Memorial Hermann Community Benefit Corporation

TEST AND MEASURE INNOVATIVE SOLUTIONS THAT PROMOTE GOOD HEALTH FOR THE INDIVIDUAL, THE HEALTH SYSTEM AND THE COMMUNITY.

ADDRESSING THE NEED FOR A "MEDICAL HOME" FOR THE UNINSURED AND UNDERINSURED, MHCBC PARTNERS WITH FIVE SCHOOL DISTRICTS, HOUSTON--THE LARGEST IN TEXAS, PASADENA, LAMAR CONSOLIDATED, ALIEF AND ALDINE FOR ITS HEALTH CENTERS FOR SCHOOLS PROGRAM DESIGNED TO PROVIDE A "MEDICAL HOME" FOR UNINSURED CHILDREN AND A SECONDARY ACCESS POINT FOR INSURED CHILDREN, GRADES K-12TH. THE HEALTH CENTERS PROVIDE PRIMARY HEALTHCARE, MENTAL HEALTHCARE, NUTRITIONAL CARE AND DENTAL CARE TO MEDICALLY UNDERSERVED, AT-RISK CHILDREN. THE PROGRAM BEGAN IN 1996 WITH TWO SCHOOL-BASED HEALTH CENTERS SERVICING THREE SCHOOLS. TODAY, MEMORIAL HERMANN OPERATES HEALTH CENTERS ON-SITE AT TEN CAMPUSES IN THE GREATER HOUSTON AREA PROVIDING ACCESS TO HEALTHCARE FOR STUDENTS AT 80+ SCHOOLS. "FEEDER" PATTERNS ARE ACCOMMODATED, MAKING IT POSSIBLE FOR A CHILD TO RECEIVE CONTINUITY OF CARE FROM PRE-KINDERGARTEN THROUGH TWELFTH GRADE. WHILE MEDICAID ELIGIBLE SERVICES ARE BILLED, ALL SERVICES ARE PROVIDED AT NO COST TO FAMILIES. THE HEALTH CENTERS FOR SCHOOLS OPERATE MONDAY THROUGH FRIDAY, 7:30 AM TO 4:00 PM, 12 MONTHS A YEAR. THE PRIMARY GOAL OF THE HEALTH CENTERS FOR SCHOOLS PROGRAM IS TO BRING INCREASED HEALTH CARE TO CHILDREN WHO WILL OTHERWISE NOT OBTAIN IT AND TO KEEP CHILDREN HEALTHY AND IN SCHOOL SO THEY CAN LEARN THE SKILLS THEY WILL NEED FOR A BRIGHTER FUTURE. 64% OF THE CHILDREN SERVED AT THE CLINICS DO NOT HAVE ANY TYPE OF HEALTHCARE COVERAGE. 24% HAVE SOME FORM OF MEDICAID. THE REMAINING 12% ARE CHILDREN WHO WILL NOT OBTAIN HEALTHCARE DUE TO TRANSPORTATION ISSUES, WORKING PARENTS UNABLE TO AFFORD A DAY OFF, HIGH PRIVATE INSURANCE DEDUCTIBLES OR SIMPLY A LACK OF PARENTAL INVOLVEMENT. 91% OF STUDENTS SERVED THROUGH THE PROGRAM ARE ON THE FREE/REDUCED LUNCH PROGRAM, AND 33% ARE MORE COMFORTABLE SPEAKING, READING AND WRITING IN A LANGUAGE OTHER THAN ENGLISH. THE SCOPE OF SERVICES OFFERED INCLUDES IMMUNIZATIONS, GENERAL AND SPORTS PHYSICALS, ACUTE, CHRONIC AND MINOR INJURY CARE, MENTAL HEALTH THERAPY, SOCIAL SERVICE COUNSELING AND REFERRALS, HEALTH EDUCATION, AND NUTRITIONAL GUIDANCE AS WELL AS OTHER SPECIFIC CARE TO MEET STUDENTS' NEEDS. STAFFING AT EACH CENTER CONSISTS OF A NURSE PRACTITIONER OR PHYSICIAN ASSISTANT, LICENSED CLINICAL SOCIAL WORKER, LVN AND A RECEPTIONIST, WITH MEDICAL OVERSIGHT