To kick-off the Community Health Champions program, President and CEO, Mike Geeslin presented a high-level overview of Central Health and it’s Enterprise affiliates. Senior Director of Eligibility, Kit Abney Spelce, gave a presentation about health coverage and eligibility where participants learned about coverage programs like the Medical Access Program (MAP) and MAP Basic. To take a deeper dive into the work and services provided by the Central Health Enterprise, Health Champions got a chance to speed date each entity. Last but not least, participants had the opportunity to tour the Central Health Southeast Health & Wellness Center to learn more about clinical services and community resources available.
Central Health is the local public entity that provides access to the high-quality care everyone needs to get well and stay healthy. The Central Health Enterprise is made up of the following entities that fulfill a specific role in our mission to improve the health of our community.
CommUnityCare Health Centers is a seperate but affiliated 501(C)(3) organization of Central Health that provides a wide range of medical, dental, behavioral, and prescription services through Travis County’s largest network of Federally Qualified Health Centers (FQHCs). In 2017, CommUnityCare provided 356,518 medical, behavioral health and dental encounters to 98,907 unique patients.
Sendero Health Plans is the local nonprofit, community-based health maintenance organization (HMO) of Central Health designed to serve the unique needs of Central Texas residents. By the end of 2019, Sendero will have provided over $550 million services to over 175,000 members of the community through more than 2.5 million encounters.
Presentation: Central Health Enterprise & Health Coverage 101
On Tuesday, September 17, the 2019 Community Health Champions met for Workshop II to learn about Health Care Outcomes. Dr. Alan Schalscha, Chief Medical Officer at CommUnityCare Health Centers, kicked-off the workshop with a presentation about Value Based Care. Historically, health care systems practice fee for service. In reality, higher productivity of providers does not necessarily correlate with better health outcomes. This is why CommUnityCare is currently working to change the fee for service model to a fee for value model. The transition of patient centered care to partnership of care ensures that all players are making informed decisions together. Not only does this improve the communication among medical team members but it also helps increase patient competency and self-management to ensure better health outcomes.
The second portion of the workshop was a panel discussion about health disparities identified in the 2017 Central Health Demographic Report. Every two years, Central Health produces this tool to assist all governmental, non-profit, and private entities serving Travis County’s safety net population. Details in the report include census tract-level analysis of:
- Families in poverty
- Health care providers
- Availability of public transportation
- Households without vehicles
- Availability of subsidized public housing
The panel discussion focused on 3 of the most prevalent health disparities in Travis County: HIV, Diabetes, and Behavioral Health. The panel was moderated by Central Health’s Director of Medical Management, Veronica Buitron-Camacho. Panelists included Louise Lynch (Integral Care), Brandon Wollerson (Kind Clinic), and Aida Garza (CommUnityCare Health Centers). Did you know?
- The prevalence of Schizophrenia Diagnosis in Asian (14.6%) and African Americans (14.3%) is significantly higher compared to Whites (6.1%)
- The prevalence of diabetes in African American (13%) and Hispanics (12%) is significantly higher than non-Hispanic Whites (6%)
- The rate of Black females living with an HIV diagnosis is 17.4 times that of White females
Although these statistics are only the tip of the iceberg when it comes to local health disparities, organizations like CommUnityCare, Integral Care, and the Kind Clinic are currently working to address them. For example, the Kind Clinic is improving their messaging and outreach efforts to reach diverse audiences when it comes to promoting PrEP and PEP. Their goal is to move away from the stereotype that only a single type of person is affected by HIV.
Recently, CommUnityCare (CUC) began a program that specifically identifies and targets diabetic/pre-diabetic patients to attend Saturday diabetes management classes and medical appointments. In addition, preventative care programming at the Central Health Southeast Health & Wellness Center, such as exercise and healthy cooking classes, are another way the CUC is empowering patients to take control of their health.
Integral Care has long-standing relationships with community partners to support access to behavioral health services, and improve the health of patients. For example, the Emerge Program is a collaboration with CommUnityCare in which behavioral health specialists act as consultants with primary care providers. This integrated care model also includes co-locations that house both Integral Care and CommUnityCare providers.
