Links of Care Building Linkages to Specialty Care for Community Health Centers

Links of Care Building Linkages to Specialty Care for Community Health Centers

Links of Care: Overview National Colorectal Cancer Roundtable Support 3 Nationwide Pilot Projects Low-Country, SC New Haven, CT Saint Paul, MN 18 Month Initial Project Started in mid-2014 Project extended through mid 2017

Why Links of Care? Solve the Access to Specialty Care for CRC Uninsured, underinsured and uninsurable patients at FQHCs face barriers to specialty care Patients who completed take-home stool tests didn t have a way to get follow-up colonoscopy and treatment, if necessary Providers unwilling to offer stool testing options if no follow-up available Big Barriers!!!

Saint Paul, MN Pilot Project Partners Partners National Colorectal Cancer Roundtable (NCRCRT) American Cancer Society Midwest Division Minnesota Department of Health Sage Scopes Program West Side Health Services, Inc. MN Gastroenterology P.A. Colon & Rectal Surgery Associates

Pilot Site: West Side Community Health Services Why West Side Community Health Services? Largest FQHC in Minnesota Over 35,000 patients seen annually Serve those who have the greatest barriers 83% from communities of color 97% have income below 200% of FPL 53% prefer other than English

West Side Health Services, Inc. Baseline Data 36% of West Side patients were uninsured in 2014 About one half of the insured were on Medicaid 9% had private insurance Significant number of under-insured with high out-ofpocket deductibles making colonoscopy unobtainable Many uninsured are uninsurable Over 3,700 patients age 50 and older About 15% screening rate

West Side Health Services, Inc. 2 Pronged Strategy Implemented at West Side - Internal Clinical Systems Improvement - Developing a medical neighborhood for specialty care

Links of Care Challenges at West Side Stool tests under-utilized - Follow-up colonoscopy not available for uninsured patients if test was positive No formal process for walking alongside patients during colorectal cancer screening process or colonoscopy referral No registry tracking system to know individual patient outcomes

West Side Health Services, Inc. The Big Problem! Tremendous need for follow-up, diagnostic and treatment for uninsured, under-insured, and uninsurable patients West Side s patients had no access to routine specialty care

How did we go about solving the problem? 1. Design Community Assessment 2. Convene Stakeholder Group 3. Studied and Shared High Performing Models 4. Made a business case for donated care 5. Distribute the burden of providing uncompensated care

How did we go about solving the problem? 6. Quality Improvement (QI) Coach 7. Recruiting Screening Navigator 8. Resource Development / Sustainability 9. Relationship Management with GI Practices 10. Dedicated Project Manager at ACS

MN CRC Roundtable Right Partnerships Convened Executive Leaders from Minnesota s largest Health Systems (i.e. Insurance Plans, Medical Practices, Public Health) Recruited key decision-makers - 55 individuals from 30 organizations Incorporated the Links of Care into the agenda to create momentum

Links to Care Partnerships developed for free colonoscopy testing for uninsured patients MN Colorectal Roundtable pulled stakeholders together to plan strategies Stakeholder meeting to discuss need in January 2015 Two GI partners committed to donating free colonoscopies plus additional services - Minnesota Gastroenterology - Colon & Rectal Surgery Associates

Links to Care Successful Partnership Development Engagement from many angles - Community Clinical Champions (Commission on Cancer Physician) - State support and engagement - ACS, ACS CAN staff - Engagement among many disciplines Both GI partners agreed to free colonoscopies (Total of 16/month)

2015 Outcomes 2015 Outcomes Clinic-wide screening rate increased from 24% to 44% 926 patients screened for colon cancer in just one year 74 diagnostic colonoscopies and surgeries donated from private, local specialty practices = ~$300,000 in donated care 8 patients with pre-cancerous polyps removed 4 cancers diagnosed Decreased specialty care access wait time from 67 to 25 days

2016 YTD Outcomes 2016 Outcomes 701 patients screened between Jan 1 and June 30, 2016 158 screening colonoscopies completed 68 diagnostic colonoscopies donated 9 patients with adenomas detected 2 cancers diagnosed Average specialty access wait time 33 days (an increase from 2015)

CRC Screening Trend at West Side Stool testing in last year or Colonosocopy in last 10 years or Sigmoidoscopy in last 5 years 50% 45% 43.8% 40% 35% 30% 25% 24.7% 20% 15% 14.3% 15.5% 10% 5% 0% 2012 2013 2014 2015

Securing Donated Resources GIs and hospitals are often willing to provide donated services and care if expectations are clear (i.e. a defined number of colonoscopies per week or month), business case is clear (fulfill Community Benefit; reduce downstream ER use of CRC patients) and burden is clearly shared among local providers or systems. Volume can be managed if all parties work collaboratively and there is effective coordination/distribution of cases.

Policy Solutions Advancing Policy Solutions Building on ACS CAN policy work in MN Highlight successes of Links to Care with State & Federal legislators Build Congressional champions for and raise visibility of this publicprivate partnership State funding for centralized referral coordination and screening navigation

Looking into 2017 & 2018 What s Next Develop partnerships with hospitals for gap coverage Continue to support and develop community and GI partnerships=medical neighborhood Add additional GI partners Spread program to additional FQHC clinics Support daily workflow at FQHCs Continue to secure local philanthropic support Develop centralized referral coordination and screening navigation