FEBRUARY 2008 ISSUE

SWNG conducts mid-term assessment

The Safety Net Working Group (SNWG) met on February 7th to complete a six month mid-term assessment and determine whether the initiatives currently underway continue to be the top priorities for the group.

The group developed a wish list for clinics that would allow them to operate more efficiently and provide the structure for a sustainable safety net system. The wish list focused on improved Medicaid eligibility, assessment of system capacity, stable funding, assistance with electronic medical record (EMR) systems, information sharing, legislation advocacy and system navigation. Key themes included working with funders to streamline and standardize the grant application process, focusing on issues that are of concern to both Kansas and Missouri providers, and developing initiatives that address more than just daily operating expenses.

The SNWG will meet on March 25 to refine the wish list into key priorities for the group and refine the SNWG administrative structure. Staff will send out a list of the issues in advance of the meeting and ask each member to prioritize their importance.

	The Outcomes Committee met on February 11 to review the priority list developed by the SNWG. The committee discussed a variety of ways to identify the most important priorities, and suggested that SNWG members could vote on the five most important priorities, from their own perspectives, either prior to or during the next full SNWG meeting. The committee members noted that the priority list could be grouped around common themes and that several of the themes were similar to what the committees are working on. The members suggested a variety of methods for adapting the current committee structure to accommodate the revised priority list. This included combining the Access to Care and Continuum of Care committees to create a committee concentrating on health capacity for the Safety Net System and for the Kansas City region. Members agreed to develop a draft priority list and a draft committee structure to circulate among the committees for input. A final review and analysis of the information will take place at the next SNWG meeting in March.
	The Provider Relations and Advocacy Committee met on February 14. Manny Trillo, MARC’s Research Data Center manager, updated the committee members on the progress of analyzing Missouri Hospital Association emergency room data. Manny is working with the MHA to clarify some questions about the data, and will update the committee in March with further emergency room data analysis. Members discussed the updated list of priorities that were recommended for the Provider Relations and Advocacy committee. The main discussion focused on the need for advocacy for coverage for the uninsured. The committee agreed that it is critical to develop a focused advocacy agenda based upon data, and agreed to continue to work toward this goal.
	The Access to Care Committee met on February 19 to discuss the priorities developed by the SNWG. The draft structure suggests that the Access to Care Committee and the Continuum of Care Committee be combined to form a single committee. This committee would focus primarily on an assessment of the capacity of the current safety net system. Members discussed the data analysis necessary to determine system capacity for the SNWG, including data on need, extent of need, capacity to meet need, and the nature of emergency room visits. The committee discussed some additional issues related to determining capacity: What is the best method for gathering data on wait times? What is the best method for gathering data on no-shows? How can we gather zip code data to determine where patients are coming from and what clinics they are using? The committee also reviewed the PATHWAYS Evaluation from the conference that took place in January. Members agreed that they would like to explore the PATHWAYS model further, but should wait until the analysis of system capacity has been completed.
	The Information Sharing and Technology Committee met on February 20. The committee reviewed the draft committee structure and priority list developed by the SNWG. Members discussed whether electronic medical record implementation was a high priority and agreed that monitoring external developments, while important, would not be considered a priority. Members focused their attention on developing a process to determine a Health Information Technology vision for the safety net community. After much discussion, the group reached consensus on a framework to help gather critical information needed to develop this vision. The framework is a matrix of information needs for clinicians, administrators, funders and others for three groups — clinics, the Safety Net System and the community. Focus group meetings comprised of clinicians and clinic administrators could be the first step in completing the matrix. The committee also discussed the data analysis needs required to determine system capacity for the Safety Net Working Group.

Chamber Health Council hosts Colleen O’ Toole

The Greater Kansas City Chamber of Commerce Health Council sponsored a presentation by Colleen O’Toole PhD , CEO of the Greater Cincinnati Health Council on February 11. Dr. O’Toole shared information regarding the work of the council, which is composed primarily of hospitals in portions of three states — Ohio, Indiana and Kentucky. The organization focuses on three primary issues: improving the quality of care for patients; physical and financial access to care; and value and cost efficiency of care provided.

