  DIRECTOR'S NOTE:
Engaging Patients
There is a lot of good work being done in the region to improve the health of low-income residents and advance health equity. When RPCC looked at ways it might best contribute to these efforts, it decided to focus on patient engagement as the lever to improve individual and population health and help to reduce cost. As two of our colleagues in the Institute for Healthcare Improvement's Triple Aim Initiative note, it is people who "...choose doctors, agree to treatment regimes, and are in control of carrying out their care plans. People interact with the health care system in offices and hospitals, but they take care of their health in their homes, at school and work, and in their communities. Creating partnerships between people, health care, and the community resources with which people engage is critical..."[1] to improving the health of both individuals and the broader populations.
With this in mind, RPCC created a framework to help consumers, providers, policy makers, and other stakeholders see the different ways in which people can be involved in their own health care, what it means for people to take ownership of their health and play a critical role in improving population health, and what it takes to make that happen. This issue of Ties presents this framework and focuses on some other work that is advancing patient engagement and can improve patient experience and outcomes, including the District of Columbia's Community Health Worker certification program, increasing parity across jurisdictions for some HIV/AIDS services, a growing collaboration between the Alexandria Health Department and Alexandria Neighborhood Health Services to improve care coordination for low income residents, and a new National Capital Area Breast Heath Quality Consortium being piloted in Montgomery and Prince George's Counties.
We hope you enjoy learning more about safety net organizations in our region are working to engage patients in their health care. We welcome your comments on RPCC's framework and the newsletter. To learn more about RPCC, its mission and its work, go to www.regionalprimarycare.org.
Phyllis E. Kaye, MPA
Director, Regional Primary Care Coalition
phyllis@regionalprimarycare.org
[1] From The Triple Aim from the Patient's Perspective: Acting with the Individual to Learn for the Population.
Developed by Eva Powell, National Partnership for Women and Families and Catherine Craig, Community Solutions in collaboration with the Regional Primary Care Coalition
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RPCC Triple Aim Team Develops Patient Engagement Framework
Engaging patient perspectives in quality improvement ensures that improvement is driven by the needs of those using the services. Engaging patient voices in the primary care visit empowers patients to better manage their conditions at home and reduces the frequency of costly procedures. Engaging patients in sharing health knowledge and healthy behaviors with their communities increases prevention and improves community health. These ideas and more are included in RPCC's new framework for engaging patients in improving health and lowering cost, from the medical visit, to the health system, to the community. The framework and an accompanying resource guide are now available on the RPCC website:
RPCC's patient engagement work is led by RPCC's regional Triple Aim Team, an official member of the Institute for Healthcare Improvement's Triple Aim Initiative with representation from Washington DC, Northern Virginia, Montgomery County, and Prince George's County. The framework was developed through a review of cutting edge patient engagement work from around the nation, the UK, and Canada.
RPCC's framework was featured in a breakout session at the Communities Joined in Action Annual Conference in October 2011, and at a breakout session in the Institute for Healthcare Improvement's Triple Aim Meeting in March 2012. RPCC has also collaborated with IHI to develop tools for providers to assess their patient engagement methods. Any clinics in the region who are currently engaging patients or who are interested in further engaging patients to improve quality of care should feel free to contact RPCC, at: info@regionalprimarycare.org.
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Ryan White Regional Planning Council Increases Parity in Access to HIV/AIDS Care
Starting in March 2012, people with limited income living with HIV (PLWH) who are out of care in the Washington metro area will find it easier to access the services regardless of where they live as a result of recent actions by the area's HIV regional planning body.
For many years, PLWH have been required to obtain federally funded HIV care in the state where they live, even though available choices vary considerably by jurisdiction. The Metropolitan Washington Regional Ryan White Planning Council, working with the DC Department of Health and program administrative agents in Suburban Maryland and Northern Virginia, has taken the following actions in recent months to increase parity in access to care:
- It developed and allocated funds for a regional peer-based model Early Intervention Services (EIS) program. This will train and employ community health workers with HIV to help find other PLWH and help them get connected to care and navigate the care system.
