485 completed phone survey – 46% response rate)
• All participants born in Latin America and lived in US < 7 years
• More intensive case management going to:– Clients who lived in Durham longer (7 vs. 6 years)– Clients who needed health care but could not get it
• 80% reported having a “usual source of care”• ED use from 2004-2005 reported decrease: 32%
(unweighted) to 21% (unweighted)* after controlling for health and demographic characteristics (*p<0.01)
LATCH outcomes, con’t.
Emergency Department Use by LATCH Enrollees
3221
0
25
50
75
100
Year (2004) Year 3(2005)
Time
Per
cen
t
Average ED Visits per Person
0
0.2
0.4
0.6
0.8
1
Year 2 (2004) Year 3 (2005)
TimeN
um
ber
2008: Making LATCH a Base to Grow Systems of Care for Un/Underinsured
• HealthNet: State grant through Medicaid Care Management:– Re-enroll 700/mo. who “fall off” Medicaid/sCHIP– Campaign for consistent surname $174K– Staff – health educator
• Subcontract: El Centro Hispano: SEPA $80K– Latino Stroke prevention– Screen/Educate through El Centro Hispano– LATCH to provide education/care management for
patients with stroke risk factors– Staff – health educator
2008: Making LATCH a Base, con’t.
• Project Access of Durham County: $299K– All-share system for specialty care– LATCH to provide navigation, support and
disease management– New: RN, SW, CHW, p/t secretary and IT
In closing, we are learning
• The strength of our coalition and capacity to eliminate barriers
• The ability of our patients to adapt to a new (and difficult) environment
• How to pull together all local resources to focus on a population
• How to change patterns of care – seeking and create medical homes for un/underinsured patients
Thank you.
Contact: Susan D. Yaggy
Chief, Division of Community Health
DUMC Box 2914
Durham, NC 27710
(919)681-3187
