Stakeholder Health Meeting: Chicago
Bold Leadership Through Partnership
Friday, September 25, 2015
Garfield Park Conservatory
Welcome: Rev. Kathie Bender Schwich, Senior Vice President, Mission and Spiritual Care, Advocate Health Care and Rev. Gerald Winslow, VP, Mission and Culture and Director, Institute for Health Policy and Leadership, Loma Linda University Health, Chair, Stakeholder Health Advisory Council
Context and Purpose: Rev. Bonnie Condon, Vice President, Faith Outreach, Community Health and Mission Integration and Rev. Kirsten Peachey, Director, Congregational Health Partnerships. Advocate Health Care
See Reflection on the Meeting by Gary Gunderson here.
Health Collaborative of Cook County
Click on this link to download presentation: stakeholderhealthHICCpresentation-revised
Health Impact Collaborative of Cook County (HICCC)—a collaborative Community Health Needs Assessment initiative among 23 hospitals, several public health departments and other key partners
Presenters: Bonnie Condon, Vice President, Faith Outreach, Community Health and Mission Integration, Advocate Health Care and Elissa Bassier, CEO, Illinois Public Health Institute. A group of five organizations to see how they could work collaboratively to improve health in Cook County.
Three people were talking about the possibility of different groups collaborating on long-term community in Cook County. Their first step was to invite a larger number of groups to join the conversation. On February 15, 2015, 60 people representing many stakeholders (hospitals, health departments, etc.) squeezed into a small room. The room was full of smart people but it was also full of passion as they agreed to work together on the task was ahead. PHI has served as the backbone organization. When they convened the whole collaborative, Cook County is too big to have one whole group. There are three sub regions each using he same processes and instruments, steps all at the same time. About half of the nonprofit hospitals in Cook County are involved.
More than 23 hospitals and six public health institutions are involved today. That number may still grow. Long-term vision is to have broader involvement from more hospitals.
About 30 to 50 people are participating on each of the three Stakeholder Advisory Teams. They are identifying and prioritizing the health issues for each region. A data advisory committee is figuring out how to bring data across jurisdictional lines. The MAPP process is being used, it’s designed to help health departments work in collaboration with their comities. Looking at health from multiple perspectives, system capacity, policy and trends that affect health, etc. the idea is to get planners to be more system focused and strategic.
With a Community Health Status Assessment, they’re looking at a large number of public health data. Following the assessment will be some strategic actions that the different institutions can take, that are based on this large collaborative effort. Hundreds of peole are engaged in getting the best data. Along with data is passion for the mission, among broader stakeholders.
What’s next? Layout-ready/template Collaborative CHNA report for hospitals with IRS requirements. Same for Implementation plans. “We are establishing a future by working together, rowing in the same direction. This can be powerful,” says Condon. ‘What started with three people talking in a non-hierarchical process will have a large, shared outcome.”
Response from the group included: Are there large local funders that could help support the initiatives that come from the process. Look at the “wellness” models are starting around the country where resources are pooled for preventative (upstream) activities as the needs are identified. What if hospitals dedicated one percent of the bottom line? Reach out to community foundations and other finances for this. How did this get beyond the normal competiveness normally found? Important that these groups were invited to be part of a “movement.” Also, there was a sense that there was enough to go around, economy of scale and other motivators. And the power of convening was at the center of this effort.
CeaseFire Hospital Initiative
The group heard from LeVon Stone, Director, Hospital Intervention Program, Cure Violence and Richard James, Trauma Chaplain, Advocate Christ Medical Center.
Richard James: Tragically, the problem of gun violence and other violence is large, and many of those harmed want to retaliate. Two trauma doctors at Advocate Medical Center were asking, “How can we help prevent some of the violence from coming here in the first place?” The partnership between Advocate and CeaseFire started about 10 years ago when the doctors went to a community meeting where CeaseFire presented. The doctors said, maybe if we partnered with them we could make an impact on violence retaliation.
A person gets shot, gets to the hospital. The chaplain asks is there anyone you’d like to make a call to. In those short moments they bond with the patients, building trust. They work and contact their significant other. (The chaplains are trained in getting the person to the hospital and communicating with that person coming to visit.) A referral is made to CeaseFire. The bond with the chaplain and the patient (or their significant others) are transferred to CeaseFire.
