Monthly Update
 December 2014

CCC Board of Directors Meetings:

  • All CCC Board of Directors meetings are held at 1111 E. Cesar Chavez St., Austin, TX 78702.  Next Meeting:  TBD for January 2015.
  • More information on CCC Board meeting dates for 2015 to be provided in January.
  • The Central Health Board of Managers must approve budgets of the CCC in an open meeting.
  • All meetings of the Board of Managers of Central Health and the Board of the CCC are open to the public. 
  • One of two monthly meetings of the BOM of Central Health is streamed live. 
  •  The BOM of Central Health must approve budgets of the CCC in an open meeting.
:: 512-978-8164

Contact: Mark Hernandez
What's New?

Certified Scrum Master (CSM) Training


Preeti Ahluwalia, CCC Senior Business Analyst, facilitated the delivery of in-house CSM training as part of a technology skills development initiative in late October. Participating in the class entitles trainees to take the Certified Scrum Master Test and obtain a "CSM certification." Since completing the class, many of the individuals who completed the training have taken the CSM test and are now Certified Scrum Masters. They are actively incorporating Scrum Project Management to manage their projects and workflow.


The name "Scrum" was inspired by rugby (the scrum is where all the players gather around the ball when play restarts) due to its similarity to the two key Scrum "events" that are part of the methodology (the daily standup meeting and regular sprint planning/review sessions). Scrum is a set of principles and practices that add up to a team and project management methodology, focused on delivering work in short cycles, enabling fast feedback and continual improvement, and emphasizing rapid adaptation to shifting requirements. 


Prior to the  two-day Scrum class, Dan Chauncey, Enterprise Chief Performance Officer, and Edward O'Connor, CCC Chief Information Officer, provided a short primer on Agile methodologies in general (Scrum is one of many approaches to Agile.) - and helped connect the dots between Agile, Lean, and Theory of Constraints as synergistic skill sets.


The class was led by Agile coach, author, and Certified Scrum Trainer Angela Druckman.  Along with CCC staff, other attendees at the two-day course included representatives from CommUnityCare, Seton, the Integrated Care Collaboration, El Buen Samaritano, Sendero, and Austin Travis County Integral Care. A total of 26 students took the class. In addition to acquiring key skills, an ancillary benefit from this class was the increased collaboration built among staff of the various organizations as they  worked on simulated scrum projects.

The objective of the CCC is to create a system-wide team empowered with the skills needed to build out the technology platform for the integrated delivery system, and future educational opportunities are being considered (and prioritized in an Agile backlog!) - please share your ideas for technology education with the CCC IT team by emailing

A Note from the CMO  


Mark Hernandez, MD
Chief Medical Officer

"Winter is coming."

--Eddard Stark 


A quote from a fictional character might seem out of place for our newsletter, but I think it reflects a reality for us in Central Texas. Winter is coming, and many people in our community do not have the privilege of a roof and four walls to protect them from the elements in this dark and cold time of year. Our newsletter this month speaks to several initiatives we are involved in to help ensure these individuals can access healthcare and other needed social services.


As you prepare to celebrate the holidays this year, give a thought to how you might make a difference in the life of another person less fortunate than you.  Your contribution may seem very small to you, but it can make a world of difference to the impacted individual -- allow me to leave you with a well-known story that illustrates this.


A young girl was walking along a beach upon which thousands of starfish had been washed up during a terrible storm. When she came to each starfish, she would pick it up, and throw it back into the ocean. People watched her with amusement. She had been doing this for some time when a man approached her and said, "Little girl, why are you doing this? Look at this beach! You can't save all these starfish. You can't begin to make a difference!" The girl seemed crushed, suddenly deflated. But after a few moments, she bent down, picked up another starfish, and hurled it as far as she could into the ocean. Then she looked up at the man and replied, "Well, I made a difference to that one!


- Adapted from The Star Thrower by Loren C. Eiseley


Happy Holidays!


Providing Healthcare to the Homeless 


As the Community Care Collaborative works toward transforming the local healthcare delivery system, one group that will benefit from new, targeted healthcare initiatives is the homeless population. 

The local Ending Community Homelessness Coalition (ECHO) reports that over 1,660 individuals experience homelessness each night in Austin.  This population includes single individuals, families with children, and unaccompanied runaway and homeless youth.  Approximately 32% of the homeless population in Austin is chronically homeless which means that either they have been homeless for a yea or longer or have experienced at least 4 episodes of homelessness in the last three years and have a disability.

Along with the myriad of issues that these individuals have to deal with while living on the streets, in shelters, or in temporary housing, homeless individuals with acute or chronic illnesses face additional challenges.


The National Coalition for the Homeless website details the interrelationship between homelessness and poor health and the difficulties with trying to care for this population:


Poor health is both a cause and a result of homelessness. Many people are reduced to homelessness because of poor health, which can rapidly escalate into employment problems, financial difficulties and housing issues with over half of personal bankruptcies in the US resulting from health issues. Homeless persons also suffer from multiple health problems at a much higher rate than the general population with increased exposure to the elements, disease, violence, unsanitary conditions, malnutrition, stress, and addictive substances. Additionally, conditions which require regular, uninterrupted treatment, such as tuberculosis and HIV/AIDS, are extremely difficult to treat or control among those without adequate housing.


One approach to providing care for the homeless is to take health care to these individuals and meet each individual on his or her own terms as they are ready.    

One approach to providing care for the homeless is to take health care to these individuals and meet each individual on his or her own terms as they are ready.   


This approach is called Street Medicine, and this innovative approach is being piloted locally by the CCC to help increase the effectiveness of healthcare services to this population.

