JUNE 2008 ISSUE

Safety Net Working Group hears progress reports

The Safety Net Working Group (SNWG) held its regular meeting on June 24 at the MARC Conference Center. Committee members reported on the progress that each committee has made in achieving established priorities.

• Rose Tiszka reported on the work of the Access to Care committee. She said the committee narrowed its focus to patient navigation programs and plans to gather information about programs that are currently in place in Kansas City. Rose also reported that the committee finalized its outcomes and developed a visual that identifies timeframes for the completion of work products.
• Mary Virden of the Health Information & Exchange committee reported on an upcoming meeting with representatives from the Kansas Association for the Medically Underserved (KAMU) and the Missouri Primary Care Association (MPCA). This meeting will take place on August 20, 2008 at 8:30am at MARC and information will be shared regarding state level health technology initiatives. Committee members are also continuing to gather details about the information sharing needs of the safety net system. Two focus groups have already taken place and additional focus groups are scheduled in August 2008.
• Jacque Amspacker, chair of the System Capacity committee, discussed the components of a regional capacity study and shared maps that provide visual information about poverty in Kansas City and identify zip codes of patients who use the safety net clinics in Kansas.
• Liz Levin, co-chair of the Provider Relations and Advocacy committee, shared information from the two focus groups held in June. She said that committee members are in the process of developing a message that conveys the work of the safety net system and the story of the uninsured. A stakeholder list of key individuals is also in development. The message will be shared with stakeholders and the broader community.

SNWG members also discussed submission of the HRSA patient navigation grant. The grant posed several problems for the group, as the deadline was very tight. Since none of the safety net providers could submit the grant application within the limited timeframe, MARC submitted it on June 13th.

Committee Updates — June 2008

	The System Capacity Committee met on June 3. Committee members discussed their top five priorities for addressing the issue of system capacity for safety net clinics. Members focused attention on the infrastructure needs of safety net clinics, which includes expanding facility space, workforce recruitment, general operating funds, education and training, and collecting basic resource information on electronic medical records. Jeff Pinkerton, MARC Senior Researcher, presented poverty maps for the Kansas City Metropolitan region and a safety net utilization map for the Kansas safety net clinics. The maps are based on 2000 census tracks and 2007 Kansas safety net clinic patient zip code visits. The committee members also discussed a cooperative purchasing plan for safety net clinics. The plan would help safety net clinics receive discount rates on bulk purchasing.
	The Health Information and Exchange Committee met on June 18. Members reviewed information from the two safety net focus groups held on June 16. After some discussion, the members focused on two critical points — the ongoing financial sustainability of electronic medical records (EMR) and the establishment of a written EMR roadmap to help with the purchase and implementation of an EMR. The committee members viewed the HRSA HIT toolkit online, a password-protected HIT planning resource for the implementation of an EMR. Members felt it could be adapted for utilization in Kansas City. Cathy Harding, executive director of the Kansas Association of the Medically Underserved and a technology representative from the Missouri Primary Care Association, will present an update on state health technology issues at the August 20 Health and Information Exchange (HIE) committee meeting. Committee members discussed the implementation of a Safety Net E-Library. The E-Library is in the pilot stage and will be hosted for one year by MARC. The E-Library contains information on local, state and national health technology initiatives that may impact the region. The committee members recommended sharing it with the SNWG at an upcoming meeting and then making it available to the public in the early fall.
	The Provider Relations and Advocacy Committee did not hold its regular meeting in June. The next meeting will be on Thursday, July 10 at 1:00 p.m. at the MARC Conference Center.
	Access to Care Committee members discussed the HRSA navigation grant. The grant application was submitted on June 13, and HRSA will contact successful applicants by the end of September. The committee members agreed if the grant is not funded by HRSA, the members of the Metropolitan Safety Net Coalition should pursue other sources of funding to develop the patient navigation program.   Members also discussed the differences in care coordination and patient navigation. They determined that care coordination is the internal clinic coordination, which meets the needs of the patient through social, medical, and referral services; while patient navigation systems are focused outside of the clinic and done in coordination with the clinic. The committee members agreed that patient navigation should be the primary focus of the committee. Cindy Moore, Mercy & Truth Medical Center, announced that she was stepping down as committee chair. Members nominated Jimmy Brown, Swope Health Center, to serve as chair and he accepted.

