Community Partnership for Community Partnership for Patient Activation Patient Activation

Santa Cruz ExperienceSanta Cruz ExperienceWells Shoemaker MDWells Shoemaker MD

September 29, 2008September 29, 2008

3 Messages, Thinking 20153 Messages, Thinking 2015

1.1. Flogging the “usual suspects,” the delivery Flogging the “usual suspects,” the delivery system, will help for diabetes and heart system, will help for diabetes and heart disease… and we will keep it up…but only disease… and we will keep it up…but only help a little bit. (HEDIS is a narrow view.) help a little bit. (HEDIS is a narrow view.)

2.2. Public Health thinking and customized, Public Health thinking and customized, broad community initiatives are essential. broad community initiatives are essential.

3.3. Patient activation is the key to the Patient activation is the key to the garden… and we can turn itgarden… and we can turn it

Bumper Sticker WisdomBumper Sticker Wisdom

• Think GloballyThink Globally

• Act LocallyAct Locally

• ……and…Get all the help you can!and…Get all the help you can!

DIABETES PYRAMID

Late Complications

Patients with Diagnosed diabetes

Undiagnosed and “Pre diabetes”

Obese, Sedentary Children

Primary Care Workforce Primary Care Workforce CrisisCrisis• New entrants now << 50% of 1995New entrants now << 50% of 1995• New kids can’t buy houses hereNew kids can’t buy houses here• Leaving CA—hassles, regulations, no “life.” Leaving CA—hassles, regulations, no “life.”

…and seeking niches if they stay. …and seeking niches if they stay.• Overwhelmed with “WYODI’s”—impossible Overwhelmed with “WYODI’s”—impossible • Disaffected, to say it politelyDisaffected, to say it politely• Think FTE’s, not “heads”—they’re getting Think FTE’s, not “heads”—they’re getting

gray, part time; we’re in deep troublegray, part time; we’re in deep trouble

What can be done?What can be done?

• Expand capacity of each doctor—practice Expand capacity of each doctor—practice redesign, teams, community supports, redesign, teams, community supports, information systems, outreachinformation systems, outreach

• Respond to reimbursement disparity, Respond to reimbursement disparity, including novel payment for chronic careincluding novel payment for chronic care

• Improve job satisfaction and personal life Improve job satisfaction and personal life balance—delete stupid time wastebalance—delete stupid time waste

Think Local: Santa Cruz Think Local: Santa Cruz CountyCounty• Small county with natural geographic Small county with natural geographic

boundaries. Mix: urban, residential, ag boundaries. Mix: urban, residential, ag • Population 260,000, fairly stablePopulation 260,000, fairly stable• Microcosm of Pacific Coast demographics, Microcosm of Pacific Coast demographics,

with ethnic clusterswith ethnic clusters• University & Junior CollegeUniversity & Junior College• Liberal politicsLiberal politics• Both collaboration and frictionBoth collaboration and friction• Severe PCP recruitment handicapsSevere PCP recruitment handicaps

Two Grass Roots Two Grass Roots CollaborativesCollaboratives

• Health Improvement Partnership—Health Improvement Partnership—Executives of all health “Usual Executives of all health “Usual Suspects”Suspects”

• Regional Diabetes CollaborativeRegional Diabetes Collaborative—”Worker Bees” in diabetes care, —”Worker Bees” in diabetes care, education, advocacyeducation, advocacy– Diabetes Health Center Diabetes Health Center

Patient engagement Patient engagement resourcesresources• Diabetes Health Center—non-profit, Diabetes Health Center—non-profit,

local, ethnically attuned, community local, ethnically attuned, community engaged… and struggling for nickels engaged… and struggling for nickels and dimesand dimes

• Hospital based programs “pt education”Hospital based programs “pt education”

• Group & clinic-based programsGroup & clinic-based programs

• Entrepreneurial programs “if you got Entrepreneurial programs “if you got the money, honey, I got the time”the money, honey, I got the time”

What can Plans do to help?What can Plans do to help?

