Regional Health Connectors

Transcription

1 Regional Health Connectors SIM LPHA Grantee Kick-Off Meeting September 19, 2016 Sarah Lampe Colorado Foundation for Public Health and the Environment Ashlie Brown Colorado Health Institute 1

2 The Project described is supported by Funding Opportunity Number CMS - 1G from the US Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) and by contract/grant number 1R18HS from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services (HHS). Opinions expressed in this document are those of the authors and do not reflect the official position of AHRQ, CMS, or HHS. 2

3 Program Structure & Administration 3

4 Why Regional Health Connectors (RHCs)? 4

5 RHCs Focus on Coordination 5

6 RHC Role in Practice Transformation PF: Practice Facilitator CHITA: Clinical Health Information Technology Advisor 6

7 The RHC Roadmap Local relationships and priorities in each region will drive the work of each RHC, throughout the following steps: 1. Review existing initiatives and data 2. Align local priorities with statewide target areas 3. Develop a roadmap for RHC work on local priorities 4. Implement the roadmap plan 7

8 Align local priorities with statewide target areas Local Priority 1 Local Priority 2 Local Priority 3 ENSW Target Area Colorado SIM Behavioral Health Target Area Comorbidity or other linkage Any Colorado SIM Target Area 8

9 Align local priorities with statewide target areas ENSW Target Areas Example RHC Projects Cardiovascular Disease Help practices implement evidence-based clinical-community linkages for smoking Hypertension cessation Cholesterol Substance Use Tobacco Obesity Disseminate patient engagement materials about cardiovascular health Increase access to local community college fitness facility 9

10 Align local priorities with statewide target areas Colorado SIM Behavioral Health Target Areas Anxiety Child Development Screenings Depression Substance Use Alcohol Substance Use Prescription Drugs Example RHC Projects Connect primary care to statewide early intervention resources Disseminate stigma reduction materials from SIM LPHA grantees to primary care Facilitate coalition between law enforcement, substance use providers, and primary care Improve access to behavioral health services in rural communities via coordinating transportation networks and/or supporting adoption of telehealth. 10

11 Align local priorities with statewide target areas Anxiety SIM Target Areas Child Development Screenings Depression Substance Use Alcohol Substance Use Prescription Drugs Hypertension Asthma Substance Use Tobacco Obesity Asthma Diabetes Prevention Breast and Colon Cancer Prevention Flu Safety Falls Example RHC Projects Facilitate community social support network to address comorbidity between depression and obesity Implement follow-up referral to BH specialist after positive cancer screening Help practices establish referral networks that include support for comorbidities (e.g., joint referral for home assessment for falls and social support evaluation) 11

12 The RHC Roadmap - Example Local Priorities Target Areas Example Projects Example SMART Objectives Safe places to exercise Obesity Facilitate referral network from practices to local community college fitness facility Expand fitness center access to 200 low income families at an affordable rate of no more than $15/month by Apr Opioid overdose rate Substance Use Increase availability of naloxone through community coalition Distribute free naloxone kits to 1,000 residents by Jan Suicide death rate Depression Engage local providers and community organizations in LPHA-led mental health stigma reduction campaign Reduce suicide death rate from 19.4 per 100,000 to 17.6 per 100,000 by Jan

13 RHC Regions 13

14 Need more information? Online The Project described was supported by Funding Opportunity Number CMS -1G from the US Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) and by contract/grant number 1R18HS from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services (HHS). Opinions expressed in this document are those of the authors and do not reflect the official position of AHRQ, CMS, or HHS. 14

15 Backup Slides 15

16 Colorado State Innovation Model 16

17 EvidenceNOW Southwest EvidenceNOW helps primary care practices use the latest medical research to improve outcomes associated with the ABC s of cardiovascular disease: Aspirin use by high-risk individuals, Blood pressure control Cholesterol management, and Smoking cessation 17