Connecting those at risk to Care
Community Health Access Project (CHAP)
CHAP is focused on reaching those at greatest risk and assuring they connect to primary care and prevention services. We recognize the interlocking issues of social determinants of health and also assist with connection to housing, food clothing, adult education and employment. We are excited to see many of our clients work forward from high risk pregnancy and homelessness to a healthy baby, stable housing and sustainable employment.
CHAP focuses on three principals – Find, Treat and Measure. We work within our own community and a network of communities across Ohio and the United states to develop evaluation strategies that specifically target high risk individuals. Using the Pathways model at risk individuals are supported through a process that identifies the health and social service needs and assures their connection to critical interventions.
It is recognized that an at risk 17 year old who is homeless and without prenatal care has both health and social service concerns that are intrinsically linked and must be addressed in parallel. Her health is also critical to her unborn child.
The expenses that will occur if these issues are not addressed are currently highlighted in our national health care expense and health outcome reports. We have by far the greatest expense for health care in the developed world and the worst health outcomes.
CHAP works with Community Health Workers, Social Workers, Nurses and Physicians to achieve the goal of connection to care. We see the packages of evidence based interventions in primary care, obstetrical care, immunizations, dietary education and many more as critical, on the shelf ready to be delivered. Our job is to reach into the forgotten urban housing complexes and isolated rural house trailers helping provide a kind and competent guide to assure those at risk connect to the packages.
Pathways as a model for care coordination assures that the individual actually connects to care as part of the payment structure. Payment contracts utilizing Pathways are at work in great variety connecting payment to confirmed connection to care and positive outcomes. The model of payment is far different than the current program based purchase of the health care system. Pathways draws from the success and wisdom of private business that currently has many highly effective and accountable strategies for not only developing great products but also assurance that those products go to where they are needed. UPS does not get paid unless the package is delivered. An at risk individual today is less likely to connect to basic prevention and treatment then they were 10 years ago and the health care budget has more than doubled in that time. Where is the assurance that those in greatest need are being reached and served effectively? We can reach those at greatest risk and assure their connection to critical prevention and treatment. Ours the most wealthy nation can also have the best health outcomes at an accountable cost.
Health Care Reform – Care Coordination Critical to Fundamental Improvement
Not all Americans have equal opportunities to be healthy. Conditions such as inadequate education and low income interact with unstable housing and unsafe neighborhoods to produce poor health in individuals and communities. These social determinants of health exert a powerful influence on health disparities—may be even more powerful than medical care or genetics. More over poor access to health care services worsens the harmful effects of these social conditions. Access to health care through effective care coordination provides a strategy to addressing these determinants of health by assuring barriers to care are address and individuals are connected to critical prevention and treatment services.
Amber is a 17 year old pregnant mother who lives with her 15 month old child in a dangerous housing complex in Columbus Ohio. She is eligible but has not signed up for insurance. She has no transportation. The eviction notice on the card table creates a different set of priorities that she and her 15 month old have to face. She needs to be found by a care coordinator, who is effective, engaged and supportive in ensuring that she reaches preventive medical care as well as suitable housing, gets back to her GED and eventually employment. The resources available to Amber involve multiple agencies, and tracking that coordination of care across these agencies requires multiple metrics that cross multiple sectors.
Our nation has the best specific health care interventions in the world. People travel from across the globe to receive heart surgery etc. These specific interventions and their value must be protected. Interventions with scientific basis for substantial improvement including prenatal care, parenting training, nutrition training for parents of young children and many more, have great potential to improve health and reduce cost. The problem is in our system, our delivery system. Those who need these interventions the most don’t get them and ultimately connect to care of the most expensive and catastrophic type starting out in the back of an Ambulance.
Our current system will come right to your door if you have an expensive health care disaster. We are almost unreachable if you would like to receive a preventive treatment. We need focus, measures and contracts that hold the system accountable to find, treat and measure the outcome. Systems that not only reach the rich as they do now but also reach those more complex and high risk patients currently avoided by the American Health Care system.
Private business is successful or out of business based on the same type of product and delivery accountability needed within the health care system. Policy makers and founders must stop simply purchasing programs and start examining the specific products and assurance of delivery for critical health interventions that hold hope for dramatic disparity reduction and cost savings.
The network of communities currently utilizing the Pathways model represent a beginning early structure demonstrating this work and this type of accountability and contracting can be done using existing infrastructure. Contracts are in place the work across the community system of care assuring those at greatest risk are found and assured to be connected. Duplication is eliminated and payment is tied to both connection to care and affirmed healthy outcomes. The Pathways manual and the Draft Community Hub Manual offers more detail.