Wednesday, May 28, 2008

The Importance of Advocacy

As I mentioned in a previous post, the Future Task Force I (FTF I) recommendations solidified our strategic focus on our four directions to excellence, but also indicated that if declining reimbursement and the rapid introduction of non-invasive technology were going to be the major drivers for the first decade of CHRISTUS Health, philanthropy and advocacy needed to be added as strong strategic initiatives. Consequently, we have been focusing on both, with clearly defined staff, business plans and operational tactics.

With regard to advocacy, we have attempted to minimize our interactions with state and federal governmental representatives that focus on requesting additional funding, which is the primary message they generally hear from any health care leadership team that visits them in Washington or their state capitals.

We recognized that an approach that only and repeatedly requested funding would not be successful, for one of the scenarios predicted in the FTF I process was that a national disaster would occur, as well as a war in a foreign country, causing great amounts of U.S. governmental funding to be removed from education and health care and reallocated to these efforts.

Our predictions came to pass, and unfortunately the results were as negative as we expected. With the occurrence of 9/11 and the Iraq war, both state and federal governments have been working feverishly to do whatever it takes to reduce reimbursement for Medicaid and Medicare for health care institutions as well as physicians and other health care providers.

Therefore, we have focused on educating elected government officials as well as members of regulatory agencies on the causes of the rapidly rising numbers of uninsured as well as pilot projects we have undertaken to more effectively and more cost-effectively care for this population of people.

In addition to this educational process, we have also indicated—particularly to the regulators who could possibly be in their present jobs even with the change of administration in January of 2009—that because of our innovative work in creating the pilots mentioned above, we would hope to be invited to participate when the next president chooses to put together a task force to make an attempt to design a new health care system that will be more affordable and provide basic health care to all.

Last year, we made a trip to Washington, D.C. and met with the top leadership of key regulatory agencies to give them both our educational message and redesign inclusion request. They appeared very receptive, and asked us to provide as much data to them as possible which would indicate that our pilots are actually raising the quality of health care while reducing the cost for the uninsured. We are in the process of collecting and refining this data now.

The majority of our discussions regarding these pilot projects focused on two which we are currently undertaking.

First, in Mexico, in each community where we are asked to establish a “for-profit hospital,” we also commit to opening and operating a clinic, complete with x-ray and lab capabilities as well as 10 short-stay beds to care for the poor. We now have six of these in operation and will have three more opened by December of 2008.

In our process of developing these clinics, we first identify the geographical location where we will have the greatest potential to serve the largest number of poor people. However, we often find that the government has already placed a health care clinic in this area, but so often these clinics are under-funded, poorly staffed and rarely see more than 5 to 10 patients a day. Therefore, on numerous occasions, we have successfully asked the Mexican government to give us this clinic, which they are more than happy to do. Upon receipt, we renovate the clinic, add air conditioning and begin services which not only include health care, but also other social services such as day care, craft classes, literacy classes and even grooming and beauty salons.

As you will recall, in a previous post regarding a Future Task Force II trip to Canada, I re-emphasized that health status is determined by seven factors, only two of which are clinics and hospitals, with the remaining five being connected to social services such as housing, food, clothing and employment. Our clinics for the poor try to provide educational opportunities to enhance or improve the skills and outcomes in these five other areas as well.

One interesting outcome of our clinics in Mexico is that we are seeing, on average, 300 people in each 24-hour period for at least the first 18 months after opening. Then, we see about a 10 percent reduction in the number of patients who come for treatment each day. On researching why that is occurring in areas where the populations are stable or growing--which would indicate that our clinic visits should increase--we discovered that many of our prior patients were saying that what we were doing for them was keeping them well, and therefore they did not need to come back for subsequent visits.

Again, this is really proof that if you provide good health care in all seven determinants, eventually the over-users of health care will become appropriate users of health care, and therefore improve the region’s overall health care status as well as reduce the cost for individuals. This is the kind of information that people must have in order to redesign health care so they can direct resources to where they will be most beneficial.

Although we need to collect more data, our initial findings in Mexico seem to suggest that if we open more of these clinic and short-stay hospitals for the poor, we could build fewer hospitals in the future.

A second pilot is our investment in Community Health Workers (CHWs), who help clients access health resources at the appropriate level of care, find medical homes impact the client’s health status and specifically prevent and manage chronic illnesses.

Our Associates who serve as CHWs generally do not have a background in health care, but we provide them with training and then assign them to 9 or 10 chronically ill, uninsured people.

The CHWs really become navigators for these people, to get them as expeditiously through the health care system as possible, but also provide them with resources that permit them to monitor their health care status at home, hoping that they will require less costly health care services as they continue life’s journey.

Our initial data from studying these patients cared for by CHWs show that their ED visits have been reduced drastically, the medications they have taken could be eliminated or reduced also, and their activities of daily living are enhanced.

Like our programs in Mexico, we will continue to develop and study the outcomes of these CHWs and present this data to governmental regulators as they are refined, so hopefully CHWs will become reimbursed in the future.

The growth of these pilots will depend on funding, but again, we are not advocating more money for these programs, for we realize that there is none available. However, by presenting the knowledge from these pilots and educating both elected officials and regulators as to the importance of them and the positive outcomes they have created, we are hoping that they will pass legislation and implement regulations that will take money from present inpatient funding and reallocate it to these programs that we are sure would prove to be successful in reducing the number of uninsured and keep patients out of very expensive hospital settings.

We have learned that advocacy is and will always be important, but is no longer a trip to the state capitol or Washington D.C. for more—it rather must become a trip to educate those who will listen regarding support for the health care strategies which will make a sustainable difference in the future.

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