By Hannah Lambalot | Categories: | Comments Off on Opioid Use Disorder | A Population Health Collaboration
The 2016 Pennsylvania Opioid Data Dashboard reported 21,878 individuals covered by Medicaid with a diagnosis of Opioid Use Disorder (OUD). Of those suffering from OUD, only 11,591 (52.9%) received medication-assisted treatment (MAT). Temple University Health System developed an approach, in collaboration with the City of Philadelphia, the State of Pennsylvania, and various community-based organizations (CBO) focused on OUD through bridging medical care, behavioral health treatment, and addressing social determinants of health (SDoH).
With a one-million-dollar grant, Temple University built a hub and spoke network for the delivery of MAT in a primary care setting. The main goal of the program was to establish a hub and spoke model aimed at delivering and expanding best-practice treatment of OUD. The hub, led by OUD treatment experts, was charged with engaging other medical practices to launch best practice treatment at those sites. Best practice treatment of OUD includes medications to mitigate the effects of opioid withdrawal. A specific waiver is necessary to prescribe certain medications; as part of this program, clinicians attained this waiver in order to prescribe medications such as Buprenorphine. To monitor quality, a goal was set to decrease the readmission rate of patients with OUD, regardless of primary diagnosis.
To help patients overcome SDoH, Temple aimed to formalize relationships with community-based organizations (CBOs) to address food insecurity, housing insecurity, transportation, and pharmacy support. The Philadelphia Office of Homeless Services and Resources for Human Development specializes in housing placement for those with housing as a barrier. Philabundance delivers hot meals to recovery group sessions. In addition, they run a catering service called Philadelphia Community Kitchen which is a 14-week culinary training program open for enrollment to low-income adults and people in recovery. The program delivers 40 meals a week to the Temple hub and spokes. Sustainable food sources, such as SNAP benefits, are identified through case management. The Southeastern Pennsylvania Transit Authority provides subway/bus passes at no cost to the program’s patients. Temple also partnered with Uber/Lyft to provide rides for more medically complex patients. These services are available for appointments or any related service for their recovery. Lastly, Temple partnered with their outpatient pharmacy to be able to pay for medications that patients cannot otherwise afford, with grant funding.
Baseline objectives included the addition of spoke sites and the total number of patients treated from July of 2018 through May of 2019. The most powerful results were the increase in the number of patients who accepted treatment. The hub increased the capacity to see new patients by 267%. The spoke locations increased the ability to see new patients by 82.7%. Temple established warm handoff protocols for the organization’s emergency departments and crisis response center; warm handoff improved by 20% during that time. A total of 110 providers were trained in three sessions provided by the program. The program educated 22 Skilled Nursing Facilities providers and improved the OUD acceptance rate from 16 % to 28%.
By Hannah Lambalot | Categories: | Comments Off on The Sky Farm
Wellness and prevention have long been key components of the Eskenazi Health model of care. Through a large primary care network, numerous community-based health fairs, the Eskenazi Health Farmers’ Market and other initiatives, Eskenazi Health has been committed to community health and wellness. Dr. Lisa Harris, CEO of Eskenazi Health, believes the best opportunity to improve the lives of patients and, by extension, the health and vitality of our community lies in helping individuals stay well. Several years ago, employees at then Wishard Health Services (now Eskenazi Health), developed a garden area in a courtyard where employees could plant and grow flowers as well as fruits and vegetables. When plans moved forward to build a new hospital campus, leaders looked at ways to enhance its commitment to wellness for employees, patients, and visitors.
The construction of The Sky Farm occurred as part of the overall construction of the Sidney & Lois Eskenazi Hospital and Eskenazi Health campus, which opened in December 2013. Marion County voters approved construction of new facilities to replace the Wishard Memorial Hospital campus in the Nov. 3, 2009 election, with 85 percent support for the measure. Sidney and Lois Eskenazi of Indianapolis contributed $40 million to the project’s capital campaign in June 2011, and Health & Hospital Corporation of Marion County recognized their gift in naming the new hospital the Sidney & Lois Eskenazi Hospital, as well as the campus and system Eskenazi Health.
