population health - california hospital association · path for future generations of female...

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Population Health

2017 California Hospital Volunteer Leadership Conference

Ron Werft President & CEO, Cottage Health

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Overview

1. Cottage Health Introduction

2. Population Health at Cottage Health

3. Listening Tour

4. Community Health Needs Assessment

5. Next Steps

6. Critical Evolving Role of Volunteers

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Since opening on December 8, 1891, SBCH has

never closed its doors. Caring for patients

through challenging times — the 1918 flu

epidemic, the 1925 earthquakes, and various

floods and fires — we’ve also been privileged to

share some of the brightest moments, welcoming

tens of thousands of babies into the community.

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Dr. Jane E. Spaulding was the first

SBCH superintendent, forging a

path for future generations of female

physicians. She treated patients,

trained nurses, managed the

hospital and even provided

oversight for the hospital’s farm. As

the hospital gained financial footing,

she took no pay during a year of her

tenure. She and our founding Board

members were among the earliest

volunteers in our history.

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Santa Barbara Cottage Hospital Original Articles of Incorporation:

“A home for the sick…where skilled physicians, trained nursing, home

comforts, and help where help is needed will be offered to all…”

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Unique Breadth of Services

• Cottage Children’s Medical Center: Acute pediatrics, NICU, PICU, trauma center and outpatient

specialty clinics

• Heart & Vascular Center: Blue Distinction Center, STEMI (heart attack) Receiving Center

• Center for Orthopedics: Blue Distinction Center and Gold Seal of Approval from the Joint Commission

• Neuroscience Institute: JC Primary Stroke Certification

• Center for Advanced Imaging: ACR (American College of Radiology) accredited for CT, MRI, Ultrasound,

Mammography and Lung Cancer Screening

• Cottage Rehabilitation Hospital: Accredited by JC and CARF for brain injury, integrated inpatient

rehabilitation and stroke specialty programs

• Ridley-Tree Center for Wound Management at GVCH: JC Gold Seal of Approval, Center of Distinction

• Fortune Top 20 Best Workplaces in Health Care 2016

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Building for the Future

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• Santa Barbara Cottage Hospital including Cottage Children’s Medical Center, Cottage Rehabilitation Hospital and Cottage Residential Center

• Goleta Valley Cottage Hospital and Goleta Valley Medical Building, including Grotenhuis Pediatric Clinics

• Santa Ynez Valley Cottage Hospital

• Pacific Diagnostic Laboratories

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Population Health: Why is it important?

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What makes us healthy?

SOURCE: Washington Post

http://www.washingtonpost.com/blogs/ezra-klein/post/health-care-spending-vs-health/2012/06/05/gJQAxCPjGV_blog.html

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U.S. is spending

much more for

older ages

Source: Fischbeck, Paul. “US-Europe Comparisons of Health Risk for Specific Gender-Age Groups.”

Carnegie Mellon University; September, 2009.

Healthcare Spending Cost by Age

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Population Health Video Dr. Fred Kass Medical Director Cancer Center of Santa Barbara

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https://www.youtube.com/watch?v=slvJ7_WNDU0



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Building for the Future: Beyond Hospital Walls

Population Health

• 2015: Devoted Board Retreat to Population Health

• 2016: laid groundwork for expanded community partnerships for health and wellness programs

• Listening tours and needs survey

• 2017: Collaboration/Interventions

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Cottage Health Mission (before

Population Health program)

To provide superior health care through a commitment

to our communities and to our core values of

excellence, integrity, and compassion.

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Cottage Health Mission (updated)

To provide superior health care for and improve the

health of our communities through a commitment to

our core values of excellence, integrity, and

compassion.

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Cottage Health Framework

COMMUNITY

INTERVENTIONS

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COMMUNITY

INTERVENTIONS

INSURED

POPULATION

INTERVENTIONS

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COMMUNITY

INTERVENTIONS

PATIENT

INTERVENTIONS

INSURED

POPULATION

INTERVENTIONS

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PATIENT

INTERVENTIONS

INSURED

POPULATION

INTERVENTIONS

COMMUNITY

INTERVENTIONS

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Guiding Principles for an Effective Population Health Program

• Principle 1: Integrate Population Health and Health Care to Improve

the Health of Our Patients and Communities.

• Principle 2: Data Drives Our Decision-Making.

• Principle 3: Partnerships Enhance Our Impact.

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Guiding Principles for an Effective Population Health Program

• Principle 4: Focus on Health Equity Ensures Health Improvement for

the Most Needy Populations.

• Principle 5: Evidence-Based Interventions Maximize Success.

• Principle 6: Evaluation Ensures Continuous Improvement and

Desired Results Are Being Achieved.