In October, Community Health Champions gathered at the Dell Medical School at the University of Texas at Austin for Workshop III: Quality of Care. One of our very own Health Champions, Edna Parra, kicked off the workshop with an introductory presentation to the Dell Medical School. The presentation covered things like the Health District map, unique aspects of the medical school curriculum, and the partnership between the Dell Medical School and Central Health.
The panel discussion was focused on quality of care, which encompasses the patient experience. The reason quality of care is important to discuss is because it is an indicator for health equity. The panel moderated by Vanessa Sweet, Central Health’s Strategy Manager, included representatives from each of the Federally Qualified Health Centers (FQHC) in Travis County: Lone Star Circle of Care, CommUnityCare, and People’s CommUnityClinic. The panelists had an in-depth conversation about quality of care and patient experience in each of the FQHC’s. As we know, language and cultural competency is a big barrier and challenge when it comes to high-quality patient experience. Experts also touched on other barriers such as the political climate and how this effects people’s willingness to go to the doctor, or even step out of the house. Elizabeth Marrero, Program Director of the Central Health Southeast Health & Wellness Center spoke about the process of how the heath center was designed to better help the community. Things like colors, numbers and building aesthetics were taken into account to address language barriers and way-finding.
Other things like the team-based care delivery model also enrich the patient experience. When a clinic can focus on the whole health of a patient and include all parties in the decision making process, patient health outcomes are better. Understanding the patient population, community data, and working to improve patient education and patient engagement is also highly important when an FQHC is looking to improve quality of care and daily operations. FQHC’s understand the challenges and barriers that come with caring for people of color. There is always room for improvement but these types of health centers are in fact, poised to meet the needs and reduce health care inequalities.
Community Health Champions gathered for their 4th workshop on Tuesday, November 12 at Integral Care Dove Springs in Southeast Austin. Workshop IV: Social Conditions covered topics like health care for the homeless and social determinants of health. Our partners at CommUnityCare, Dr. Audrey Kuang and Josh Rivera presented about the ways CommUnityCare (CUC) is addressing homeless health care. CUC currently operates a Mobile Team, Street Medicine Program and the Shelter Clinic at ARCH. Patients have resources and services such as acute care, prescriptions, case management, and financial screening. More recently, the Care Connections Clinic has been a great step in the right direction. Alongside Integral Care, ECHO, and Austin/Travis County EMS, CommUnityCare co-locates within the facility. The care team includes providers, medical assistant and registered nurse. This has become a one-stop shop for patients suffering homelessness, mental and behavioral health issues as well as substance abuse disorders.
During the second half of the workshop, panelists Sarah Cook (Central Health), Eli Covarrubias (Central Health) and Carmen Cardenas (CommUnityCare) discussed the ways in which Central Health and CommUnityCare are addressing social needs and conditions. As Health Champions learned at an earlier workshop, only 20 percent of an individual’s health is determined at the doctor’s office. The remaining 80 percent is determined by their environment at home, school and work – this 80 percent is what we call social conditions or in the policy world, social determinants of health. As the Travis County Healthcare District, by law Central Health’s role in addressing health outcomes falls within that 20 percent (meaning, we/Central Health can only affect what happens at the doctor’s office). So the question is how do we help?
A main theme throughout the conversation is that this line of work requires a shift in mentality and a lot of collaboration/partnership. Things being done within the Enterprise include care management teams, community health workers and Health Resource Assessments. Most importantly, it’s about asking comprehensive questions about social determinants of health and taking notes on how the patient describes their care. This serves as a catalyst for referring patients to care management and health workers. When we listen before assume a situation we want to fix, the outcomes is a lot better for everyone.
The 2019 Community Health Champions had their fifth and final workshop at the Central Health Administrative Offices on Tuesday, December 3. As a wrap-up to the program, this workshop focused on individual and group reflection activities and involvement opportunities beyond the program.
Central Health asked Health Champions to choose a workshop topic from the year (Access to Care, Health Care Outcomes, Quality of Care, and Social Conditions) and identify a need or concern then propose a thoughtful solution or intervention. They then broke out into small groups based on the workshop topic they chose and worked collaboratively to build an even stronger proposed solution. These worksheets will be incorporated into the new Alumni Association Committee (Health Equity Projects) where members will put each proposed solution through a feasibility test to identify which ones can be carried through to implementation within the Central Health Enterprise.