- It allocated funds for support groups that will be open to all Ryan White clients, regardless of where they live.
- It approved establishment of a pilot local pharmacy assistance program to provide HIV drugs on a short-term basis to PLWH anywhere in the metro area who are on waiting lists for life-saving HIV/AIDS medications, which could be of immediate assistance to Virginia residents since the state currently has a waiting list of more than 1,000 PLWH.
- It began setting consistent eligibility and operational standards for emergency food vouchers across all jurisdictions.
These actions were taken after town hall meetings of PLWH in the District, Suburban Maryland, and Northern Virginia; a review of needs assessment findings; and discussions in Planning Council committees.
The HIV/AIDS Regional Update #2, December 2011: Increasing Regional Parity in Access to HIV Care prepared for RPCC provides a more complete update.
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Community Health Workers Complete DC's First Certificate Training Program
The DC Primary Care Association (DCPCA) is helping to increase the numbers of community health workers trained to connect residents to care in the District. In December 2011, an inaugural class of 24 Community Health Workers (CHWs) graduated from the District's first official Community Health Worker certificate training program, and a second cohort began training in February 2012. The program uses a training curriculum developed in a 2010 pilot run by the University of the District of Columbia Community College (UDC-CC) and funded by DCPCA with support from the Greater Washington Workforce Development Collaborative, the DC Department of Health, and UDC-CC. Tuition for the CHWs is provided by Capital Health Careers, a stimulus-funded program led by the Providence Hospital Foundation to train and place 550 health care workers in the District, including 50 CHWs.
In an effort to continue to strengthen and grow the field of CHWs in the District, DCPCA has invited CHW graduates and incumbent workers to come together and form the CHW Professional Network of DC. The Network is an opportunity for CHWs to share resources, obtain additional professional development, advocate for sustainable employment for the field, and establish their own voice as a growing field in the District. The Community Health Worker Professional Network of the DC is supported by DCPCA, the Community Foundation for the National Capital Region's Greater Washington Workforce Development Collaborative, and Common Health ACTION'S Institute for Public Health Innovation. Read More.
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National Capital Area Breast Health Quality Consortium Being Established
The Primary Care Coalition of Montgomery County (PCC) received a four-year grant from Susan G. Komen for the Cure to create a National Capital Area Breast Health Quality Consortium (Consortium). The Consortium will initially focus on improving the quality of care along the full continuum of breast health for low-income, uninsured ethnically diverse women in Montgomery and Prince George's Counties. During the second half of the grant period, Consortium activities will spread to include the entire National Capital Area.
The Consortium has three main objectives: to engage breast health experts and stakeholders in the creation of standards that measure patient experience, health outcomes, and cost across the care continuum; to improve processes for getting low-income women the breast health care they need; and to educate public and private stakeholders about breast health disparities among low-income women. RPCC is a member of the broader Project Task Force.
The idea for the Consortium grew out of work done by the Metropolitan Chicago Breast Cancer Task Force. PCC and the Chicago Task Force will partner in developing quality metrics and leverage learning between the two regions. For more information, please contact Mary Jane Joseph at maryjane_joseph@primarycarecoalition.org.
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PCC and NOVA ScriptsCentral Build Clinical Pharmacy Counseling Programs
The Primary Care Coalition of Montgomery County and NOVA ScriptsCentral have built innovative pharmacy counseling programs to help patients in the region address medication-related issues, from non-adherence to adverse drug reactions.
Rosemary Botchway, Director of the Center for Medicine Access at PCC and recently selected "Innovation Advisor" for the Center for Medicare and Medicaid Innovation, focuses on integrating medication therapy management (MTM) into safety-net clinics in Montgomery County. A pilot MTM pilot program at Mercy Clinic in Germantown featured a weekly pharmacy clinic where University of Maryland pharmacist faculty and pharmacy students consult with patients to identify, prevent, and resolve medication-related problems (e.g. adverse drug reactions, drug interactions, non-adherence, etc.). Results of the pilot showed improved HA1C levels in 78% of a defined population of complex high-risk diabetic patients.
