Bohorquez, Betty, PA

Gallardo-Cochran, Margaret, MD

Gutierrez, Laura, MD FACP AAHIVM

Lopez, Luis, MD

Penaloza, Orlando, MD FACP AAHIVM

Santiago, Claudia P., MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of MedicineSaving Money While Meeting Quality Targets inLatino Health Disparities: A Reason for OptimismClaudia P. Santiago MDLehigh Valley Health Network, claudia_p.santiago@lvhn.orgMargaret Gallardo-Cochran MDLehigh Valley Health Network, m_a.gallardo-cochran@lvhn.orgLuis Lopez MDLehigh Valley Health NetworkBetty Bohorquez PALehigh Valley Health Network, betty_y.bohorquez@lvhn.orgLaura Gutierrez MD FACP AAHIVMLehigh Valley Health Network, Laura_T.Gutierrez@lvhn.orgSee next page for additional authorsFollow this and additional works at: http://scholarlyworks.lvhn.org/medicinePart of the Medical Sciences CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtSantiago, C., Gallardo, M., Lopez, L., Bohorquez, B., Gutierrez, L., Penaloza, O. (2015, March 27). Saving Money While Meeting QualityTargets in Latino Health Disparities: A Reason for Optimism. Poster presented at: National Hispanic Medical Association, Washington,DC.AuthorsClaudia P. Santiago MD, Margaret Gallardo-Cochran MD, Luis Lopez MD, Betty Bohorquez PA, LauraGutierrez MD FACP AAHIVM, and Orlando Penaloza MD FACP AAHIVMThis poster is available at LVHN Scholarly Works: http://scholarlyworks.lvhn.org/medicine/803 Background•		Enhance	healthcare	delivery,	access	and	patient	navigation	within	our	network	and	community	organizations	through	a	values-based	approach	focusing	on	superior	quality,	compassionate,	integrated,	and	culturally	sensitive	patient-centered	care.	•		Educate	and	empower	our	community	to	increase	self-confidence	and	skillfulness	in	the	management	and	prevention	of	chronic	conditions.	•		Create	an	exemplary	cost-effective	care	model	for	vulnerable	populations.ObjectivesCentro	de	Salud	Latino-Americano	(CDS)	is	a	bilingual,	bicultural,	internal	medicine,	primary	care	physician	practice	dedicated	to	advancing	the	health	care	and	well-being	of	the	North	East	Pennsylvania	region’s	adult	Latino	community.	CDS	achieves	the	Institute	for	Healthcare	Improvement	Triple	Aim.	© 2015 Lehigh Valley Health Network Results•		1,650	Patients	are	receiving	care	at	CDS:	100%	are	adults;	97%	are	Hispanic	or	Latino.	90%	are	low	income	and	receive	public	assistance.	65%	of	patients	have	been	diagnosed	with	mental	health	issues.	75%	of	patients	have	multiple	chronic	conditions.•		CDS	is	part	of	the	Lehigh	Valley	Physicians	Group	which	tracks	32	healthcare	quality	measures.	Out	of	32	quality	measures	tracked	by	LVPG;	CDS	has	26	between	target	and	maximum;	2	between	threshold	and	target	and	4	below	threshold.Conclusions•		The necessity of committed leadership. Without	top	leadership	and	physician	champions	willing	to	support	innovation	and	invest	financial	resources	toward	meaningful	care	the	work	at	CDS	would	not	be	possible.•		Lessons on trust and teamwork. Trusting	relationships	in	healthcare	are	important;	however,	there	is	a	flip	side	of	developing	deep	trusting	relationships	between	patients	and	practice	teams.	Sometimes,	patients	rely	heavily	on	practice	teams	to	help	with	needs	that	might	be	considered	outside	of	the	scope	of	medicine	which	ARE	important	to	a	patient’s	overall	health,	and	are	time	consuming	for	stretched	practice	teams.•		Lessons on time and communication. Language	and	Culture	matters.	Creating	a	practice	that	includes	without	judgment	matters.	Time	spent	listening,	understanding,	and	making	sure	information	is	understood	is	time	well	spent.	HypothesisWill	Bicultural,	linguistically	concordant	health	care	result	in	better	than	average	quality	metrics	and	outcomes	in	vulnerable	Latino	patients?	MethodologyInnovation	in	Clinical	Practice,	The	practice	team	consists	of	3	physicians,	1	PA,	1	RN/clinical	care	coordinator,	1	RN/CDE,	1	scheduling	coordinator,	1	care	manager	and	a	practice	manager.	