RHIP COUNCIL No November 17, 17, 2020 2020 Meeting Objectives - PowerPoint PPT Presentation

RHIP COUNCIL No November 17, 17, 2020 2020

Meeting Objectives • Det eter ermine n e next s steps eps f for r equ equity wo work rk • He Hear ar key ey upd pdates es r rel elated t to He Heal althConnect an and Trueblo lood od • Provi vide ad advi vice an e and f feed eedback

Approve Minutes and Review Applications • Ap Approv ove m minutes fr from om Se Septe tember 2020 r 2020 RHIP IP Cou ouncil l Meet eeting • Revie iew N New w RHIP P Counc uncil il M Member Applic ications

Equity Growth Next Steps

HealthConnect

HealthConnect Hub Evaluation November 2020 RHIP Council

Overview • Overall evaluation • HealthConnect Hub evaluation activities • Results

Overall Evaluation Five interconnected activities: 1. HealthConnect Hub: Understanding how the Hub impacts client health and wellbeing 2. Community Connections: Understanding how individuals interact with different sectors (housing, health care, education, criminal-legal system) 3. HHIP Evaluation: Understanding the impact of housing on health care utilization 4. Partner Evaluation: Understanding the experiences and viewpoints of SWACH’s partner organizations 5. Workforce Evaluation: Understanding the experiences and viewpoints of frontline staff in clinical and community based organizations in the region

HealthConnect Hub Evaluation Activities for the evaluation presented in this report: 1. HealthConnect Hub: Collecting data from HUB, its programs, & its clients. 2. Partner Evaluation: Collecting data from the systems partners you are working with. 3. Workforce Evaluation: Collecting data from the people who work in your partner orgs.

Results

HealthConnect Hub: Enrollment Cumulative client enrollment per month Average CHW caseload per month over time 250 20 200 15 150 10 100 5 50 0 0 F M A M J J A S O N D J F M A M J J F M A M J J A S O N D J F M A M J J 2019 2020 2019 2020

HealthConnect Hub: Demographics Age (years) Gender 18 - 25 12% Female 51% 25-45 47% Male 47% 45-65 36% <5% Transgender 65+ <5% Missing <5% Missing <5%

HealthConnect Hub: Demographics Race Ethnicity AI/AN 4% Not Hispanic/ 68% Latino Black 4% White 74% Hispanic/ 4% Latino Multiracial 3% Other 3% Missing 28% Missing 13%

HealthConnect Hub: Health Physical and Behavioral Health Conditions Anxiety disorder 58% Self-reported health: Depression 58% Addictions/Substance abuse 44% • 40% in good health PTSD 35% Chronic Pain 35% • 80% multiple chronic Tobacco abuse 31% Alcohol abuse/Withdrawal 22% conditions ADHD 21% Bipolar disorder 20% • 59% co-occurring physical & Vision loss or impairment 19% Arthritis 19% behavioral health conditions Hypertension 17% Mood disorder 13% • 52% use tobacco Panic disorder 13% Asthma 12% • 25% use alcohol Diabetes Type II 12% Hepatitis C 12% Hearing loss or impairment 10% • 29% use other substances Movement impairment 8% Other Chronic Condition 12%

HealthConnect Hub: Health Care • Only 20% had a medical home • Nearly 20% reported the ED was their usual source of care • Over 50% indicated needing a family doctor

HealthConnect Hub: Health Care ED Visits in Prior Year Hospital Visits in Prior Year 0 41% 0 64.8% 1 16% 1-3 14.8% 2-5 25% 4+ 9.5% 6+ 6% Missing 0% Missing 13%

HealthConnect Hub: Housing • 38% homeless • 60% housing concern in prior year • 65% family crisis in prior year • 30% safety concern in the home

HealthConnect Hub: Social Needs Top social needs identified Housing 59% Transportation 58% Food 46% Clothing 44% Legal 38% Medications 26% Utilities 18% Childcare 8%

HealthConnect Hub: Complexity Percent of clients with each need who also had: Health condition ED visit in prior year Housing need 96% 51% Transportation need 97% 50% Food need 96% 52% Clothing need 97% 56% Legal need 99% 54% Medications need 97% 59% Utilities need 96% 54% Childcare need 97% 48%

HealthConnect Hub: Pathways Most commonly opened and closed complete pathways Opened Pathways Closed Complete % Closed Complete Education 2233 1892 84.7% Social Service Referral 2149 678 31.5% Medical Referral 454 160 35.2% Tobacco Cessation 213 0 0.0% Medication Assessment 198 41 20.7% Medical Home 189 61 32.3% Behavioral Health 160 41 25.6% Housing 154 38 24.7% Employment 110 15 13.6% Health Insurance 65 13 20.0% Adult Learning 46 7 15.2% Family Planning 10 3 30.0% Medication Management 7 3 42.9% Developmental Referral 6 6 100.0% Pregnancy 4 1 25.0% Lead 1 0 0.0% Postpartum 1 0 0.0% Overall 6000 2959 49.3%

HealthConnect Workforce Focus Group Being able to coordinate the care of the client and all be working on the same page to offer services would be amazing. Pathways is a good tool …. and I hope to see it rolled out to other agencies in Clark County. It could be a one stop hub for resources that everyone could access . My own sense of belonging to a more holistic care team has been empowering and invigorating.

