Baylor Health Care System Overview

1. AHRQ Annual ConferenceProgress of a Learning Network: Working to Reduce Disparities by ImprovingAccess to CareBethesda, MarylandSeptember 14, 2009Jim Walton, DO, MBABaylor Health Care System – Dallas, TX

2. Baylor Health Care SystemOverview • Baylor Health Care System (BHCS) • Dallas-Ft. Worth metropolitan area of N. Texas • 15 owned, leased, or affiliated hospitals and 6 short-stay hospitals • Affiliated physician organization, Health Texas Provider Network, has 450+ physicians in 110+ practices in the region • Baylor’s flagship hospital, Baylor University Medical Center, is a 1000-bed inner city hospital with Level 1 trauma designation

3. Addressing Disparities:BHCS Office of Health Equity • The BHCS Office of Health Equity • Responsible for the identification, measurement, and elimination of health disparities within the Baylor Health Care System and the communities it serves BHCS Equity Triangle • Health Care Access • Insuring Equal Access to Care & Decreasing Unnecessary Utilization • Health Care Delivery • Insuring Equal Quality of Care & Decreasing Adverse Events • Health Care Outcomes • Improving Health Outcomes & Decreasing Mortality and Morbidity Equity in Healthcare Health Care Delivery Health Care Access Health Care Outcomes

4. Disparities in DFW:Limited Access to Health Care • The Problem: • Approximately 23.6% of the population in the Dallas-Ft. Worth metropolitan area are without health insurance coverage. • Translates to 1.3 million individuals with limited access to care1. • That number increases when you consider the number of Medicare and Medicaid patients struggling to access care. • BHCS facilities bear much of the burden of uncompensated care in our community. 1Parkland Health & Hospital System, 2006 Estimates

5. Office of Health Equity:Health Care Access Goals Primary Objective:By increasing access to needed health services in community and home-based settings, underserved patients will experience less health disparities and require less frequent utilization of hospital services (ED and admissions), resulting in decreased uncompensated care for BHCS facilities. • Health Care Access Strategies: • Facilitate access to medical services (Medical Home, Ancillary, and Specialty Care) • Facilitate access to affordable prescription medications • Care coordination to overcome barriers (i.e. low SES, language, health literacy)

6. Care Coordination & Pathways:An Adaptive Model • Leveraging Baylor’s infrastructure – Physicians • Adjunctive support - Community Health Workers • Pathways model – Care protocols to ensure connection with and delivery of evidence-based care • BHCS has adapted the CCC model over the past eight years to improve: • Access to primary care • Health outcomes • Financial savings • Innovation in care delivery

7. Care Coordination-First Steps:Community Health Navigation • A collaboration with Project Access Dallas: • A network of volunteer providers across Dallas Co. organized to provide care to uninsured working poor • Community Health Navigation was created to help patients overcome barriers to care: • Translation, Transportation, Medication assistance • Health Education to improve patient knowledge and behaviors • Coordination of referrals within the PAD program

8. Adapting Care Coordination:1. BHCS Vulnerable Patient Network • A unique “house-calls” program utilizing a multi-disciplinary team to provide home-based primary care services to underserved patients with complex medical and social conditions • Neuro-trauma and Heart Failure • Specially-trained CHW supports the care team with physicians and nurse practitioners: • CHW’s have medical assistant training • Utilize clinical and social “Equity care-path” tools • Serve as a single point-of-contact for home-bound patients

9. 47.8% Reduction 36.4% Reduction 58.3% Reduction

10. 72.6% Reduction 71.2% Reduction 29.6% Reduction

11. Adapting Care Coordination:2. Community Diabetes Education (CoDE) • Use of Community Health Workers to provide chronic disease education and self-management training to underserved diabetics within charitable health clinics across Dallas County • Conduct one-on-one counseling with patients • CHW is bilingual/bi-cultural • Contextualizes diabetes curriculum & messages • Advocates for diabetics & families (meds, referrals, etc.) • Additional point-of-contact for patient/families

12. Community Diabetes Education (CoDE):Clinical Outcomes

13. Care Coordination-Next Steps:3. Ambulatory Care Coordination • Supporting the move toward NCQA certification - Patient-Centered Medical Home (PCMH) • Multi-disciplinary teams • 2007 - The AAFP, AAP, ACP, and AOA publish the Joint Principles of the Patient-Centered Medical Home with 7 Core Features • Ambulatory Care Coordination (HT-ACC) • Using non-physician staff to navigate patient care • Coordinating care/follow-up for patients (in-patient & out-patient) • Addressing barriers, assessing progress and utilizing care paths for care management • Generating reminders for preventive care • Implementing evidence-based guidelines for disease management Sources: “Joint Principles of the Patient-Centered Medical Home” available at http://www.aafp.org/online/etc/medialib/aafp_org/documents/policy/fed/jointprinciplespcmh0207.Par.0001.File. tmp/022107medicalhome.pdf

14. Summary • Community Care Coordination and the Pathways model has been successfully adapted to provide a wide range of services to underserved patients • Navigation; clinical and social support; chronic disease education • The model has produced: • Improved clinical outcomes • Decrease in avoidable hospital utilization • Positive financial impact for hospitals • The model will be applied in new efforts to achieve NCQA certification for PCMH