A number of individuals and organizations were involved, including RATIO Architects, Inc., of Indianapolis. The original design of The Sky Farm at Eskenazi Health was developed by Erik Reid Fulford of NINebark, Inc. Fulford was an Indianapolis-landscape architect who passed away in 2012. David Rubin of Land Collective, a world-renowned landscape architect, who also designed the outside main entrance landscape at the Sidney & Lois Eskenazi Hospital, helped to carry out Fulford’s work.
The rooftop farm is utilized to grow fresh produce for patient education, which is distributed to the community at Eskenazi Health’s community health centers and given to employees during “Fresh Veggie Fridays” (FVF). In addition to the produce, the farm is home to approximately 500 bees to increase crop production through pollination. The Sky Farm, open 24 hours a day, 7 days a week, has 24 crop beds, some of which are wheelchair height for easy accessibility, and produced and harvested more than 3,700 pounds of produce in 2018. Additionally, The Sky Farm, in partnership with the Eskenazi Health Food & Nutrition Services, provides classes, “Fresh Veggie Fridays” to sample healthy recipes, learn healthy cooking techniques, receive at-home gardening tips, and obtain fresh vegetables grown from The Sky Farm. “Fresh Veggie Fridays” hosts more than 1,000 visitors each season. It also welcomes field trips and tours throughout the year.
Produce grown on The Sky Farm is used to engage Eskenazi Health patients and employees. The Sky Farm Produce Classes are held at Eskenazi Health Center sites, with another 100 people participating in CSA-style 4-week classes. Each class includes a full nutrition lesson, cooking demo, recipe book, and take-home produce. Fresh Veggie Friday is a drop in nutrition, recipe sampling, and produce distribution free to employees, patients, and visitors during the summer growing season. Around 125 people attend each session, there are 10 sessions each summer.
The Sky Farm opened as part of the opening of the Sidney & Lois Eskenazi Hospital and Eskenazi Health campus in December 2013 and we are finishing up our sixth growing season. Overall, through our various programs, we distribute about 3,000 pounds of produce with cooking and nutrition education directly into our community at no cost to the participants.
By Hannah Lambalot | Categories: | Comments Off on Lyft Partnership and Vouchers
Denver Health formed a partnership with Lyft to provide no-cost rides to recently discharged patients or those in need of transportation to and from outpatient clinic appointments. The program began in the ED and expanded after three months to include the hospital and outpatient clinics. Hospital and clinic staff request and track Lyft rides for patients, and the Denver Health Foundation funds the service at an average cost of $8.50 per ride, with a 25-mile limit. Now in its third year, the program has provided more than 5,000 rides. Denver Health also offers no-cost bus tickets, cab vouchers, and a car service using a vehicle donated by Oprah Winfrey to those patients with limited resources. The “Oprah” car is staffed by local retired community residents on a volunteer basis.
By Hannah Lambalot | Categories: | Comments Off on Neighborhood Transformation
Henry Ford Health System, in Detroit, is involved in a 300-acre neighborhood transformation that will include mixed-income housing surrounding the new Henry Ford Cancer Institute. In partnership with the Michigan Department of Transportation and the City of Detroit, Henry Ford is working to make the newly renovated community and the area surrounding Henry Ford Hospital’s main campus more bikeable and walkable to promote healthier lifestyles and create easier access to and from the hospital.
Since 2018 the health system has partnered with Lyft, SPLT, Signature LLC and Ford Mobility GoRide to specifically address patient transportation as a social determinant of health. Over 1500 round trip rides have been provided to and from appointments for patients across nine departments. In 2019, the health system is working on addressing transportation and additional social determinants of health through the same service offerings.
By Jamie Cetrone | Categories: | Comments Off on Flavor Harvest@HOME
Studies indicate that as many as 1 in 3 patients 65 or older are at risk for malnutrition upon admission. Without proper treatment, approximately 2/3 of malnourished individuals will experience further decline in their health status due to increased risk of infection, pneumonia, etc, which is then posing financial risk to the health system.
