ACHIEVING HEALTH EQUITY IN THE MOST CHALLENGING ENVIRONMENTS Gail Lapidus and Gerard Clancy

1. ACHIEVING HEALTH EQUITY IN THE MOST CHALLENGING ENVIRONMENTS Gail Lapidus and Gerard Clancy

2. Hubris • Extreme haughtiness, pride or arrogance. • An overestimation of one’s own competence or capabilities, especially when one is in a position of power…. • Rufus Fears:OU Classics Professor – “outrageous arrogance that inflicts suffering upon the innocent.” • My Introduction to Tulsa Health Care…. Healthcare leader, 2002 - “ I don’t know why we are here today meeting on this…we have the best health care in America right here in Tulsa.”

3. Billboards and plaques

4. Commonwealth Fund 2012

6. Commonwealth Fund 2012

7. Individuals without insurance are 1.4 to 2.6 times more likely than the insured to be diagnosed with last versus early stage cancer.

9. Commonwealth Fund 2012

14. News Flash – We Knew This in 2006 14

15. In a nation short of physicians, Oklahoma starts the furthest behind of all States in building an adequate health system. Ranking of States by Primary Care Access-Challenge Index

16. Our Founding Fathers had a hand in what you are feeling right now….they set a moral high ground for us today…. “We hold these truths to be self evident, that all men are created equal, that they are endowed by their creator with certain inalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” Thomas Jefferson • France – Liberty, Equality, Fraternity • Germany – Unity, Justice and Freedom • Australia - Life, Liberty and Prosperity • George Kaiser – “with what we now know, to not act is morally offensive.”

17. Advancing the moral high ground • 1776 – Declaration of Independence, Representation • 1861 – Civil War, Liberty and Slavery • 1870 – 15th Amendment, Voting Rights Race • 1920 – 19th Amendment, Voting Rights Sex • 1935 – Social Security Act, Retiree Protection • 1964 – Civil Rights Act, Segregation • 1965 – Voting Rights Act, Voting Rights Race • 1965 – Social Security Amendments, Medicare and Medicaid – Federal Sponsorship of Health Care Coverage “may you live in interesting times” • 2009 – American Recovery and Reconstruction Act (Stimulus) • 2010 – Patient Protection and Affordable Care Act (ACA) • 2012 – Supreme Court Upholds ACA • Oklahoma – faces greatest challenges of all. • will we choose to ….cover 250,000 uninsured oklahomans through medicaidexpansion…..will we take advantage of opportunities to reshape our sick health care system?

18. ACHIEVING HEALTH EQUITY IN THE MOST CHALLENGING ENVIRONMENTS • Critical thinking • Study the problems. Be Honest About What is Not Right. • “To achieve health equity, Learning the anatomy of the community is as important as learning the anatomy of the body.” a summer institute central theme • Critical communications • Be able to persuade multiple audiences including peers, politicians and the media. • Talk less and Listen more…. • “Listen to the Patient, he is telling you the diagnosis.” sir williamoslera white coat ceremony oldie but goodie • “Listen to the community, she is telling you the problems and the solutions.” a summer institute central theme • Critical emotions • Experience It…feel it…overwhelmed  passionate. • Critical actions • “Get Busy Livin’ OR GET BUSY DYIN’ ” • Gail Lapidus takes on mental illness…

19. Critical Thinking - Tulsa’s Disparities In Health: - 14 year difference in life expectancy North vs. South. - North, East and West Tulsa; 40% of population, 4% of Docs Age-Adjusted Death Rate in Tulsa Physician Density in Tulsa 19

20. Critical Communications: “Is Tulsa North Being Pimped by OU?”January 2010 “To Tulsa north’s ‘rescue,’ Oklahoma University has come. Unquestionably, medical care is needed in Tulsa north. Why then, pose such a negative question when OU appears to be doing the right thing?” “Our answer….Pimps use the bodies of women to make money. For whatever reason, the women are vulnerable. The residents of Tulsa north are very vulnerable because of their poor health outcomes. Hundreds of millions of dollars will be spent ostensibly for better health care for Tulsa north residents. Who gets the money for such an endeavor? OU will. Who receives $20 million dollars for building the facility? Manhattan Construction has been selected as the contractor.” “If a healthy community is the goal of OU, does it not recognize that a healthy community involves more than improving traditional healthcare facilities and services? A healthy community must have a good economy and a chance for good jobs for its residents. Tulsa north’s personal sense of well-being and its ability to thrive socially and economically are tied together. It is impossible to have a healthy community without a strong educational and economic engine in its midst.” “Why do we pose the question, “Is Tulsa north being pimped by OU?” Do not pimps use bodies to get income? OU will receive income from treating sick bodies. When will OU learn that the elimination of healthcare disparities among population groups is not a zero sum game?”