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Listening Tour

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Listening Tour Overview

June–August 2016

More than 230 participants

Internal and external focus groups and interviews

Videos posted on Cottage Health website: cottagehealth.org

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Listening Tour – Internal

7 internal focus groups

Participants included:

• Nurses

• Clinical staff

• Physicians

• Residents

• Environmental services & nutrition

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Listening Tour – Internal Findings

There is a lot of pride in the high quality of care provided at Cottage Health.

Employees are very involved in and knowledgeable of the community.

Frustration exists with repeatedly seeing the same patients and sending them back to the same conditions that created poor health.

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Collaboration is lacking.

Some of our own employees struggle with very poor health.

In general, participants felt population health could play an important role in facilitating collaboration to address root causes of poor health in Santa Barbara County.

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Employee perspective: Audio clip

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Employee perspective: Audio clip

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Internal medicine resident physician perspective: Audio clip

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Internal medicine resident physician perspective: Audio clip

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Listening Tour – External

13 external focus groups and interviews

Participants included:

• Community influencers (e.g., business, education, government, faith-based, and non-profits)

• Deeper dive sessions with organizational leaders and those they serve

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Listening Tour – External Findings

Collaboration is lacking.

Cottage Health can fill the roles of facilitating, convening, and coordinating.

Housing insecurity, mental health, and food insecurity were mentioned time and time again.

Underlying economic and racial/ethnic inequalities make this work more complicated.

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Listening Tour Video Rev. Allysa DeWolf Lead Minister First Congregational Church

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Listening Tour Video Dr. Takashi Wada Former SB County Public Health Dept Director

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Community Health Needs Assessment

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BRFSS Data Collection

Followed the CDC Behavioral Risk Factor Surveillance System (BRFSS) model

8 weeks: July–August, 2016

2,500 random phone surveys

Powered to represent demographics of Santa Barbara County

Landline and cell sample

Oversampled low-income

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Indicator

Above HP 2020 Target

Overall good health

Alcohol use (binge drinking, past 30 days)

Physical inactivity

Oral health (dentist in past year)

Smoking (cigarettes)

Obesity

Below HP 2020 Target

Insurance status (insured)

Primary care provider (have usual PCP)

Cost as a barrier to care

Diabetes

Food insecurity

Depression

HP 2020 Target Not Available

Housing insecurity: 10% in SB County

BRFSS Data Collection

Behavioral Risk Factor Surveillance System

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On average, Californians are healthy and Santa Barbarans are even healthier.

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On average, Californians are healthy and Santa Barbarans are even healthier. But that’s not the whole story…

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Collecting Data, Asking Questions

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Five Priority Areas Emerged

Access to Care (cost, PCP, insurance)

Mental Health (depression, mentally healthy days)

Chronic Conditions (diabetes, obesity)

Housing Insecurity

Food Insecurity

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Five Priority Areas Emerged

Access to Care (cost, PCP, insurance)

Mental Health (depression, mentally healthy days)

Chronic Conditions (diabetes, obesity)

Housing Insecurity

Food Insecurity

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CHNA Website

CHNA full report posted on website

cottagehealth.org/about/community-benefit/

New interactive CHNA website

https://www.cottagehealth.org/about/community-benefit/



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CHNA Website

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Next Steps

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Next Steps

1. Brainstorming Meeting with Health Organizations

2. Ongoing Data Analysis

3. Cottage Data2Go & Population Health Learning Lab

4. Population Health Workshop Series

5. Community Benefit Grant Making

6. Health Leads

7. Implementation Strategy

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Brainstorming Meeting with Health Organizations

Purpose: convene key stakeholders to share data and priorities and begin conversation about the potential for collective action through varying roles

Half-day meeting in February

Stakeholders:

• Santa Barbara County Public Health Department

• Sansum Clinic

• CenCal Health

• Santa Barbara Neighborhood Clinics

• Santa Barbara Foundation

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How Might Cottage Participate?

Access

to Care

Mental

Health

Chronic

Conditions

Food

Insecurity

Housing

Insecurity

(Co)-Funder

Convener

Backbone

Support

Evaluator/TA

Advocate

Grantee

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On-going Data Analysis

Further analysis of the CHNA data in priority areas:

• Which populations are most impacted by not having access to care?

• What role do chronic conditions play in health outcomes for vulnerable populations?

• What factors impact mental health – social determinants? Access? Chronic conditions?

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Cottage Data2Go

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What is Data2Go?

