Community Care Coordination and Case Management

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Community Care Coordination and Case Management

• Kansas Public Health Association, Inc.
• 2006 Fall Conference

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Central Plains Regional Health Care Foundation,
Inc.

• Charitable, nonprofit organization, closely
  affiliated with and housed within the Medical
  Society of Sedgwick County
• Our vision is to improve the health and well
  being of the people of Wichita/Sedgwick County,
  Kansas
• Program areas
• Project Access Coordinates donated medical care
  for low-income, uninsured residents of Sedgwick
  County
• Clinics Patient Index A shared data project
  encompassing five safety net clinics and Project
  Access
• Enhanced Care Management of Sedgwick County A
  five-year pilot care management program for
  eligible Medicaid HealthConnect patients
• Various special projects and studies, implemented
  in partnership with local providers, to assess
  needs and potential areas of impact
• Hospital-wide utilization study/KU School of
  Medicine-Wichita
• ED case management program through area hospitals

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Background/Need

• The need to improve the health of vulnerable,
  invisible patient populations
• The need to increase access to health care
  services for the uninsured and underserved
• The need for a more coordinated system of care
• A coordinated system of enrollments, referrals
  and communication among providers related to
  patient needs
• A more coordinated effort among providers to
  develop innovative models that work
• The need to track data and information to share
  with the community about local efforts
• Our projects fit within the Healthy People 2010s
  Leading Health Indicator, Access to Health Care

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Goals/Objectives

• Our goals are to
• Improve the health status of our patients
• By coordinating care and services
• By reducing inappropriate utilization of medical
  services that are not in the best interest of our
  patients and are very costly to the community
• By educating patients about how to manage their
  conditions and access the services they need to
  live healthier lives
• Extend more care to more people at less cost

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Who Is Involved?

• Physicians and the Medical Society of Sedgwick
  County
• Area hospitals
• Safety-net clinics
• KU School of Medicine-Wichita and related
  residency programs
• Pharmacies
• Funding partners including United Way of the
  Plains, City of Wichita, Sedgwick County,
  Sunflower Foundation, SRS Wichita Area Office,
  and the Kansas Health Policy Authority
• Community representation on an Operations Council
  and many working committees
• Keep our programs patient-focused and
  community-based
• Provide important leadership and guidance
• To respond to environmental changes
• To make course corrections in current program
  areas
• To consider new initiatives

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Progress or Results

• Clinics Patient Index
• Safety net system is stronger and more viable by
  communicating more effectively
• New data will provide a unified voice across
  safety net
• Project Access
• 6,900 Project Access patients have accessed more
  than 51 million in donated medical care and
  services
• Broad range of partners convened to serve the
  uninsured and develop new models that work
• Enhanced Care Management
• Early results are promising
• More than 100 patients served
• Developed care management concepts that include
  intensive supportive services provided by a
  multi-disciplinary team, patient education
  techniques, coordination of health care services
  and integrated quality standards of practice

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Expected Impact

• Project Access patients experience a
  clinically-significant improved health status
• They are also much less likely to visit area
  emergency departments for primary care conditions
• Local medical community saves money because care
  is accessed when needed rather than waiting until
  conditions become severe and acute
• Enhanced Care Management patients are
  experiencing positive results early in the
  program
• Anecdotal stories of success
• A unique model has been developed and implemented
• Detailed evaluation plans in place to track
  program outcomes
• Currently working with the Kansas Health Policy
  Authority staff on funding issues so that we may
  continue this pilot project
• The medical community has taken a lead in
  coordinating activities that serve the
  underserved
• This leadership will drive us towards new models
  and approaches that will improve the health of
  our entire community

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Application

• Many communities have initiated similar programs,
  perhaps your community is ready
• Visit our website and the American Project Access
  Networks website for more information about
  volunteer-physician programs
• www.projectaccess.net
• Click on evaluation reports
• www.apanonline.com
• Access information from many other communities
• Identify potential approaches/models
• Develop a leadership group to further your
  mission
• Build the political and community will to
  implement your programs
• Develop the key partnerships to get them off the
  ground
• Implement programs with integrity and include
  objective evaluation activities to assess
  strengths and weaknesses
• Use that information to make course corrections
  quickly
• Report successes and failures honestly

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Contact Information

• Anne Nelson, Chief Operations Officer
• Central Plains Regional Health Care Foundation
• 1102 South Hillside
• Wichita, KS 67211
• Phone [phone]
• Email annenelson_at_projectaccess.net