JANUARY 2008 ISSUE

SWNG Committees continue progress

The January meeting of the full Safety Net Working Group was canceled due to inclement weather, but the SNWG committees met as scheduled in December and January. Highlights of each meeting are included here, and full meeting minutes are available online.

	In December, Wende Baker, executive director of the Health Partners Initiative, presented information on the PATHWAYS model used in Lincoln, Neb., to the Access to Care Committee. She told how the model was introduced to the community and how it is currently coordinated, financed and implemented in Lincoln. Wende also discussed barriers to implementation and the importance of financing and coordination with other health entities. At the January meeting, the committee finalized the plans for the PATHWAYS presentation held on Jan. 22, 2008. They reviewed the invitation list for the PATHWAYS conference, discussed questions that could be asked during the presentation and selected final evaluation questions. The committee also met with Valerie Miller, medical transportation specialist for the Community Transportation Association of America, and Ron Achelpohl, assistant director of transportation for the Mid-America Regional Council. Valerie and Ron provided an overview of non-emergency medical transportation in Kansas City and surrounding communities.
	The Outcomes Committee met for the first time in December 2007. Its members include the co-chairs of the SNWG and the committee chairs. Committee members discussed the outcomes development process, and identified two primary goals: To improve the effectiveness of the SNWG To develop an evaluation tool to gauge the SNWG’s progress The Outcomes Committee envisions a process that incorporates the principles previously established by the SNWG, although outcomes are not directly tied to the principles. At its January meeting, the committee determined that it is critical to complete a mid-term assessment of the work of the SNWG. At the next full SNWG meeting, Outcomes Committee members will “check in” with the safety net providers and develop a wish list that can result in more immediate support for the stakeholders.
	During its December meeting, the Provider Relationships and Advocacy Committee finalized a survey to be sent to emergency department doctors. The committee agreed that the primary focus for the survey is to identify barriers that cause individuals to use the emergency room for primary care. Information from the survey will be used to inform changes that can help individuals gain primary care providers and reduce use of the emergency room for primary care. The data will also help build an advocacy position regarding additional funding for safety net services. At both the December and January meetings the committee examined preliminary data results from the Missouri Hospital Association regarding use of emergency rooms.
	In January, the Continuum of Care Committee reviewed data from the survey of safety net providers. This data included basic demographic information from each clinic. The data will be used as the foundation for a web-based application that will provide information regarding clinic location, hours and services. The web-application (see November newsletter) will be available in April 2008.
	Members of the Information Sharing and Technology Committee met in January to revisit the purpose of the technology assessment survey. Committee members decided that it was important to first agree on a shared vision regarding health information technology (HIT), so the technology survey will be put on hold until that vision is developed. Members will review relevant research, meet with experts in the HIT field and visit other communities that have implemented technology sharing applications to help articulate an HIT vision. The committee also finalized a model to provide recognition to clinics that have effective practices, which will be presented to the full Safety Net Working Group for approval.

KC Wellness Collaborative

Members of the KC Wellness Network are developing a comprehensive wellness model that could be implemented in Kansas City businesses and in local churches. The model provides a continuum of evidence-based support services and is designed to provide wellness care and support to the uninsured. The model, entitled KC Wellness Collaborative, is broken into three main areas (see full diagram) that will result in the improvement of health outcomes for the uninsured. These three areas include:

Coverage

• Eligibility determination for Medicaid/SCHIP/Medicare
• Information on low-cost health insurance products
• Eligibility determination for other social service programs

Worksite-Based Wellness

• On-site wellness screenings and individual health risk assessments
• Support through on-site Wellness Friends to connect individuals at high risk for poor health outcomes to a medical home and primary care provider
• Development of a wellness strategic plan for each organization
• Targeted health education and wellness seminars delivered on-site
• Wellness Academies that provide a comprehensive wellness curriculum focused upon developing an organizational wellness culture

Community Resources

• Establishment of a Wellness Access Program to provide free or low-cost wellness services (smoking cessation, occupational/physical therapy, chiropractor, nutrition support, resiliency training, physical fitness facilities, etc.) for eligible patients.

PATHWAYS Presentation

On Jan. 22, the Access to Care committee invited Dr. Mark Redding to Kansas City to present the PATHWAYS model for improving health outcomes. More than 65 health care leaders attended the presentation at the Kansas City Public Library. The presentation focused on work that has been completed in Alaska and Ohio resulting in improved health outcomes and reduced costs. The PATHWAYS model has been used in Lincoln, Neb., to reduce the incidence of low-birth-weight babies and in Oklahoma City, Okla., to address the establishment of medical homes and reduce emergency room use. (See the handout for a brief overview of the PATHWAYS model used in Lincoln.)

Mark Redding, MD, FAAP, has worked with his wife, Dr. Sarah Redding, since the late 1980s, focusing on health disparities reduction initiatives. This work has included the training and support of Community Health Workers (CHW) — first in Kotzebue, Ala., and then in Baltimore, Md. For the past seven years, Dr. Redding has worked in Ohio to support CHW programs both across the state and nationally. The PATHWAYS model was developed in 2000 as part of these initiatives. The PATHWAYS model has resulted in a nationally recognized care management structure which regiments outcome focus. Dr. Redding works with experts in the managed care industry on methodologies to support outcome-focused service delivery.

Visit with St. Louis Regional Health Commission

Several members of the SNWG visited St. Louis, Mo., in January to gather information about the integration and collaboration of safety net providers in the St. Louis area and to learn what has worked well and where challenges have occurred with their planning processes. Those attending included:

• David Garrett, Practice Facilitator, American Academy of Family Physicians
• Gervean Williams, Chief Financial Officer, Samuel Rodgers Health Services
• Kathy Knotts, Government Affairs, Truman Medical Center
• Michael Mayberry, CEO, Community Health Council of Wyandotte County
• Laura McCrary and Dean Katerndahl, Mid-America Regional Council’s Regional Health Care Initiative

The Kansas City team was invited to attend a series of committee meetings as well as the full meeting of the St. Louis Regional Health Commission (RHC). The highlight of the two-day trip was an opportunity to visit with Steve Lipstein, chief executive officer of Barnes Jewish Christian (BJC). BJC is one of the largest non-profit health care systems in the United States. Lipstein talked about the importance of supporting Truman Medical Center and the mistakes that were made in St. Louis that allowed its public hospital to close.
The trip itinerary included:

• St. Louis Regional Health Commission meeting
• Improving Entry Workgroup (RHC Behavioral Health) meeting
• Lunch with Brooke Sehy, CEO, STL Integrated Health Network
• Coordinating Care for High Users Workgroup (RHC) meeting
• Interview with Melody Eskridge, CEO, St. Louis ConnectCare, and tour of SLCC
• Dinner with Kathleen Reynolds, Executive Director, Washtenaw County, Mich., Health Organization
• RHC Behavioral Health Steering Committee meeting
• Interview with Steve Lipstein, President and CEO, Barnes Jewish Christian Health Care
• Access to Care meeting

For more information on the trip please contact any of the team members.