PROVIDED BY A FAMILY PRACTITIONER. TWO DIETITIANS AND CERTIFIED COMMUNITY HEALTH WORKERS ROTATE AMONG THE TEN CENTERS. THE DIETITIANS DELIVER THE HEALTHY EATING AND LIFESTYLES PROGRAM (HELP) DESIGNED TO EDUCATE HEALTH CENTERS FOR SCHOOLS' STUDENTS AND THEIR FAMILIES ON THE IMPORTANCE OF PROPER NUTRITION AND EXERCISE. THE PROGRAM IS INTENSIVE AND INDIVIDUAL, MEETING THE STUDENT AND FAMILY WHERE THEY ARE ON THE "STAGE OF CHANGE" CONTINUUM. THE NAVIGATORS SUPPORT IN HEALTH AND SOCIAL SERVICE APPLICATIONS AND REFERRALS. ONE WRAPAROUND FACILITATOR IS IN PILOT PROGRAM WORKING TO MOVE THE NEEDLE FROM CRISIS TO THRIVING FOR HOMELESS STUDENTS, PARENTING STUDENTS, AND STUDENTS AT RISK FOR FAILURE DUE TO ABSENTEEISM. THE THREE MOBILE DENTAL CLINIC VANS ROTATE AMONG THE HEALTH CENTERS FOR SCHOOLS AND ARE STAFFED BY A DENTIST AND ONE TO TWO DENTAL ASSISTANTS. THE VANS PROVIDE SERVICES THAT INCLUDE PERIODIC ORAL EXAMINATIONS, DIAGNOSTIC X-RAYS, PROPHYLAXIS, FLUORIDE TREATMENTS, ORAL HYGIENE INSTRUCTIONS, SEALANTS, COMPOSITE FILLINGS, EXTRACTIONS, STAINLESS STEEL CROWNS, AND PULPOTOMIES. THIS PROGRAM HAS SERVED AS A "DENTAL HOME" TO UNINSURED STUDENTS SINCE 2000. AN EVIDENCED-BASED PROGRAM, MEMORIALHERMANN HEALTH CENTERS FOR SCHOOLS BENCHMARKS ARE DERIVED FROM THE NATIONAL ASSOCIATION OF SCHOOL BASED HEALTH CENTERS, PRE/POST DATA, AND HEALTHY PEOPLE 2020. OUTCOMES IN 2021 INCLUDE: 2.7% OF HEALTH CENTER STUDENTS USED AN ER FOR PRIMARY CARE PURPOSES VERSUS 10.5% OF THE GENERAL PRIMARY CARE PEDIATRIC COMMUNITY. ASTHMA EXACERBATIONS, EMERGENCY ROOM VISITS, HOSPITALIZATIONS AND ABSENTEEISM WERE REDUCED BY 95%. 93.9% OF STUDENTS RETURNED TO THEIR CLASSROOM ON THE SAME DAY. STUDENTS WHO RECEIVED THERAPY FROM LICENSED CLINICAL SOCIAL WORKERS IMPROVED GPAS, REDUCED DAYS ABSENT, AND REDUCED DETENTION/SUSPENSION INCIDENTS. 85% OF STUDENTS WITH 4+ MENTAL HEALTH THERAPY VISITS REALIZED MEANINGFUL AND RELIABLE IMPROVEMENT ON THE CAFAS (CHILD AND ADOLESCENT FUNCTIONAL ASSESSMENT SCALE). 94.3% OF STUDENTS WITH 3+ CLINIC VISITS FOR ACUTE OR CHRONIC REASONS RECEIVE A BI-ANNUAL PHYSICAL. 18.4% OF STUDENTS AGE 4-11 AS WELL AS 6.8% OF STUDENTS AGE 12+ EXPERIENCED CARIES AT RECALL. HEALTHY PEOPLE 2020 CALLS FOR THE PROPORTION OF CHILDREN WITH ONE OR MORE CARIES TO BE NO MORE THAN 49% AND 48%, RESPECTIVELY. 97.1% OF CHILDREN AGED 6 TO 9 RECEIVED DENTAL SEALANTS ON ONE OR MORE OF THEIR PERMANENT FIRST MOLAR TEETH COMPARED TO THE HP 2020 TARGET OF 28.1%.