• Participate in regional collaborativesParticipate in regional collaboratives

• Seek and pay for local patient Seek and pay for local patient activation activation services that workservices that work

• Flexibility in criteria for vendorsFlexibility in criteria for vendors

• Protect these in limited benefit Protect these in limited benefit productsproducts

• Openness to novel chronic care Openness to novel chronic care reimbursement strategiesreimbursement strategies

Santa Cruz backgroundSanta Cruz background

• Following slides for background—not Following slides for background—not likely time for presentation 9/29likely time for presentation 9/29

Health Improvement Health Improvement PartnershipPartnership

Executive representation, monthly meetings:Executive representation, monthly meetings:• Public Health Dept & HSAPublic Health Dept & HSA• 3 hospitals3 hospitals• 2 private sector medical groups2 private sector medical groups• The Alliance—Medi-Cal managed careThe Alliance—Medi-Cal managed care• Hospital staffs & Medical SocietyHospital staffs & Medical Society• ERsERs• 3 Community Foundations3 Community Foundations• Cabrillo Junior CollegeCabrillo Junior College

HIP: Cross-Cutting TargetsHIP: Cross-Cutting Targets

• Healthy Kids launchHealthy Kids launch• ER Frequent Users ProgramER Frequent Users Program• Diabetes Program supportDiabetes Program support• Students & health professionsStudents & health professions• Electronic connectivityElectronic connectivity• Area 99 injustice Area 99 injustice • Community forums & “United Nations” Community forums & “United Nations” • Grant magnetGrant magnet

Regional Diabetes Regional Diabetes CollaborativeCollaborative• Santa Cruz, Monterey, San Benito CountiesSanta Cruz, Monterey, San Benito Counties• 800,000 people total800,000 people total• 7% diabetes prevalence 7% diabetes prevalence 50,000 + 50,000 +• ““Worker bee” professionals from Worker bee” professionals from

– Public health, medical groups, Comm Clinics, Public health, medical groups, Comm Clinics, AllianceAlliance

– Hospitals (7) diabetes education staffHospitals (7) diabetes education staff– Diabetes Health Center—non profit, ethnic ++Diabetes Health Center—non profit, ethnic ++– Advocacy organizations & SeniorsAdvocacy organizations & Seniors– CA Diabetes Program CA Diabetes Program – Cal State Monterey Bay, Cabrillo, UCSCCal State Monterey Bay, Cabrillo, UCSC

Three Thrusts of RDCThree Thrusts of RDC

1.1. Clinical Care ImprovementClinical Care Improvement2.2. Patient education…morph to self- Patient education…morph to self-

management support, culturally management support, culturally appropriate, community focusedappropriate, community focused

3.3. Public information and PolicyPublic information and Policy

• And liaison with related organizations, And liaison with related organizations, i.e. Pediatric Obesity, CCCNi.e. Pediatric Obesity, CCCN

RDC ActivitiesRDC Activities

• Quarterly general meetings—best Quarterly general meetings—best practices, education, networkingpractices, education, networking

• Annual conferenceAnnual conference• Health fairsHealth fairs• Multiple local engagementsMultiple local engagements• Lawmaker outreachLawmaker outreach• Public information & speakersPublic information & speakers• AHRQ grant conduit 2004-7AHRQ grant conduit 2004-7• Amplifier of messagesAmplifier of messages

HighlightsHighlights

• HIP adopted diabetes formal goal 2003HIP adopted diabetes formal goal 2003

• IOM Presentation 2004IOM Presentation 2004

• AHRQ grant Registry project 2004-7AHRQ grant Registry project 2004-7

• Annual tri-county diabetes forum with Annual tri-county diabetes forum with “hot” speakers, lots of pub, political push“hot” speakers, lots of pub, political push

• Expansion, solidification of RDCExpansion, solidification of RDC

• Coordination with othersCoordination with others

• Still playing catch-upStill playing catch-up

Take HomeTake Home

• Local resources potentially powerfulLocal resources potentially powerful

• Can reach further than “medical” aloneCan reach further than “medical” alone

• Bake sale economics to startBake sale economics to start

• Grant funding appealing but can be disruptiveGrant funding appealing but can be disruptive

• High degree of customization neededHigh degree of customization needed

• Leadership cultivation requiredLeadership cultivation required

• Costs real $ to launch and maintainCosts real $ to launch and maintain

• Easy to fall back to silo thinkingEasy to fall back to silo thinking