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Community Partnership for Patient Activation

Community Partnership for Patient Activation. Santa Cruz Experience Wells Shoemaker MD September 29, 2008. 3 Messages, Thinking 2015.

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Community Partnership for Patient Activation

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  1. Community Partnership for Patient Activation Santa Cruz Experience Wells Shoemaker MD September 29, 2008

  2. 3 Messages, Thinking 2015 • Flogging the “usual suspects,” the delivery system, will help for diabetes and heart disease… and we will keep it up…but only help a little bit. (HEDIS is a narrow view.) • Public Health thinking and customized, broad community initiatives are essential. • Patient activation is the key to the garden… and we can turn it

  3. Bumper Sticker Wisdom • Think Globally • Act Locally • …and…Get all the help you can!

  4. DIABETES PYRAMID

  5. Primary Care Workforce Crisis • New entrants now << 50% of 1995 • New kids can’t buy houses here • Leaving CA—hassles, regulations, no “life.” …and seeking niches if they stay. • Overwhelmed with “WYODI’s”—impossible • Disaffected, to say it politely • Think FTE’s, not “heads”—they’re getting gray, part time; we’re in deep trouble

  6. What can be done? • Expand capacity of each doctor—practice redesign, teams, community supports, information systems, outreach • Respond to reimbursement disparity, including novel payment for chronic care • Improve job satisfaction and personal life balance—delete stupid time waste

  7. Think Local: Santa Cruz County • Small county with natural geographic boundaries. Mix: urban, residential, ag • Population 260,000, fairly stable • Microcosm of Pacific Coast demographics, with ethnic clusters • University & Junior College • Liberal politics • Both collaboration and friction • Severe PCP recruitment handicaps

  8. Two Grass Roots Collaboratives • Health Improvement Partnership—Executives of all health “Usual Suspects” • Regional Diabetes Collaborative—”Worker Bees” in diabetes care, education, advocacy • Diabetes Health Center

  9. Patient engagement resources • Diabetes Health Center—non-profit, local, ethnically attuned, community engaged… and struggling for nickels and dimes • Hospital based programs “pt education” • Group & clinic-based programs • Entrepreneurial programs “if you got the money, honey, I got the time”

  10. What can Plans do to help? • Participate in regional collaboratives • Seek and pay for local patient activation services that work • Flexibility in criteria for vendors • Protect these in limited benefit products • Openness to novel chronic care reimbursement strategies

  11. Santa Cruz background • Following slides for background—not likely time for presentation 9/29

  12. Health Improvement Partnership Executive representation, monthly meetings: • Public Health Dept & HSA • 3 hospitals • 2 private sector medical groups • The Alliance—Medi-Cal managed care • Hospital staffs & Medical Society • ERs • 3 Community Foundations • Cabrillo Junior College

  13. HIP: Cross-Cutting Targets • Healthy Kids launch • ER Frequent Users Program • Diabetes Program support • Students & health professions • Electronic connectivity • Area 99 injustice • Community forums & “United Nations” • Grant magnet

  14. Regional Diabetes Collaborative • Santa Cruz, Monterey, San Benito Counties • 800,000 people total • 7% diabetes prevalence  50,000 + • “Worker bee” professionals from • Public health, medical groups, Comm Clinics, Alliance • Hospitals (7) diabetes education staff • Diabetes Health Center—non profit, ethnic ++ • Advocacy organizations & Seniors • CA Diabetes Program • Cal State Monterey Bay, Cabrillo, UCSC

  15. Three Thrusts of RDC • Clinical Care Improvement • Patient education…morph to self- management support, culturally appropriate, community focused • Public information and Policy • And liaison with related organizations, i.e. Pediatric Obesity, CCCN

  16. RDC Activities • Quarterly general meetings—best practices, education, networking • Annual conference • Health fairs • Multiple local engagements • Lawmaker outreach • Public information & speakers • AHRQ grant conduit 2004-7 • Amplifier of messages

  17. Highlights • HIP adopted diabetes formal goal 2003 • IOM Presentation 2004 • AHRQ grant Registry project 2004-7 • Annual tri-county diabetes forum with “hot” speakers, lots of pub, political push • Expansion, solidification of RDC • Coordination with others • Still playing catch-up

  18. Take Home • Local resources potentially powerful • Can reach further than “medical” alone • Bake sale economics to start • Grant funding appealing but can be disruptive • High degree of customization needed • Leadership cultivation required • Costs real $ to launch and maintain • Easy to fall back to silo thinking

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