COMPOUNDED BY TEXAS' LACK OF MEDICAID EXPANSION, ARE PEOPLE WHO CANNOT AFFORD PRIVATE INSURANCE; WHO ARE ELIGIBLE BUT NOT ENROLLED IN GOVERNMENT SPONSORED PROGRAMS, AND WHO ARE RECENT OR UNDOCUMENTED IMMIGRANTS. A GROWING NUMBER OBTAIN THEIR HEALTH CARE IN ERS. A HOUSTON STUDY CONDUCTED BY THE UNIVERSITY OF TX SCHOOL OF PUBLIC HEALTH INDICATED THAT ROUGHLY 46% OF ER VISITS ARE USED FOR NON ER CONDITIONS. IN NOVEMBER, 2008, WHEN UNINSURED RATES FOR THE NATION AND THE HOUSTON AREA WERE 15% AND 32%, RESPECTIVELY, THE MEMORIAL HERMANN COMMUNITY BENEFIT CORPORATION LAUNCHED A PATIENT NAVIGATION PROGRAM TO ADDRESS PRIMARY CARE RELATED ER USE AT MEMORIAL HERMANN SOUTHWEST HOSPITAL. OVERALL OBJECTIVES WERE AND CONTINUE TO BE: (1) TO CONNECT PATIENTS WITH MEDICAL HOMES THAT ARE THE RIGHT LOCATION, THE RIGHT COST, THE RIGHT HOURS OF OPERATION, AND THE CORRECT SERVICES FOR EACH INDIVIDUAL; (2) TO REDUCE PRIMARY CARE RELATED ER USE; AND (3) TO REDUCE PRIMARY CARE RELATED COSTS, AT LEAST TO THE POINT OF COVERING THE COST OF THE PROGRAM. TODAY, ER NAVIGATORS ARE LOCATED IN MEMORIAL HERMANN HEALTH SYSTEM ERS. THE TARGET POPULATION CONSISTS OF UNINSURED INDIVIDUALS BETWEEN 18 MONTHS AND 64 YEARS, WHO UTILIZE THE ER FOR LOWER ACUITY CONDITIONS. THE STUDY DESIGN IS BASED ON PRE/POST DATA; AND THE INTERVENTION INCLUDES PATIENT NAVIGATION, CONDUCTED BY BI-LINGUAL, STATE CERTIFIED COMMUNITY HEALTH WORKERS (CHWS) TRAINED IN PEER-TO-PEER COUNSELING. DURING THE ER VISIT CHWS MEET WITH PATIENTS TO: EXPLORE ALL ACCESS ISSUES; ACCESS IS MORE THAN HAVING HEALTH INSURANCE; COACH ON HOW TO ACCESS HEALTHCARE AND COMMUNITY RESOURCES; AND, EDUCATE ON THE IMPORTANCE OF FINDING AND MAINTAINING A MEDICAL HOME. ALL PATIENTS LEAVE THE ER WITH SOME SORT OF FOLLOW-UP INSTRUCTIONS FROM THE MEDICAL TEAM--THE CHWS MAKE SURE THEY HAVE A PLACE TO GO. AFTER THE ER VISIT CHWS: FOLLOW UP WITH PATIENTS; USUALLY WITHIN ONE WEEK MONITOR/REVIEW/RESOLVE ONGOING PATIENT NEEDS AND CONTINUE TO FOLLOW-UP UNTIL THE CASE IS CLOSED. ESSENTIAL TO THE PROCESS IS CONTINUING TO BUILD RELATIONSHIPS WITH HOSPITAL STAFF AND COMMUNITY