Street Medicine Defined   


Street Medicine is a systematic approach to the provision of health care to the unsheltered homeless.  The core mission of Street Medicine is to develop a relationship with individuals sleeping on the streets that will create the potential for them to live healthier lives.  Street Medicine programs go to where the unsheltered homeless live and engage each individual on their own terms.  While access to medical care is the core function of Street Medicine, any intervention which promotes a healthier life may be integral to the Street Medicine practice.


Street Medicine is not intended to be an adequate, on-going primary care resource, but instead, is a form of intermediate care which provides "bridge" medical services to patients while an appropriate primary  care relationship is identified and secured. In every encounter Street Outreach teams should work to identify and refer patients to a primary care relationship.To this end, the local Street Medicine project, detailed below, will initially focus on outreach and engagement with homeless individuals on health issues with the goal of ultimately referring these individuals, as appropriate, to one of CommUnityCare's 25 Primary Care clinics.

Local Street Medicine Project 


The Community Care Collaborative (CCC) is piloting a Street Medicine effort as the latest component of the Mobile Health DSRIP project.  With the addition of a new team in early 2015, the CCC Mobile Health DSRIP will have three mobile health teams (MHTs) each of which will rotate through the Street Medicine project.  CommUnityCare has been selected as the contracted provider for these DSRIP services.  All three MHTs will be based out of the CommUnityCare ARCH clinic in downtown Austin. 


The Street Medicine pilot is expected to begin in January 2015.  

  • Care Team.  Street Medicine will be provided by multi-disciplinary teams, consisting of a provider, a nurse, a case manager, and a medical assistant that will travel in pairs to identified areas of need in designated north, central, and south locations.  A medical access clerk will provide clinic-based clerical and support services for this work.
  • Services.  Initially, Street Medicine teams will focus on outreach and engagement while providing primary and acute care services.  Additional services may be offered in the future based on identified need and resources.
  • Partnerships.  The Street Medicine project is benefitting from close collaborations with the Austin-Travis County Emergency Medical Services (EMS) Community Health Paramedics (CHP) program as well as with Austin Travis County Integral Care's (ATCIC) Project for Assistance in Transitioning from Homelessness (PATH/Access) and Safe Haven programs. 
    • The EMS's CHP program, led by Commander Andy Hofmeister, will refer individuals to the Street Medicine program. 
    • ATCIC's PATH/Access and Safe Haven programs, led by David Gomez, Program Manager, already have established relationships with many of Austin's homeless population and will be working with the Street Medicine teams. 

Data gathering and an evaluation component are planned for this project to track and determine the impact and effectiveness of the services.


In conjunction with the other CCC DSRIP projects that build critical infrastructure, expand access to care, and ensure that patients receive the right services in the right place at the right time, this project extends services to an underserved and difficult-to-reach population. Additional information on the MHTs, including the Street Medicine Team, can be obtained by calling 512-574-1003. 
Leader Spotlights    


The Street Medicine program is being coordinated for the CCC by Margarita Arroyo, CCC Program Manager.  Margarita Arroyo, MSW, has a Masters in Social Work, and is a Licensed Clinical Social Worker. She worked as a Behavioral Health Consultant when the CommUnityCare Clinics were part of the City of Austin. She has her Project Management Professional Certification, and has supervised projects for almost 8 years. She is currently working on the following CCC DSRIP projects with CommUnityCare: Expanding Primary Care, Expanding Dental Care, and the Mobile Health Teams.  She has been married to Eric Arroyo for over 18 years and they have an amazing 16 year old son, Isaiah, who attends St. Andrew's Episcopal School. 



The Mobile Health Teams, including the Street Medicine program, are staffed by multi-disciplinary teams of dedicated CommUnityCare professionals who are committed to serving harder-to-reach populations.  Within CommUnityCare, the Mobile Health Teams Project, including the Street Medicine Program, is managed by Patricia Barrera, LPC, Practice Administrator at the ARCH.  While the third team will be hired in January, current team members include -



Team ATeam BAdditional Staff
  • Selena Crane, Physician Assistant
  • Jose Del Aguila, Case Manager
  • Emily Osborn, Registered Nurse
  • Velerie Moreno, Medical Access Clerk
  • Ismael Rivera, MD
  • Vacant, Case Manager
  • Letitia Patterson-Richardson, Registered Nurse
  • Nicole Garcia, Medical Access Clerk
  • Todd Jarrell, MD
  • Angela Brubaker, Nurse Practitioner
  • Shizzell Hjella, Clinical Dietician
  • Kasey Legget, Clinical Pharmacist
  • Monick Hamlin, Medical Assistant

Volunteer Request: CD Doyle Clinic 


Another local effort to provide healthcare services to Austin's low-income population is the CD Doyle Clinic.  This clinic is both managed and staffed by a volunteer base of community physicians, medical students, graduate students of social work, and undergraduate students.  It is the only student-run clinic in Central Texas.  The clinic currently accepts patients on a walk-in basis on Sunday afternoons, from 2:00 p.m. - 5:00 p.m., at the Trinity Center in downtown Austin.


Medical students evaluate patients, develop management plans, and present to an attending physician, who then endorses or modifies plans as necessary.  In addition to medical evaluations, patients can receive prescriptions, over-the-counter medications from the clinic's inventory, vaccinations, wound care and referrals to case managers, social services, and community resources, such as the Medical Access Program (MAP). The clinic serves approximately 15-20 patients during a typical afternoon session.


Physician volunteers are essential to clinic operations and contribute deeply to the professionalization of future health care leaders.  Physician volunteers are scheduled on a rotating basis, in three-month cycles. In general, each physician attends clinic once per three-month period (i.e., three hours per three months).  To learn more about the CD Doyle Clinic, please see the website at  If you are interested in joining the physician scheduling list, or if you have any questions or comments, please send an email to