Community Health Champions also had the opportunity to learn about involvement opportunities beyond the program which include:
- Advisory Committees in Eastern Travis County
- Central Health Equity Policy Council
- Volunteering with the Outreach team
- Health Champions Alumni Association Committees
In addition to the opportunities listed above, Health Champions were able to hear from the Central Health Board Treasurer, Dr. Charles Bell. They learned about his professional background, experience serving on the Central Health Board, the application and interview process, and how day-to-day decisions are made among the full Board and Committees.
In general, when compared to other states, Texas has a higher proportion of small employers that are less likely to provide health insurance. That, coupled with a lean Medicaid program, results in Texas having one of the highest uninsured rates in the nation. With 18 percent of Travis County residents under 65 who are uninsured, Central Health has a pivotal role in addressing health inequities at the local level. On Feb. 15, the 1st Community Health Champions Workshop of the year took place at the Central Health Southeast Health & Wellness Center. The workshop was kicked off with an overview of Central Health and our Enterprise partners—CommUnityCare Health Centers, Sendero Health Plans, and the Community Care Collaborative (Central Health’s nonprofit partnership with Seton). Health Champions learned the history of Central Health and about Central Health today.
To lay the framework for the rest of the year, Health Champions listened to three presentations regarding health inequities in Travis County and the local region. Katie Coburn, Regional Healthcare Partnerships Manger at Central Health, presented findings from the 2017 Regional Health Care Partnership 7 Community Health Needs Assessment and discussed leading causes of mortality and major inequities seen in Central Texas—some of which include:
- Affordable Housing and Migration
- Economics and Health Disparities
- Chronic Conditions, Prenatal Care, Sexually Transmitted Infections
- Behavioral Health
- Accessibility of Health Care and Transportation
Dr. Jaeson Fournier, CEO of CommUnityCare Health Centers, went through a high-level overview of patient analytics and how this data informs services provided by CommUnityCare. The process of the CommUnityCare Community Health Needs Assessment looks at differences and disparities in:
- Prevention Quality
- Vital Statistics
- Clinical Indicators
- Available Resources
JP Eichmiller, Director of Strategic Communications at Central Health, presented the highlights from the 2017 Central Health Demographic Report. The presentation outlined health disparities in Travis County, where current patients live, where they are projected to move in the future, and identified focus areas in Travis County:
- Northeast Austin
- North Central Austin
- East Central Austin
- Colony Park/Hornsby Bend
- Southeast Austin
- South Austin
- Del Valle
You may find bios of the panelists here.
Central Health 101 by Ivan Davila
RHP 7 Community Health Needs Assessment by Katie Coburn
CommUnityCare Patient Analytics by Jaeson Fournier
Central Health 2017 Demographic Report by JP Eichmiller
Social Media Training by Ted Burton
On April 19, the Community Health Champions met for their second workshop of the year to discuss health care coverage and behavioral health disparities.
To kick off the workshop, Kit Abney Spelce, Senior Director of Eligibility Services at Central Health, talked about health coverage options and eligibility requirements. With options like the Medical Access Program and the Sliding Fee Scale program, Central Health helps uninsured Travis County residents get health care coverage. Community Health Champions participated in an interactive pop quiz, where they were given scenarios of individuals with certain income levels. Based on what they learned, they were tasked with choosing the health coverage option for which that individual was eligible.
Community Health Champions then participated in a panel discussion with Ellen Richards, Chief Strategy Officer, Integral Care; Dr. James Baker, Associate Chair of Clinical Integration and Services, Dell Medical School; and Dr. Alan Schalscha, Chief Medical Officer, CommUnityCare Health Centers.
Panelists discussed local initiatives related to disparities in behavioral and mental health like the E-Merge Program, which co-locates behavioral health services within a patient’s primary care medical home.