As the pharmacy clinic continues, Botchway plans to conduct a cost-benefit analysis of the Mercy Clinic program to understand whether it reduced cost in addition to improving health. In addition, MTM will be introduced to a second clinic: Proyecto Salud in Wheaton. Botchway also plans to collaborate with other local teams participating in the HRSA Patient Safety and Clinical Pharmacy Services Collaborative (PSPC) through the Delmarva Foundation for Medical Care (Maryland's Quality Improvement Organization).
NOVA ScriptsCentral, also a PSPC member, has built an onsite clinical pharmacy counseling program at Jeanie Schmidt Free Clinic in Herndon, VA. In addition to pharmacy counseling, dedicated volunteer pharmacists have focused on gathering data about the root causes of potential adverse drug events. Ordering errors - particularly due to inadequate pharmacy history - are the leading cause, according to preliminary results.
Building on the success of the onsite clinical pharmacy, NOVA ScriptsCentral most recently received a grant to hire a clinical pharmacist who will be a fully integrated member of the care team at Jeanie Schmidt Free Clinic.
For more information, please contact Rosemary Botchway, Primary Care Coalition, at rosemary_botchway@primarycarecoalition.org or JoAnn Knox, NOVA ScriptsCentral, at jpknox@novascriptscentral.org.
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ANHSI and Alexandria Health Dept. Collaborate to Provide Care for Alexandria Patients
Alexandria Neighborhood Health Services, Inc. (ANHSI) and the Alexandria Health Department have begun a collaborative practice model to provide care to Alexandria patients. ANHSI provides Ryan White care for HIV/AIDS patients as well as adult primary care services, while Alexandria Health Department's Casey Clinic provides medical case management including medication, housing, social security, transportation, and dental care. Casey Clinic also continues to provide obstetric care. With a mental health counselor and prenatal nurse case manager from ANHSI placed at Casey Clinic, the clinic is initiating a "centering" model for prenatal care in 2012: prenatal group education classes that provide social support and prenatal health education to low-risk women.
While the two clinics continue to smooth operations to ease patient care, case managers at Casey Clinic do have access to appointment scheduling at ANHSI, patient electronic medical records, and Carewares, a data collection system for the Health Resources and Services Administration and Ryan White. The Alexandria Health Department also continues to manage a shared Title 10 Family Planning Grant, through which it provides shared training with ANHSI and improved access to care for family planning services.
For more information, please contact Veronica Aberle, Alexandria Health Department, at veronica.aberle@vdh.virginia.gov or Martha Wooten, ANHSI, at mwooten@anshi.org.
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REGIONAL PRIMARY CARE COALITION
SPRING 2012 eNEWSLETTER
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MORE NEWS + EVENTS
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THE REGION: QUICK FACTS
- Includes 8 health departments in three "states" - the District of Columbia, 2 counties in Suburban Maryland and 5 health districts in Northern Virginia
- Population of almost 4.7 million is larger than that of 26 states
- Racially, economically and ethnically diverse population whose demographics vary by jurisdiction and are changing dramatically
- Health care safety net includes over 30 health centers operating in over 90 sites; including Federally Qualified Health Centers and free clinics
- Over 10% of children live below poverty, with anywhere from 4.3% to 30.4% of children living below poverty depending on where one lives
- Three separate Medicaid programs with wide variations in eligibility requirements
- Major variations in state and local funds for coverage programs
- Almost a 10-year variation in life expectancy, depending where one lives
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Ties, our e-newsletter, will link readers to information about regional health issues, policy and practice innovations in addressing the health service needs of low income populations, resources, and upcoming events. We hope it will stimulate discussion, encourage innovation, inform policy, and leverage lessons learned for the benefit of the region.
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