Questions?

www.providenceoregon.org/CORE

Jane S e Smith th's 's S Story

Pathways Utilization, Expanding Programs Launching in April 2019, HealthConnect The he He Heal althC hConnect M Model continues t to a add dd partners a and d HUB and Pathways has supported program pr ams tha hat c connect t thr hrough the H HUB UB: 356 P 356 Particip ipants • Community Paramedicine • 5383 5383 of 7736 7736 Pathwa ways c closed ( d (~70% 70%) • (CCFR) Clie ients-per-Pa Pathway u use • Health Homes (AAADSW) • 1. Social Service Referrals (99%) Q&I Hotel (CCPH/DCS) • 2. Education (81%) 3. Smoking Cessation (65%) CDSME (WSU-Extension) • 4. Medical Referrals (60%) CarePort HUB (CPAA) 5. Medical Home (55%) • 6. Housing (44%) Opioid Treatment Network • 7. Behavioral Health (40%) (PeaceHealth/ Lifeline 8. Medication Assessment (38%) Connections)

HealthConnect HUB Infrastructure "Care Traffic Control"

Looking Ahead Stabilizing Crisis, Building Resilience, Supporting Health Equity: The HUB Makes it Happen Studies underscore the enormous value of CHWs and PPs, an often overlooked, usually underutilized, yet highly versatile health workforce, as powerful health equity change agents. https://www.familiesusa.org/wp-content/uploads/2019/11/HEV_PCORI-CHW-Report_11-04-19.pdf COVID CARE Equity Capacitation Effort: The COVID CARE opportunity supports equity focused workforce development funding - bringing on trusted CHW representatives of marginalized communities to connect Community Care Coordination and COVID Care.

Trueblood

Definition of Terms • Compete tenc ncy: M Menta ntal c capacit ity o of an indiv ivid idua ual t to partic ticip ipate i in, an and b be e res espo ponsible f for, leg egal al pr proceed edings o or r transactions. • Compete tenc ncy r restoratio tion: A process o of treatm tment nt, e educatio tion, n, a and sup upport to to a assis ist th those f found inc incompetent to to sta tand tr tria ial ( (IST). Thi his p proce ocesses i is intended t to le o lead t d to t o the he i indi dividuals t to be o be adju djudicated com competent t to p o proce oceed. d. • Forensic ic: R Relati ting ng t to cour urts ts o of law or investig tigatio tion a and establis ishment o nt of facts ts i in a cour urt o t of law. • Clas ass m mem embers rs: Those wh e who f fal all u under a r a group af affec ected ed b by a a cla class-actio ion l n lawsuit uit.

Overview of the Trueblood Case • Tru rueblood ood et t al. al. v v. Was ashi hington on S Sta tate D Depar artment of of Social Soc al H Healt alth Se h Serv rvices (T (Tru rueblood ood) • Nam amed af afte ter a attor torney C Cas assie Tru ruebl bloo ood, ‘ ‘next fri friend’ of A. of A.B. • A.B. i is ab abbrevi eviation f for r repr epres esen ented pl plai aintiff • Class M Members in in this is c case are ind indiv ivid iduals d detained in city ty an and c d cou ounty ty jai jails ls aw awai aiting c com ompete tency serv rvices • The he cas ase challe hallenged u uncon onsti titution onal de l dela lays i in com ompete tency e evalu aluation on an and r d restor toration on References: Various HCA Publications, Trueblood Court Documents, and https://www.dshs.wa.gov/bha/trueblood-et-al-v-washington-state-dshs

Phased Implementation • Phas ase O e One (2019-2021): S Southwes west, S Spo pokane, an and P Pier erce Regio ions f focus used i implement ntatio tion • At reg egional i impl plem ementation, t the f e followi wing el elem emen ents wi will b be e ad addres essed ed: • Compete tenc ncy E Evalua uatio tion • Compete tenc ncy R Resto toratio tion • Cri risis Tri riag age an e and D Divers version S Supp pports ( (ups pstream s supp pport) • Educatio tion n and T Training ining • Work rkforce D e Devel evelopment