In late 2013 Lee Health System assessed their treatment of malnourished patients, and identified that only 1.3% were diagnosed as malnourished. Knowing that 45% of patients were 65 or older, they recognized a need to change the way they address this medical need. Initially the program was piloted at one hospital, and once outcomes were validated it was expanded to all acute and post acute facilities. The primary goal of the program is to assist patients in their recovery by facilitating their transition from Acute Care to Self Care through the provision of appropriate nutrition, which when properly administered has proven to improve recovery, limit costs, and reduce readmission rates.
Flavor Harvest@Home is an in home medical nutrition therapy program designed to provide nutritional support for the home bound patients who are either diagnosed and/or at risk for becoming malnourished. Flavor Harvest@Home provides therapeutically appropriate meals to home bound patients recently discharged from the hospital delivered to their doorstep for 4 weeks free of charge. A full array of therapeutic meals covering all meal periods, snacks and beverages are available to patients either through direct intervention by their caregiver or a nutrition call center.
Flavor Harvest@Home is part of a 4 component nutritional intervention plan designed to improve patient recovery times. Incorporating many of the Alliance for Advanced Nutrition’s multidisciplinary Nutrition intervention framework, the program includes: (1) nutrient dense food and/or nutrition home meal delivery, (2) nutrition education for clinical providers for better identification of malnourishment risk, improved screening tools and increased nutrition assessment, (3) nutritional counseling with patients and families, and (4) coordination of nutritional care during and after hospital discharge. The Flavor Harvest@Home project is designed to measure the effectiveness of an enhanced interdisciplinary nutrition intervention program on targeted hospital patients with a state of malnutrition or at risk for malnutrition.
This model is a multidisciplinary effort that requires coordination with clinical professionals, registered dietitians, providers, food service staff and third-party contractors.
Readmission rates in the program participants continue to show improvement. Between 2015 and March 2017, 1,259 patients qualified for the program. To date, over 1500 patients have completed the full 4 weeks of meals.
By Jamie Cetrone | Categories: | Comments Off on Housing is Health
Central City Concern (CCC) responded to Portland’s crisis in housing and homelessness with the Housing is Health campaign, initiated by CCC’s executive director and health system CEOs. With a lead gift of $21.5 million by a pioneering collaboration of six local hospitals and health organizations—Adventist Health Portland, CareOregon, Kaiser Permanente Northwest, Legacy Health, Oregon Health & Science University and Providence Health & Services–Oregon—the Housing is Health initiative will bring homes, health, and healing into the Portland community where they are needed most.
The Housing is Health initiative is an unprecedented push to build 379 new homes designed specifically for individuals and families who are homeless or at risk of becoming homeless. These buildings are spread across three separate locations, one of which is anchored by a critically needed health care clinic. All locations will offer residents a variety of support services, including substance use disorder recovery support, mentoring, life skills training, and help re-entering the workforce.
Housing is Health enables health care systems to work together to address social determinants of health such as housing and employment. Central City Concern’s Recuperative Care Program (in the Blackburn Building) gives homeless people who are exiting hospital stays more time to get better in a safe environment. Employment specialists in the Housing is Heath collaborative help residents to enter/reenter the workforce.
All three Housing is Health buildings are under construction. Charlotte B. Rutherford Place (51 family-housing apartments) in North Portland and Hazel Heights (153 work-force apartments) in Southeast Portland will open summer 2018. The Blackburn Building (51 units of respite care housing, 124 units of transitional housing, as well as a primary care clinic and pharmacy) will open in 2019.
By Jamie Cetrone | Categories: | Comments Off on 500 in 5 campaign (housing development)
This program originated from Truman Medical Center’s behavioral health program (TMCBH). TMCBH’s homeless outreach services needed access to housing units to stabilize behavioral health clients with multiple health care needs that were routinely rotating through the emergency department (ED). They renegotiated a state contract that had unused funds and secured a partnership with a supportive housing developer. A local university did a brief market analysis to help determine the number of units that could have a significant impact in the community. This led to a 5-year campaign to develop 500 units of housing in the metro area while measuring impact on healthcare and treatment.
The hospital does not allocate any direct resources. Medicaid pays for support services for most tenants served, and HUD pays for non-Medicaid reimbursed support services for those pending Medicaid and the chronically homeless. HUD dollars or Missouri Department of Mental Health monies are used to pay rental assistance, and private foundation dollars are sometimes used to fill gaps. In year one, the program has been targeting chronically homeless individuals that frequent the ED and transition-aged youth at risk of homelessness.