• To improve the quality of care for patients, 20 hospitals agreed to share performance measures and best practices and to release a set of quality measures to the public.
• To address physical and financial access to care, the council completed a comprehensive analysis of trend data and capacity. As a result, the council learned that Cincinnati had fewer specialty doctors then surrounding midwest regions, and established a strong physician recruiting program that has brought over 60 new specialty physicians to the region.
• To address cost efficiency, the council developed a joint purchasing program.

The Chamber Health Council hopes to invite Dr. O’Toole to return to discuss the HealthBridge program, which is the nation’s longest standing and largest health information exchange, including more than 24 hospitals and 800,000 medical professionals, including physicians, nursing homes, independent labs, radiology centers, and public health departments.

Medical Transportation Geographic Analysis

At the request of the Access to Care committee, Andrea Repinsky, MARC GIS specialist, analyzed medical transportation needs in the metro area using a data-mapping format that identifies geographic portions of the city that have critical medical transportation concerns.

Data analyzed included road network density and proximity to bus routes, safety net clinics, and hospitals. Each of these was assigned a weight or “value” to determine how important it was to achieving adequate medical transportation.

Indicators of need for medical transportation included households with incomes between 50 and 200 percent of the federal poverty level, elderly populations, households with no vehicles and individuals with limited mobility. These were all equally weighted.

System Navigation Web site and Guidebook

The Safety Net Working Group and the Cover the Uninsured Coalition will unveil an updated Health Resource Guide and a complementary, interactive Web site during the Cover the Uninsured Week on April 27th. The Resource Guide provides information about free and low-cost health care for individuals who are uninsured. It lists locations and contact information for providers of physical and mental health services in the community, broken out geographically and by service. Information on Kansas and Missouri Medicaid and SCHIP is also provided. The Resource Book covers the metropolitan area and includes information from both states.

The complementary Web site, kchealthresource.org, will allow community agencies or individuals to search online for clinics that meet their needs. (See the November/December newsletter article for more information about the Web site.)  

Swope Health Services models an alternative to emergency room care

Swope Health Services opened the Swope Health Plaza Clinic at Saint Luke’s Hospital of Kansas City in March 2007. This partnership was developed to:

1. Reduce inappropriate utilization of Saint Luke’s emergency room for non-emergent health care needs
2. Provide primary care for non-emergency patients referred by Saint Luke’s staff to the Plaza Clinic for care
3. Provide patients the opportunity to establish Swope Health Services as their medical home.

The clinic, located adjacent to Saint Luke’s emergency department reception area and triage rooms, is routinely staffed with three health care professionals (Nurse Practitioner or Physician Assistant, Registered Nurse and Medical Assistant/Patient Services Representative) employed by Swope. The clinic provides care seven days a week, from 10 a.m. to 10 p.m.

In the first 11 months of operations, the clinic recorded 1,811 visits by 1,659 patients.
All patients, regardless of insurance status, were educated by Swope Health Plaza staff on appropriate emergency department utilization during the discharge process. This targeted education, combined with strict adherence to jointly developed operating procedures, resulted in only 4 percent of the patients returning to the emergency department for care two or more times during this initial year of operations.

Approximately 85 percent of the patients who received care at Swope Health Plaza resided within 10 miles of Saint Luke’s and Swope’s Central facility. Demographically, the majority of patients who accessed care in the clinic were females between the ages of 19-44. The ethnic breakdown of patients treated from March 2007 through January 2008 was:  Black, 50 percent; White, 38 percent; Hispanic, 6 percent; other (American Indian, Pacific Islander, unknown), 4 percent; and Asian, 2 percent.

Patient satisfaction with services provided at Swope Health Plaza was consistently high, as evidenced by numerous positive comments received from patients who obtained care in the clinic. Other significant measures of success include:

• Decreased number of times that Saint Luke’s Hospital went on ambulance diversion.
• Decreased patient wait times for patients seeking care in Saint Luke’s ED.
• Perceived increase in patient satisfaction due to availability of primary care services.
• Increased ED physician satisfaction in terms of patients treated in the ED (i.e., emergent and appropriate vs. non-emergent and inappropriate), as reported by Saint Luke’s staff.