Downloadable handouts and presentations
Health Coverage 101 by Kit Abney Spelce
Workshop III took place on Thursday, June 21 at the Seton Administrative Offices. Dr. Mark Hernandez, Chief Medial Officer and Executive Vice President of the Community Care Collaborative (CCC) gave us an in-depth look at the work of the CCC. In only a few years, the CCC has moved the needle on having a fee-for-service system to the beginnings of a value-based-care system. In addition, Health Champions learned about the four strategic focus areas of the CCC:
- Build an Integrated Delivery System
- Redesign Coverage Programs
- Improve Value in Care
- Optimize Health Coverage Population
After learning about the CCC, the group heard from the following panelists on program and initiatives that focus on supporting those at risk of or living with diabetes in Travis County. From preventive cooking and Zumba classes, to diabetes management courses, these local agencies are committed to supporting people fight this chronic disease.
- Dr. Susan Dubois, Director of Endicronology, CommUnityCare Health Centers
- Elizabeth Marrero, Program Director, Central Health Southeast Health & Wellness Center
- Estephanie Olivares, Program Coordinator, Austin Public Health
- Sarah Sebton, Program Manager, Community Care Collaborative
Downloadable presentation and handouts:
On Thursday, August 16, the 2018 Health Champions met for their fourth workshop at the Dell Medical School Health Discovery Building. John Daige and Robin Richardson from the Dell Medical School kicked us off with a presentation about the history of the Dell Medical School at The University of Texas at Austin and the important partnership with Central Health. Health Champions also learned about the unique curriculum that has been built from the ground up as well as the purpose and success of UT Health Austin, the clinical practice of the Dell Medical School at UT.
Following a short coffee break, Health Champions listened to a rich and diverse panel discussion about women’s health. Clinical and social work experts joined the conversation to share what Travis County is doing to address disparities in women’s health. Michelle Rountree and Jennifer Johnson-Dungey shared their experience and success with the Black Mamas Community Collective; Dr. Becky Rogers spoke about the need for perinatal redesign in this community; and Dr. Amna Dermish spoke to the hopeful future of Planned Parenthood with upcoming leadership changes as well as the barriers and successes of the long acting reversible contraceptions (LARCs) currently being offered at Planned Parenthood and CommUnityCare Health Centers.
The fifth and final Community Health Champions workshop took place on Thursday, October 18 at the Central Health Administrative office. We dove right into discussion with Brandon Wollerson from CommUnityCare Health Centers who outlined the history and background of HIV disparities in Travis County.
Following the short overview of HIV disparities in Travis County, Brandon welcomed our panelists to take a deeper dive into community organizations, health centers and services, and patient experiences related to HIV/AIDS. Organizations represented were Kind Clinic, Center for Health Empowerment, Austin Public Health and AIDS Services of Austin.
Other partners like the Austin Public Health’s Akeshia Johnson-Smothers from Austin Public Health shared with us the most recent HIV win for the community. On Wednesday, June 20, 2018, Austin joined 96 other cities world-wide and became the 18th U.S. “Fast Track City” — a city which has signed the Paris Declaration to end the AIDS epidemic. The Fast Track cities initiative is focused on improving prevention, screening, linkage to care, retention and engagement, and ending the stigma. On the conversation of stigma, Dale Thele, 2017 Community Health Champion and HIV/AIDS Advocate shared his experience living with HIV and the stigma that goes along with it. Dale mentioned that “there are two types of stigma involving HIV diagnosis – one from healthy people projected on people living with HIV, the other, is the person diagnosed with HIV projected against themselves.”
Health Champions also learned about services available for the HIV community. CommUnityCare’s David Powell clinic is the largest provider of HIV health services in Central Texas, serving over 2,800 patients annually. In addition, Austin’s Kind Clinic provides sexual health services including PrEP and PEP access. PrEP (pre-exposure prophylaxis) is the daily pill that prevents HIV. PEP (post-exposure prophylaxis) is a medication that prevents HIV within 72 hours of exposure.
After a wonderful discussion on addressing disparities in HIV, Central Health President and CEO, Mike Geeslin talked to the Health Champions about Central Health’s FY 2018 accomplishments and a forecast of the work ahead of us in FY 2019. In 2018, Central Health focused on service expansion efforts, population health and social determinants and improving communications and engagement initiatives. In 2019, Central Health hopes to focus on Eastern Travis County Service Expansion, Sendero Health Plans, and the Downtown Campus (Brackenridge).