Bold Health Plan for Poor Unveiled in California
FRENCH CAMP, Calif. -- Imagine a health care system that provides you with medical attention when you need it, superior treatment and seamless coordination between your primary care doctor and a specialist.
It already exists.
But for thousands of chronically sick, disenfranchised poor San Joaquin County residents the concept is nothing but a pipe dream.
Until now.
Four public and private agencies that work with the same underserved populations have embarked on an ambitious collaboration to provide an integrated system of primary care, mental health, specialty care, clinical and community preventive services and support for disease self-management. At the same time, members of this safety-net partnership expect to see long-term cost savings and healthier outcomes for the ethnically diverse population they serve.
Their strong collaboration has earned the county group $1 million in grant funding to move forward with its plans.
"They have come to the table ready to find creative solutions. Kudos to San Joaquin," said Peter Long, president and CEO of the Blue Shield of California Foundation that provided a $500,000 grant toward one of two major projects initiated by the partnership.
The partnership members include Community Medical Centers, Health Plan of San Joaquin, San Joaquin County Behavioral Health Services and San Joaquin General Hospital.
The Blue Shield Foundation grant will help fund -- along with a $748,000 commitment from the partners -- a safety net Health Information Exchange system that is expected to go live by Oct. 31.
By the end of the year, physicians at the health clinics, hospital and behavioral health sites expect to be able to coordinate care for patients receiving both psychiatric and primary care services. The Health Information Exchange will allow them to access joint-care plans and exchange progress notes and other documents.
According to Long, San Joaquin County's grant proposal was one of just two out of 26 submitted statewide that was funded. Los Angeles County received the other.
"We think this is a very big deal. San Joaquin's proposal to have an integrated information system for their low-income population is the most innovative and is really transformational. If they can pull this off, identify a person across the system, it is going to be very powerful. It is one of the boldest projects we've seen. It is exactly what we want to fund as a health funder," Long said.
The partnership received a second grant of $500,000 from the Community Clinics Initiative, a collaboration between Tides Foundation and The California Endowment to help fund -- along with $220,000 from San Joaquin General and Health Plan of San Joaquin -- the Health Home Innovation project.
Initially, the emphasis will be on poor patients who visit four targeted safety net clinics in the county and have been identified as having a specific chronic disease and a mental-health disorder.
"We chose the combination of diabetes and depression to focus on and show some improvements," said Dr. Paul Mascovich, Behavioral Health Services' medical director.
Through a combination of new technology and staff coaching at the four clinics to integrate the patient's primary and mental health care, the goal will be to improve the quality of that care and prevent the targeted patients from requiring emergency care or hospitalization. Patient data will be shared openly among all participating clinic sites.
"The staff will work in teams at the clinics to improve the health of the entire population. Each patient will have a personal physician in the clinic, who will work with a nurse, a social worker, a mental-health provider, health educators and community educators. They will support chronic care self-management, which has proven to be very effective," said Dr. Dale Bishop, medical director with Health Plan of San Joaquin.
Bishop said that the new Health Information Exchange "will make the Health Home more effective. We are working on quality and payment reform, because building Health Homes isn't free." Health Plan is working on a payment system to reimburse providers for the costs they incur to implement Health Homes, he said.
"Savings have been shown from other systems around the country. It's called medical cost offset. We're hoping to show the same thing," Mascovich said.
The assumption is that some patients use less medical care if they are able to get mental-health services. That decrease in cost of medical care may be greater than the cost of mental-health services.
Jane Stafford, Community Clinics Initiative managing director for Tides Foundation that co-funded the grant, said San Joaquin's "was one of the strongest proposals we have seen. Certainly, I think, it was in part the power of these folks coming together. I think there was something about their energy that produced a really compelling proposal about how they prepare to serve the population in San Joaquin County."
Stafford, who is based in San Francisco, toured some clinic sites in the county and walked away humbled.
"The physicians and staff we engaged with in this process really listen to the stories of the kind of care they are providing. With this infusion of funds, the direction is really up. I'm hopeful about what will follow," she said.
Copyright 2012 - The Record, Stockton, Calif.
McClatchy-Tribune News Service