TMCBH partners with organizations on a project by project basis, including the Vecino Group, the Corporation for Supportive Housing, local non-profits, and multiple community landlords. When targeting transition-aged youth with mental illness, the program partnered with a local private university that had vacant dorm space to create four units of supportive housing while also enrolling the youth in college (with private foundation monies). For chronically homeless individuals, program staff secured a local landlord and master-leased 20 units with HUD and state dollars. TMCBH agreed to provide on-site staffing for 40 hours per week and keep the units filled so there are no vacancies longer than 30 days. Collaborations are specific to the population being housed.
TMCBH launched the campaign in October 2017 and have secured 25 units with an additional 45 under development. An initial report demonstrated a 68% reduction in ED visits for 22 clients in the first 6 months of housing. Research will be collected every 6 months to evaluate impact.
By Jamie Cetrone | Categories: | Comments Off on Vita Health and Wellness District
In 2000, Stamford Hospital (SH) partnered with Charter Oak Communities (COC) to expand and redevelop their respective real estate holdings on Stamford’s West Side. The 2013 Community Health Needs Assessment (CHNA) identified the neighborhood as a priority due to its disproportionate share of chronic diseases. The CHNA results, along with the Affordable Care Act’s emphasis on addressing the upstream causes of disease, prompted Stamford Hospital to undertake a series of strategic investments in the surrounding community. Stamford Hospital and COC crafted a unique exchange of owned properties that enabled both to complete a series of complex redevelopment projects, including a new hospital and hundreds of housing units. This relationship led to the Vita Community Collaborative in 2012, which aims to promote health and wellness in the West Side neighborhood. Vita developed an interactive tool, entitled Vita Impact designed to show the linkages between targeted social initiatives and other characteristics that can broadly impact a community.
The Vita Health and Wellness district has become a health-themed neighborhood where numerous distressed public housing projects have been replaced with lower-density, mixed-income communities with dedicated resident support services, public green spaces, an independent pharmacy, and a revitalized hospital and campus. Each aspect of Vita addresses the social determinants of health, including healthy housing, economic stability, education and attainment, public health and access to medical care, physical activity and improved social cohesion. The core of Vita includes hundreds of new mixed-income, townhouse-style communities (with more under construction). Vita’s unique volunteer-powered urban farm (www.FairgateFarm.com) hosts numerous community-building programs such as nutrition education, cooking classes, food waste composting, and food security. Residents of the Vita community are afforded access to non-emergent medical care with two federally qualified health centers (FQHCs) serving patients on Medicaid and Medicare along with the underinsured, and the Americares Free Clinic, which provides primary care for uninsured patients who do not qualify for any government funded programs. Stamford Hospital supports the entire Vita initiative by contributing to its operating budget and providing dedicated in-kind staff support.
Stamford Hospital and Charter Oak Communities provide the essential backbone support to the Vita initiative, which includes program management, administrative services, communications and public relations, program evaluation, fund raising and strategic leadership. Vita Collaborative members represent nearly every discipline among community organizations including healthcare, public health, mental health, human services, education, food security, affordable housing and local government representation. Stamford Hospital also provides nutritionists, data analysts, and clinical staff to participate in planning and program implementation. Stamford Hospital completed construction on its new hospital and redeveloped campus, investing $450 million, and Charter Oak Communities has completed nearly 400 units of mixed-income housing through its strategic application of public and private resources – totaling an investment of over $200 million.
Each year, Fairgate Farm engages hundreds of participants and volunteers including students of all ages, corporate and civic volunteers, gardening enthusiasts and ‘foodies’, and numerous local residents. In 2017, the Farm grew over 4,000 pounds of organic fruits and vegetables, donating much of it to local hunger relief organizations. The Parents-as-Co-Educators program, designed to improve Kindergarten readiness for children of immigrant families, had a 100% success rate in its 2015-2018 cohort. This program has been rigorously measured through its partnerships with the Harvard Business School Community Partners and the University of Connecticut. A second cohort is planned to begin in the fall of 2018.