SNWG Focus Groups gather information

The SNWG held a series of focus groups for members of the safety net community during the month of June. The focus groups were designed to gather information from safety net providers on two important issues.

1. The key elements of a message that will be used locally and regionally to tell the story of the uninsured in Kansas City and how the safety net system supports the community through care for the uninsured.
2. Identification of critical administrative and clinical data elements that are common across the majority of safety net providers, and how and when this information is used and shared with others.

A great deal of information was gathered through the focus groups. The Provider Relations and Advocacy Committee will use the information about key elements to tell the story of the uninsured as they work with marketing firms to put together a series of informational documents and marketing pieces. These will be shared with key stakeholders in the Kansas City community to raise the level of awareness regarding the uninsured and the role of the safety net providers.

Health Coverage Working Group explores innovative options

An exploratory meeting took place on June 9 to discuss opportunities to explore innovative methods of providing health coverage to the uninsured and medically underserved. The meeting was well attended and key stakeholders in the community expressed their continued support of staying abreast of possible health coverage opportunities. The group discussed a new plan from Blue Cross/Blue Shield of Kansas City, the Memphis Plan and the applicability of Mini-Meds for Kansas City small businesses. The group also expressed interest in learning more about what may be happening in both Kansas and Missouri as it relates to coverage initiatives and agreed to share information about products and initiatives. The group decided to meet again in the fall to discuss new developments and possible state and local initiatives. For more information please contact Laura McCrary.

Behavioral Health RFP released

The Metropolitan Kansas City Behavioral Health Request for Proposals was released locally and nationally on June 2. The purpose of the RFP is to select a vendor to complete an in-depth assessment of the continuum of behavioral health services that are currently available in the region and identify gaps in services. Proposals were due on June 27. Total funds available for the project are $100,000. A technical advisory committee composed of the following individuals will review the proposals and select vendors for further consideration:

• William Kyles, Director of Comprehensive Mental Health Services
• David Wiebe, Director of Johnson County Mental Health Center
• Tom Cranshaw, Director of Tri-County Mental Health Services
• Pete Zevenbergen, Director of Wyandot Center
• Charles Megerman, Director of Substance Abuse, Kansas City Community Center
• Jake Jacobs, Director of EITAS-Developmental Disability Services of Jackson Co.
• Anne Lessor, Director of Kansas City Homeless Coalition
• Sandy Wise, District Administrator MR/DD-Missouri
• John Fierro, Director of Mattie Rhodes Center
• Sue Crain Lewis, Director of the Mental Health Association of the Heartland

The technical advisory committee may choose to interview several of the vendors before making a final selection. The selected vendor will be expected to commence work immediately and complete the project by late fall. The implementation of system change initiatives will begin in January 2009. The technical advisory committee reports directly to the Metropolitan Mental Health Stakeholders and consumer advocacy organizations. For more information on the behavioral health project see the April newsletter or contact Laura McCrary.

Seeking information on referrals, care coordination and patient navigation for the uninsured

One of the key goals of the Access to Care committee is to improve access to quality health care for the uninsured. Consequently, the Access to Care committee members are very interested in understanding how the uninsured are referred into the safety net system and how they navigate through the system. The committee is compiling information about agencies or organizations that refer the uninsured to the safety net system and provide patient navigation programs that include safety net providers. If you or your organization provide referrals or patient navigation to the uninsured or medically underserved members of Kansas City we would like to talk with you about the work that you are doing. Please contact Traci Rowland.