BASED ORGANIZATIONS. IN PARTNERSHIP WITH MEMORIAL HERMANN ER BUSINESS, CLINICAL AND CARE MANAGEMENT TEAMS, THE PROGRAM ANNUALLY NAVIGATES 16,200 PATIENTS. A 12-MONTH, PRE-POST ANALYSIS OF NAVIGATED PATIENTS RESULTED IN A 63% DECLINE IN ER VISITS. RESEARCH DATA INDICATES THAT SOCIAL DETERMINANTS OF HEALTH (SDOH) HAVE A PROFOUND IMPACT ON THE HEALTH STATUS OF INDIVIDUALS, AND IN ORDER TO IMPROVE POPULATION HEALTH, HEALTH CARE SYSTEMS WILL NEED TO CONSIDER ADDRESSING SDOH. THE ER NAVIGATION INCORPORATES FOOD INSECURITY SCREENING AND PANTRY/SNAP REFERRAL INTO THE NAVIGATION INTERVENTION PROCESS. TO FURTHER ALIGN EFFORTS OF ADDRESSING SOCIAL DETERMINANT ISSUES AND INCREASE THE OPPORTUNITY FOR OUR PROGRAM TO BUILD BRIDGES TO HEALTH CARE AND COMMUNITY RESOURCES WE ARE, ALONG WITH THE SCHOOL OF PUBLIC HEALTH AND TWO OTHER HEALTH SYSTEMS SCREENING AND REFERRING FOR SOCIAL DETERMINANTS OF HEALTH TO DETERMINE THE IMPACT THAT ADDRESSING SDOH HAS ON HEALTH STATUS THROUGH CMS' ACCOUNTABLE HEALTH COMMUNITIES. AND, MOST RECENTLY, A NEW MODEL FOR WORKING WITH PARTNERS ON MEDICAL/SOCIAL NEEDS IS OUR MEMORIAL HERMANN COMMUNITY RESOURCE CENTER AT SOUTHWEST AND GREATER HEIGHTS HOSPITALS. THE CENTERS ARE DESIGNED TO OFFER THE ER DEPARTMENT, ONSITE PHYSICIANS AND CARE MANAGERS, AS WELL AS COMMUNITY MEMBERS WITH: ACCESSING COMMUNITY RESOURCES, SOME OF WHICH WILL PROVIDE SCHEDULED SERVICES ON SITE; COMPLETING ELIGIBILITY APPLICATIONS; AND, RECEIVING INFORMATION AND EDUCATION ON PUBLIC HEALTH AND SOCIAL SERVICES. TO DATE, SPECIFIC SERVICES INCLUDE: ASSISTANCE ENROLLING IN PUBLIC HEALTH INSURANCE; APPLICATIONS FOR PUBLIC SOCIAL SERVICES (SNAP, WIC, ETC.); AND REFERRALS TO THE ONSITE PARTNERS THAT HAVE BEGUN TO PROVIDE WEEKLY SCHEDULES AT THE CENTER (HOUSTON FOOD BANK, AREA FEDERALLY QUALIFIED HEALTH CENTERS, AND CHRONIC DISEASE PRESCRIPTION ASSISTANCE). AS WE WORK WITH OUR CLIENTS AND COMMUNITY, WE ARE CONTINUALLY ASSESSING THE NEEDS AND OPPORTUNITIES FOR NEW PARTNERS. THE GOAL IS FOR COLLABORATION WITH PATIENTS, THE COMMUNITY, AND SERVICE PROVIDERS TO RESULT IN UPSTREAM FACTORS AND EFFORTS.