By Jamie Cetrone | Categories: | Comments Off on Trauma to Triumph
Trauma to Triumph (T2T) began at Santa Clara Valley Medical Center in 2012 through a partnership with the City of San Jose Mayor’s Gang Prevention Task Force (MGPTF). The hospital had previously collaborated with the Task Force on the Clean Slate Program, a tattoo removal service. Interpersonal violence has increasingly become a public health issue, and the program’s priority is to embrace teachable moments in order to engage patients and help them on their journey to resilience and recovery. The T2T program provides outreach, mentorship, and community services to victims of interpersonal violence, specifically youth and their families. These resources are designed to help patients cope with present circumstances, foster hope, and promote wellness, with an ultimate goal of reducing re-injury and recidivism of violence in the community.
Eligible participants for the Trauma to Triumph Program include trauma patients ages 13 to 30 within Santa Clara County who have sustained a gunshot wound, physical assault, stab wound, or assault with a weapon. A peer intervention specialist visits the patients at their bedside within the first 48 hours of admission to the hospital. Based on needs identified by the patient, the hospital social worker and intervention specialist create a discharge plan and coordinate resources for patients and families. Resources range from victim services, housing assistance, mental health/substance abuse services, job placement assistance, education support, basic subsistence needs, and court or probation advocacy. The T2T team builds a close, trusting relationship with clients over a six to twelve month period by providing one-on-one coaching and support so that clients can overcome trauma, set-backs, and challenges to while adopting a healthier lifestyle.
The T2T Program is a partnership between the City MGPTF and Santa Clara Valley Medical Center. As a result, the T2T Program has referral access to a continuum of other City operated/funded interventions and community service providers. These service resources are not only available to the primary client but also other family, siblings, and friends that may be negatively impacted by violent incidents. As part of the hospital’s commitment to being informed and engaged in violence prevention and best practices, they maintain a membership with the National Network of Hospital Violence Intervention Programs.
The T2T Program is the only formal evidenced-based hospital-based intervention program in the highly populated Santa Clara County. Prior to the T2T program, marginalized victims were released to unstable housing, transitional living situations or homelessness. They were also often in a traumatized state, with limited coping skills, no or limited support to prevent re-victimization, and without help to establish a healthier life style. Since full program funding was received in 2015, the T2T Program has served over 210 clients with 5,844 hours of service, representing 7,305 service sessions. Program evaluation client interviews have indicated; 96% “felt program was very helpful” and 92% felt “more hopeful about their future”. Since 2015, the program has had two patients who voluntarily participated in a service plan be re-admitted to the hospital.
By Jamie Cetrone | Categories: | Comments Off on Spartanburg’s Way to Wellville
In 2015, Spartanburg was one of five communities in the nation chosen to participate in the Way to Wellville; a challenge to develop new and innovative solutions that amplify and accelerate community health. Sponsored nationally by HICCup, Spartanburg’s Way to Wellville is working to improve health outcomes through five focus areas in the City of Spartanburg: obesity prevention; kindergarten readiness; access to care for the uninsured; health for the insured; and community pride.
A Core Team of cross-sector leaders serves as the key navigator for Spartanburg’s Way to Wellville. This leadership group monitors progress, supports committees in meeting their goals, and explores and evaluates other potential partnerships and related opportunities. Way to Wellville committees create goals and develop specific projects and programs for each of the five focus areas. The hospital and participating organizations leverage resources and equally share the expenses of the Coalition. Although the Way to Wellville focuses on all residents in the City of Spartanburg, particular emphasis is placed on the vulnerable and the very young.
Hospital leadership sit on the core team and look for multiple ways to include the health system in the work. Programs working to find access for the uninsured, a small business wellness cooperative, home visitation programs for new moms…..all involve the health system in some way.
The Way to Wellville explores innovative and creative ways to address critical health issues in the City of Spartanburg. Examples include:
A major initiative to introduce nine programs that would be available to all new mothers and the 650 babies born in the city each year is underway. From home visitation to parenting classes to quality early learning, they are working on a pay-for-success model of financing and look forward to rolling out in 2019.
A prototype of a small business wellness cooperative is currently being built and a pilot will launch mid- 2018. This will allow small business owners to provide similar resources to their employees that large employers do.