LeVon Stone: He was shot and paralyzed 23 years ago when he was 18. There’s a hotline call that comes to CeaseFire. Stone described the several ways CeaseFire serves.
Violence interruption. When fully funded, CeaseFire has 24 community sites throughout Chicago — 150 to 200 people working at one time. They act as “credible messengers” who come from the community that is plagued with violence. When someone is shot, a case manager is at the hospital within one hour, talking with the patient. In the community it’s a critical time; people are grieving and threatening retaliation. With bonds in the community, the violence interrupter meets with those in the close to the person who was shot or stabbed. They’re not asking who did it; they just want to make sure people don’t retaliate. They have been trained in first aid, domestic violence training and are certified in violence prevention.
A case manager coordinates with social workers at the hospital on a discharge plan and conducts follow-up visits when the patient goes home. To stop violence it before it happens, CeaseFire outreach workers also mentor those looking for employment (for example, working with their résumés), thinking of getting back to school or otherwise wanting positive change.
Advocate Health Care’s Population Health Initiatives
Dr. Carrie Nelson: Advocate’s ACO and Accountable Care Entity
Click on link to download presentation: Medicaid Stakeholders 09 25 15
Leadership Insights. 1400/4900 Physicians have their own practice, but benefit from collaboration; 13 years old. Joint contracting is key to making this collaboration work. Relationships drive behavior change for providers. Trinity Hospital (under-served area) and the disparity has shrunk over the years between that and more affluent hospitals. Now, with BCBS and other payers they have 55% reimbursement from FFS Population Management. Asthma is a big problem in Chicago. Now they can use health care dollars to work on mold control, etc. ACE started in July 2013 (as alterative to MCD Managed Care capitated arrangement).
ACE 3-Year Risk Pathway; 37+ global capitation; NOW, new Governor has changed all that . In May, they were told they had to change by July; that has shifted to Jan. 2016 for global capitation. Negotiated for the capitated funds. Move toward one model of care of 600,000 patients and clinical integration. GME/residency practice was very dependent on MCD dollars. However, Illinois pays so little (49th in the country) and they often had delayed payment.
Advocate 2020. Some big fights at the hospital, but they pushed through. One of the loudest physicians said he wouldn’t take MCD—just 5 patients for PCPs; specialists had to take more patients. One of the OBs was accustomed to lagged payment and low pay from the past, and now he is taking more MCD patients. You have to participate in MCD by end of the year, or you will no longer be in the ACE.
CHW MCD Targeted Initiative. 2 Populations: Asthma at Trinity PHO (Feb. 2015) Home visits, up to 6 x per year; 3 month training, Motivtional Interviewing, and Asthma care; part of broader team. First success story was calling the first CHW for a job. A child called them back and said, “Who made my Mom cry?” They are great jobs with benefits, etc. Moet found a family with a 5 yo child who had not been to the MD office since 18 months old. Moet called the physician office and begged them to make the appointment. Moet meets them there and the experience was very positive; immunizations caught up, etc. Melinda works at her church and she intervened with a member who was having an asthma attack.
ED Overuse at Christ PHO (2nd QTR 2015)
- What is the longer term plan vs. pilot for the CHW program? Northside has a lot of asthma patients and they want to spread it everywhere.
- How does the CHNA work integrate with these programs? They just started to get data that can help inform the program going forward. They are trying to experiment with a voluntary CHW model.
- How are you paying for your CHWers? Built into the budget as staff and the broader team.
- What are you tracking in terms of activities? Traditional nurse and SW model didn’t work as well. Needed to add the CHWers into the team. They have a tool that they bought to track. They are building something new with Cerner (all in one system). There is a question about value addedness and how you oversee them. There is an assessment tool that they use.
- Do you have a triage tool to navigate patients to the right care? When they run a report, they look 3 ED visits in a year; look at co-morbidities, etc. The risk assessment tool is not part of the electronic health record. Can use MyChart in EPIC. Care coordination is needed across the spectrum.
- Do you see expanding the behavioral health work with CHWers? Peer based programs are probably needed. Co-location with primary care, with peers, is probably the first pathway. Taking on more risk pushes you to manage behavioral health.