Patient	care	is	reimbursed	predominantly	by	government	insurance	and	subsidized	by	LVHN’s	charity	program.Multi-Disciplinary Care: Every	diabetic	patient	with	an	A1C	over	8%	meets	with	a	diabetes	educator	during	a	routine	office	visit	with	provider	eliminating	transportation	barriers.Pre-visit-Planning: All	patients	receive	a	phone	call	per	week	before	scheduled	appointment	to	remind	them	of	outstanding	orders	that	must	be	completed	before	the	scheduled	appointment.	Barriers	preventing	them	from	getting	tests	done	are	addressed	and	resolved.Standing Orders: Standing	orders	exist	for	prevention	screenings	to	empower	the	clinical	team	and	increase	productivity	and	compliance	rates.		Weekly	Overdue	Preventive	Reports	are	run	and	patients	are	mailed	an	order	for	screening	and	instructions	on	how	to	schedule	the	study.Medication Reconciliation: Patients	are	advised	to	bring	in	medication	bottles	to	EVERY	visit	to	do	a	thorough	reconciliation	before	the	start	of	each	encounter.	Patients,	who	do	not	bring	their	bottles	on	7+	medications	or	have	had	a	recent	hospitalization,	are	scheduled	for	medication	reconciliation	with	the	RN.	Physician and Patient Agreements: In	order	to	create	a	trusting,	respectful	and	therapeutic	physician/patient	relationship	while	empowering	patients	within	their	care,	patients	with	chronic	conditions	who	are	struggling	with	compliance	and	with	making	significant	changes	to	better	their	health	conditions,	meet	with	their	health	care	provider	and	they	both	sign	and	review	an	agreement	that	outlines	and	explains	to	the	patient	the	steps	that	must	be	taken	in	order	to	better	his/her	health.	Community Care Teams: High-risk	patients	have	an	additional	team	that	provides	specialized	care	and	resources	to	the	most	vulnerable	patients.		On-site	services	provided	by	a	Behavioral	Health	Specialist,	RN-Care	Manager	and	Social	Worker	with	the	goal	of	increasing	health	and	reducing	ER	visits	and	hospitalizations.Financial Coordinators: Provide	on-site	guidance	to	patients	who	are	uninsured,	and/or	do	not	qualify	for	Medicaid.	Providing	assistance	with	medical	bills	from	office	visits,	studies,	and	medications	needed.	This	program	provides	financial	relief	eliminating	barriers	for	the	uninsured	patients.CDS’ cost per-member per-year for Gateway Health Medicaid in a year time period 2013/2014.Is approximately 38% less than its peer group. Additionally, Hospital admissions and pharmacy Net Paid per-member per-year costs are nearly 61% and 15% lower than the peer group respectively.  Aggregating these savings over the 379 Gateway patients receiving care at CDS, savings to the insurer total nearly a half million dollars annually. Measure is   Claims Utilization  Description of MeasureCentro de Salud PeerSavings per CDS Patient% Lower than Peer GroupHospital Admissions / 1000Average number of acute admissions per 1000 members. Acute inpatient setting includes hospitals, and excludes skilled nursing and rehab facility admission.91.08 233.74 142.66 61%ER Visdits / 1000Average number of emergency rom visits provided per 1000 members per year. This includes both ER visits that resulted in an admission and those that did not.701.33 1129.82 428.49 38%Overall Cost PMPY PMPY - Per Member Per Year. There are 255 members$2,295.22 $3,728.41 $1,433.19 38%Pharmacy Net Paid PMPY $1,831.39 $2,153.42 $322.03 15%Overall Yearly Saving to Gateway for Patients Receiving Care at Centro de Salud $447,581.10Centro de Salud LatinoAmericano, Department of Internal Medicine, Lehigh Valley Health Network, Allentown, PASaving Money While Meeting Quality Targets in Latino Health Disparities: A Reason for Optimism.Claudia Santiago; Margaret Gallardo, MD; Luis E. Lopez, MD; Betty Bohorquez, PA; Laura Gutierrez and Orlando J. Penaloza, MD FACP AAHIVMMagnetTM Since2002

Saving Money While Meeting Quality Targets in Latino Health Disparities: A Reason for Optimism

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1815&context=medicine

Saving Money While Meeting Quality Targets in Latino Health Disparities: A Reason for Optimism

Abstract

Similar works

Full text

Available Versions

Lehigh Valley Health Network: LVHN Scholarly Works