Interactive mapping tool that will allow Santa Barbara residents and service providers to better understand:

Determinants of health

Health outcomes in region

Health disparities among small geographic regions

We can query things like Medicaid

coverage in distinct populations…

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Summerland, CA

Population 1,500

Virtually no adults

with Medicaid

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Garey, CA

Population 70

21% of adults with Medicaid

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How will we use Data2Go?

Cottage Health will use this data to inform

population health strategy, always asking the

questions:

What’s the problem?

Who has it?

Why them?

What are we going to do about it?

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Learning Lab

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Learning Lab Site

1. Cottage Data2Go

2. Planning, Implementation and Evaluation Toolkits

3. Links to Evidence-Based Programs

4. Population Health Case Studies from Santa Barbara

5. Portal/Login supporting collaboration between health non-

profits working together toward shared outcomes

6. Online Grant Applications

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Population Health Workshop Series

Purpose: launch new tools and initiatives that create

momentum in the community around priority areas and

population health strategies

• Cottage Data2Go, Learning Lab & Toolkit Launch – May/June

• Community Partnership Grants Application Workshop – Sept

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Cottage Health Community Benefit Grant Program: 16 grants totaling $1.7 million in 2016

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Community Partnership Grants

Present • Access to Care

(clinical care)

• Organizational Outcomes

Future • Targeted Population

Health Goals

• Initiative-level Impact

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Wrap Around Care Program – 2016

• 755 unique patients served

• 2,042 patient encounters:

• Street Rounds

• Clinics in the Parks

• Women’s Free Homeless Clinic

• Homeless Shelters and Warming Centers

• 120 Companion Care missions

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Community Partnership Grants

Sustainability Grants

• Financial support for 2016 grantees during transition (approx 50% of current grant)

• Technical assistance offered

• January – December 2017

Initiative Grants

• Population Health initiative

• Pre-application workshop and evaluation assistance

• Potential for longer-term grants

2017: Transition to Initiative-Level Grantmaking

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Explore Health Leads

Critical Volunteer Role

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Implementation Strategy

Full report on how Cottage Health will address priority areas and implement initiatives

To be completed by May 2017

Compliant with IRS Regulations

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Immediate Challenges

• Emergency Departments – PC and Mental Health • Preventable Readmissions • Cultural Competencies – language

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COMMUNITY

INTERVENTIONS

PATIENT

INTERVENTIONS

INSURED

POPULATION

INTERVENTIONS

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PATTH – Post Acute Telephone Treatment Help

• Since the program started, 1,378 referrals received to PATTH.

• 638 patients admitted to program.

• 572 patients discharged from PATTH.

• Of the discharges, there were 32 hospital readmissions (5.5% readmission rate).

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Emergency Department Holding Unit 65% increase in patients stabilized, sent home, and not requiring involuntary hospitalization

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Joe’s Story: A Successful PATTH

• 69 years old, lives alone, no family in area

• Admitted to Santa Barbara Cottage Hospital, March 2016

• Upon his discharge home, was at high risk for readmission if he didn’t have appropriate support and resources

• PATTH stepped in to provide support…

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A PATTH representative:

• Scheduled his followup appointment with a cardiologist.

• Arranged EasyLift for transport so he could get to appointments and fill prescriptions, and arranged insurance coverage for the transportation service.

• Provided a prescription update reminder.

• Coordinated a phone bill reduction via California Lifeline.

• Signed him up for a Brown Bag Program for food delivery.

• Coordinated home repair for his motorized wheelchair.

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His PATTH representative:

• Scheduled his followup appointment with a cardiologist.

• Arranged EasyLift for transport so he could get to appointments and fill prescriptions, and arranged insurance coverage for the transportation service.

• Provided a prescription update reminder.

• Coordinated a phone bill reduction via California Lifeline.

• Signed him up for a Brown Bag Program for food delivery.

• Coordinated home repair for his motorized wheelchair.

These resources led to his successful transition home.

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Respect…

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Respect…

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Currently 900 Cottage Health volunteers support our acute care mission.

• Spiritual Care Clergy

• No One Dies Alone Compassionate Care Program

• ED, surgery waiting area and other service areas

• Patient Transport

• Lifeline Installation

• Gift Shop

• Pet Therapy

• Aquatic Therapy

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VOLUNTEER VIDEO https://www.youtube.com/watch?v=9cCXvAFHj2g

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Expanded Volunteer Roles

Assisting patients with forms for housing, food, social support, access to care

Spanish speaking patient liaisons

Increasing volunteer opportunities “outside the walls” to address social determinants

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“If our hopes of building a better and safer world are to become more than wishful thinking, we will need the engagement of volunteers more than ever.”

Kofi Annan, former Secretary of the United Nations, and recipient of 2001 Nobel Peace Prize

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Questions?

population health - california hospital association · path for future generations of female...

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