- Having control of the covered lives makes such a difference, especially in the non-MCD expansion states. Cost savings models do not impress CFOs right now, as it doesn’t impact payment.
- The mandate to physicians that they must take MCD patients or leave the ACE (bold leadership move).
Advocate Bethany Fund
Click here to download presentation: Bethany Fund Stakeholder Health presentation 09 25 2015
Bethany Community Health Fund—a community-centered effort to fund and build the capacity of community-based organizations in four low-income Chicago communities.
- Hospital sees benefit of being proactive
- Moving into new season: death/resurrection
- Re-missioned for a common good
- Best kept secret within organization
- Collective impact: look at it/design it for CI
- Create model: community peer partners/mentors. Domino effect
- Interim steps toward lofty goal that make it doable
- Relational, out of crisis
- Leadership can involve following, that is, following community lead
- Institutions ceding power
- How an we collect the work to policy
- Intentionally connect efforts
- Can BF get active with fight for IS, Medicaid payment, diabetes?
- Connect with others who are leading policy
- BF found a way to tap into resilience of community
- BF should write it up and document steps
What? So What? Now What?
- Humble Leadership who is willing to step out of their power zone
- Courageous leadership
- Informed Hope (Gary Gunderson’s LCL quote)
- A real connecting
- Celebration of what’s right and doable vs. what is wrong and pathology
- Energy and optimism rising provides the fizz/spark to this work (soda bottle bubbles)
- Wondrous convening and a spirit of trust
- A witness to the art of the possible
- Struck by all the moving pieces of this work being aligned
- Non-competitive fashion
- Immediate openness to conversation
- Hunger for creativity
- Storytelling and metaphorical higher level telling elicits pride in the stories of others; celebrate that
- Commonality between the stories is the struggle, difficulty, pain and hard work on these journeys (may be true for the future as well)
- When people can be that open in sharing stories, that is a gift to us all
- John Keats’ poem on Autumn: Season of mist and luminal fruitfulness…. There is a mellowness at this point in the day, but there is fruitfulness in what we are taking home
- Illustrated how people took a bad experience and made good things of it
- Name: Kicking asthma
- Ideas about what funds exist and how to leverage them
- Felt energized and inspired and fed: a good combination of mission and practicality
- Energized to see HC system taking on the SDHs
So What? Now What?
- The Pope and his remarkable magnetism, because he is so clear on caring for the poor. That is so important. People of all faiths are drawn to that and Catholic Church is being re-energized as well. If we could embrace vulnerable and marginalize, that will be part of the fizz. Now What? What does that mean for Advocate to do that?
- Deep passion is felt here.
- Two boring words: focus and discipline himself to take this back and do something with it. I have great books; I can say to my wife, I am inspired—what’s for dinner? And Monday, he’ll have focus on disciplining to bring this work home, like CeaseFire.
- Do something. Reach out to someone who could help you be accountable. Especially around the data for CHW progams in Chicago, Detroit and Winston Salem and put that together.
- Figure out how we can work together (like the 3 to 60 people on the collaboration) and alignment of resources; they happened very differently. Almost random realignment to create new models is important. In communications, try to help facilitate that process.
- There are so many people who are passionate about helping people in community and there are those in our organizations who aren’t passionate. We can be the leaders. We can be accountable for spreading this virus around our own health systems and bringing others along.
- The traditional people with power will be shifting.
- We can replicate so many of thee programs and we are close to a tipping point in health care, where we can offer up blended solutions. We still need to talk about new payment models. We are headed to the mountain top.
- Process was really great, in that many local persons were brought into the space and that Bonnie’s enthusiasm can keep rolling next week. We need to multiply vs. add new voices. There is Ted Talk type materials that we need to put out there as we create a narrative that can be captured as history and then be shared to build the movement.
- Jerry learned that in San Bernardino, CeaseFire is convening faith leaders next week. Sometimes you have to go away from home to learn what’s happening in your own backyard. The Bethany Fund is so smart about keeping those funds right in the neighborhoods. Huge thanks to Bonnie, Kirsten, Olga, Kathie and others for making this happen. The field site work is so inspirational