ACCEL: Access El Dorado; Health Care Access That Works. Simpler. Better

Slide Presentation from the AHRQ 2008 Annual Conference

On September 9, 2008, Gregory Bergner, made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (1.3 MB; Plugin Software Help).

Slide 1

ACCEL: Access El Dorado; Health Care Access That Works. Simpler. Better

Hospitals: Barton Memorial & Marshall Medical
Clinics: El Dorado County Community Health, Barton Community, Divide Wellness, Tribal Health, Marshall Physician Services, Tahoe Family Physicians
County: Department of Public Health & Department of Mental Health.

Slide 2

About El Dorado County

The slide shows a portion of the state of California with a red circle around the county of El Dorado.

• Situated in East Central California's Sierra mountains.
• Topographically two zones: Lake Tahoe Basin & Western Slope.
• Approximately 178,000 people.

Slide 3

ACCEL Care Pathways

ACCEL has developed six Care Pathways to improve access to medical care for children. These pathways are:

• Securing Newborn Health Care Coverage.
• (Newborns) Utilizing a Medical Home.
• Securing Health Care Coverage.
• Annual Eligibility Review (Insurance).
• Obtaining a Medical Home.
• Pediatric Mental Health Consult.

Community Health Workers assist each person entering a pathway. The Community Health Worker acts as a personal guide and advocate for their client, assisting them to overcome barriers to health care, providing health information, and working with medical establishments on behalf of the client. Patient hand offs occur seamlessly between agencies depending upon where a patient is in a given pathway. Standardized steps with patients are understood and agreed to between partner agencies.

Slide 4

ACCEL's phased strategy for Health Information Technology

• Phase 1: Care Pathways.
  • Serves children at or below 300% Federal Poverty Level (FPL) with emphasis upon access to care issues for the un/underinsured.
  • Outcomes-driven cross agency Patient Case Management program.
  • Web technology in use countywide.
  • NPP implemented simultaneously.
• Phase 2: (EMPI) Electronic Master Patient Index.
  • Demonstration project 2008 with initial demographic data sharing.
  • Supports pre-population of patient demo data into Care Pathways & more efficient patient registration experience.
  • Supports NPP patient status tracking and will support Health Information Exchange (HIE) connectivity.
  • Necessary Privacy & Security policies and procedures effected.
• Phase 3: Health Information Exchange.
  • Business Case completed and high level clinical data identified.
  • Steering committee actively engaged.
  • Technology alternatives explored.
  • 1st Gen demonstration project explored.
  • Will serve all El Dorado County patients.

Slide 5

Converting pathways from paper-based system to shared electronic records

• Multi disciplinary team from ACCEL's participating organizations, staffed by project managers with technical expertise, was formed to oversee development and implementation of electronic pathways.
  • Workflow mapping & redesign.
  • Business rules & technical requirements.
  • Configuration & testing.
  • Training, Launch, & Quality Review.
• ACCEL Steering Committee adopted policies and procedures developed by Privacy and Security workgroup, including common language for NPP.

Slide 6

Care Pathways Dashboard

The slide presents four colored rectangles: Securing Health Care Coverage; Pediatric Mental Health Consult; Obtaining a Medical Home; and Utilizing a Medical Home (Newborns).

• ACCEL Dashboard offers a 30,000 ft view.
• Each Pathway is distinct: the problem addressed, the clients served, the outcomes measured, completion timeframes vary due to the complexity of the problem being addressed.
• Detailed trending QA reports to support (agency site issues, user compliance, etc.) will be available beginning in October.

Slide 7

Securing Health Care Coverage (WS & SLT): 89% completed successfully.

• Demo Start: May 2006.
• Client Criteria: Birth-18 years, less than 300%FPL.
• Referral Source: Clinics, ER, Schools, 1-800.
• Number of Clients: 1451.
• Outcome: Insured in MediCal, Healthy Families, Healthy Kids CAL Kids, Kaiser.
• Percent Successful: 89% (1291 kids).
• Pending: 6% (82 kids).
• Barriers: Moved out of area, no consent, lack of follow thru.

Slide 8

Pediatric Mental Health Consult: 51% completed successfully.

• Demo Start: January 2006.
• Client Criteria: MediCal, Healthy Families needing MH consult.
• Referral Source: ACCEL provider network.
• Number of Clients: 77.
• Outcome: MH initial and MD assessment, consult report to referring provider.
• Percent Successful: 51% (39 kids).
• Percent Unsuccessful: 33% (26 kids).
• Pending: 16% (12 kids).
• Barriers: Family preference (refuses MH), relocated, out of county MediCal.

Slide 9

(Newborns) Utilizing a Medical Home: 56% completed successfully.

• Demo Start: January 2007.
• Client Criteria: No-Doc newborn, first time mom on MediCal.
• Referral Source: Marshall OB.
• Number of Clients: 142.
• Outcome: Medical home with 4 well baby visits, 3 Izs in 8 month time frame.
• Percent Successful: 56% (80 infants).
• Percent Unsuccessful: 16% (22 infants).
• Pending: 28% (40 infants).
• Barriers: Moved out of area, no consent, lost contact.

Slide 10

• Demo Start: August 2006.
• Client Criteria: Pediatric non urgent pt presenting at ER w/o home.
• Referral Source: Marshall ER.
• Number of Clients: 294.
• Outcome: Medical home secured w/1 visit post ER for kids greater than 1.
• Percent Successful: 83% (244 kids).
• Pending: 4% (9 kids).
• Barriers: Parent doesn't respond to msgs; no shows at clinics; no parent follow through, moved out of county.

Slide 11

Lessons Learned from Care Pathways: It's hard, it takes time: and now collaboration is the norm.

• Solid upfront commitment from senior leaders is essential.
• Educate, communicate, educate, communicate -- it's a continuous process.
• Transparency and allowing for airing differing views helps build a team.
• Decentralized implementation model focusing on common outcomes goals respects differences among participants.
• Clearly defined workgroup charters, processes, and processes for issue escalation helps manage scope creep.
• Approaching work incrementally helps to mitigate the "overwhelm" factor.

Slide 12

Winter can make travel tough!

The photograph shows a man shoveling a pathway through many feet of snow.

Slide 13

Care Pathways is a methodology which promotes working together

The photograph shows a view of snow covered mountains and a lake. On the snow covered hill are tracks from skiers.

Slide 14

We need to squeeze, ferment, and share!

The slide shows a photograph of two rows of grape vines inside a vineyard.

Slide 15

Thank You

• ACCEL
  http://www.acceledc.org/index.asp
• Gregory Bergner, M.D.
  bergner@sbcglobal.net

• Note: The project was supported by grant number UC1HS016129 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.