Coalition applies for grant to improve hypertension care

Truman Medical Center (TMC), Swope Health Services, and the Metropolitan Safety Net Coalition joined together to submit a federal grant to the Department of Health Resources and Services Administration (HRSA) on June 13. The Kansas City Hypertension Outreach & Patient Education Project (KC-HOPE) is a collaborative partnership between these organizations to implement a bistate, patient navigation program to reduce hypertension for the uninsured and medically underserved.

Health disparities related to hypertension are a significant health concern in Kansas City. Hypertension was the #1 diagnosis for all patients visiting Kansas City emergency rooms in 2006. Additionally, patients with hypertension were admitted to the hospital at a significantly greater rate (five times more often) then patients visiting the ER for other concerns. Kansas City hypertension data mirror that of the nation, with African-Americans having a higher prevalence and incidence of hypertension than whites. Many vulnerable members of the community are not aware of the risks they face related to hypertension.

To address this significant health concern, Truman Medical Center (TMC) a large community hospital, Swope Health Services, a Federally Qualified Health Center (FQHC) and the Metropolitan Safety Net Coalition, comprising non-profit health clinics and health departments, joined with the Mid-America Regional Council (MARC) to develop the KC-HOPE concept of a regional, bistate patient navigation program focused on outcomes. The project is specifically designed to improve health outcomes related to hypertension for the uninsured and underserved members of the Kansas City community. The KC-HOPE project will identify those at risk, ensure their connection to evidence based intervention and measure the outcomes in both health/social improvement and cost savings. For more information contact Laura McCrary.

Safety Net Profile: Cabot Westside Center

Cabot Westside Center 2121 Summit Kansas City, MO 64108 816-471-0900 Executive Director: Liz Levin

Cabot Westside Center provides culturally sensitive primary health, dental and education services to Hispanics, residents of the Westside and the Greater Kansas City area, regardless of their ability to pay.  Cabot Westside Center has been a fixture in the Westside for many years and Cabot celebrated its centennial in 2006.  Eleven women founded Cabot Westside Center to provide health care to underprivileged children in 1906. Over the years, many of Cabot’s patients have been immigrants who live in Kansas City’s Westside, but Cabot also reaches beyond its home neighborhoods and serves families in more than 20 zip codes in both Kansas and Missouri.  The entire medical staff at Cabot is bilingual/Spanish to ensure clear communication with the patients. 

Cabot offers a wide range of services including gynecology; the treatment of childhood diseases; patient care for acute and chronic disease in adults; elderly care; immunizations; health screenings; and comprehensive dental services.  Cabot provided care to over 8,000 patients in 2007 and had over 23,000 visits.  Today, 93 percent of Cabot’s patients are Hispanic and 90 percent speak only Spanish.  Pediatric care is an important part of the services provided by Cabot, as 42 percent of all current patients are between the ages of 0 and 19. Cabot has 12 general exam rooms and seven dental examination rooms.  Cabot also has a dispensary and a lab on site.

Mental health care is of significant concern to the Hispanic community.  Through a partnership with other agencies Cabot has helped more than 1,500 patients annually who report depression, anxiety or a mental disorder.  Cabot provides annual mental health and post-partum depression screenings, on-site counseling and immediate access to prescriptions for the treatment of mental illness for patients in financial need.  Cabot partners with Mattie Rhodes, Truman Medical Center, St. Luke’s Hospital Psychiatric Caseworkers and Keeler Women’s Center at Donnelly College for additional care and treatment. 

Cabot is one of the few clinics in the city that provides urgent care to the uninsured.  Urgent care is available at Cabot Monday-Friday from 7:30am-9:00am and from 12:30pm to 1:30pm.  It is not necessary to be an established patient to receive urgent care.  Cabot accepts most health insurance plans but over one-third of Cabot’s budget is spent on charity care and as the need grows, the resources to provide care have diminished.