21. Critical Emotions:L.A.’s Skid Row St. Julian Street, Los Angeles • Nation’s greatest concentration of: • Untreated major mental illnesses • Open drug dealing and drug abuse • HIV, Hepatitis and STDs • Trauma Union Rescue Mission

22. Blue Print for a School of Community Medicine: Every effort focused on improving the health of entire communities with special attention on our most vulnerable populations. These efforts visible in many forms….. • Pipeline Development and Recruitment: • Partnerships with Carver middle school, McLain high school, Booker T. Washington high school • Cherokee Nation partnership • Undergraduate college scholarships – Rogers State, Cameron State, Southeastern State universities. • Area Health Education Centers – rebuild for Oklahoma with HRSA • TU undergraduate programs • Loan pay-back program for service – GKFF • Merit scholarships – GKFF • Physician Manpower Training Commission – loan and practice set up financial aid • National Health Service Corp FQHCs • Admissions – Unique Identifiers: • SCM track – admissions subcommittee • Admissions criteria – demonstrated commitment and track record in service, demonstrated critical thinking, critical communications and critical application of knowledge and skills • Community Building in Areas of Poverty: • 36th Street North – Tisdale Clinic construction by local talent, Tisdale Clinic employment, City of Tulsa Small Area Planning, Early Childhood Education – Educare, Educareers • Improved Public Education – Teach For America, Doctoral Programs in Education Leadership,TU School of Urban Education • Healthy Schools – Fitness in Education, School-based Clinics. • True Blue Neighbors – revitalized KW “Critical Action” • Innovations in Health System Design for Efficient – High Quality Care Across the Community including Care of the Poor: • Student Led Free Clinics for the uninsured • Bedlam Evening Acute Clinic • Bedlam L – Chronic Care Clinic • Pentaho management of patient groups • Patient Centered Medical Homes • Contracts with Medicaid and Blue Cross – Blue Shield • Direct to Business Primary Care • Williams Company, Union Public Schools, OU – Physicians University of Tulsa • Sport Medicine – TU, ORU, High Schools • Outreach Primary Care • School Based Clinics – Kendall Whittier / Educare, Rosa Parks, Roy Clark, Sand Springs • FQHCs – Morton PA Clinic, Community Health Connections, Indian Health Resource Center • High Risk Populations • PACT Team – Serious Mental Illness • Palliative Care Team – Chronic / Severe Medical Illness • Heart Intervention Project – at Neighbor for Neighbor • Pediatric Diabetes Team • High Risk Obstetrics Outreach • Child Abuse Network – Justice Center • Fostering Hope Clinic – medical home for children in foster care • Youth Services – Homeless youth outreach • Addition Medicine Program • Tisdale Clinic – urgent and specialty care in under-resourced zip codes • Regional Health Infrastructure Redesign and Leadership • Patient Centered Medical Home Partnerships with OHCA, BC / BS • Care Coordination – Health Access Network contract with OHCA • Comprehensive Primary Care Initiative – multi-payor primary care collaborative. • Duals (Medicaid and Medicare eligible) Planning Grant funded through Center for Medicare and Medicaid Innovation • Beacon Communities Health Information Exchange Grant – Funded through Federal Office of National Coordinator • Inquiry: Roots of Vulnerable Populations: • Laureate Institute for Brain Research – genetic, imaging and neuro-psychology determinants of mental illness. • Science of of Adverse Environments, Tulsa Children’s Project • Integrative Immunology – role of immunology and environment in medical and mental diseases. • Curriculum Unique Identifiers: • Starts with Summer Institute for 1st year students – introduction to the anatomy of the community • Poverty Simulations • PRESENTATIONS (Calgary) Model of Curriculum • Masters and Certificates in Public Health Options • Ethics and Social Justice • Competence in Caring for the Poor • Team Care – Team Leadership – Student Led Patient Centered Medical Homes • Medical Informatics training • Populations Management • Systems Engineering Skills • Interdisciplinary Learning – medicine, nursing, pharmacy, public health, social work, human relations, urban design, law, engineering, informatics and more.

23. EDAR - Everyone Deserves A Roof Making homelessness more tolerable L.A.’s Skid Row:champions for health equity…..