april 8, 2014 better health. one connection at a time. healthleadsusa.org health leads 1
TRANSCRIPT
APRIL 8, 2014
Better Health.One Connection at a Time.
healthleadsusa.org 1
HEALTH LEADS
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Health Leads envisions a healthcare system that
addresses all patients’ basic resource needs as a standard part of quality care
OUR VISION
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THE PROCESSPATIENT-CENTRIC, CLOSED LOOP
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SIMPLE SCREENING TOOLPAPER-BASED TODAY
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EMR SCREENSHOTJOHNS HOPKINS CHILDREN'S HOSPITAL- EPIC
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SIMPLE CATEGORIZATION OF NEEDS
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COMMUNITY RESOURCES MATCH NEED CATEGORIES
RESOURCES MEETING CLIENT CRITERIA + HISTORY OF SUCCESS
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RESOURCE REFERRAL TRACKINGSPECIFIC RESOURCES FOR EACH NEED IDENTIFIED
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MANAGEMENT REPORTSOVERVIEW OF ACTIVITY BY DESK OR CLINIC
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SAMPLE REPORT: CLIENT NEEDSCATEGORIZATION OF NEEDS OPENED
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SAMPLE REPORT: NEED RESOLUTIONHOW DID WE DO?
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• Helped 11,000+ clients, representing nearly 43,000 household members
• 20+ clinics across 6 cities• Top 5 categories of needs
• Child-Related (16%)• Housing (14%)• Employment (13%)• Food (12%)• Utilities (12%)
• Met at least one need for 60% of our clients• Almost 1000 college student Advocates from 14 universities
HEALTH LEADS 2013PROGRAM HIGHLIGHTS
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Executive Champions are Essential Workflow Matters Timing Matters
KEY LESSONS
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Engage leaders who Have already identified SDOH as a critical part of quality
care Are willing to commit financial resources toward
identifying, tracking and solving patient’s basic resource needs
Have the authority to prioritize the resources needed to be successful• Physician, Clinic Staff, IT and Legal
EXECUTIVE CHAMPIONS
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The screening and referral process must be sustainable• Measure it. How many patients screened positive? How
many of those screens are documented in the EMR? • The target starting population must be easily identifiable• Ex/ Screening patients between the ages of 5-10 with asthma
and who are at risk for obesity is complicated to identify Start small- learn from a sub-set of the patient panel• Universal screening sounds great, until you are
overwhelmed by patient needs surfaced Pay attention to the details• Where are screening forms kept? Who prints patient
labels?
WORKFLOW MATTERS
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Take advantage of EMR implementations or upgrades• This is a time where process change is already happening, and
budget is often available for minor changes Be aware of budget cycles• Arm clinic leadership advocating for this work with data at
budget time Do not wait for EMR changes to start building a
process to identify needs• Building credibility in screening for needs and addressing
them will help clinic champions advocate for changes at budget time
TIMING MATTERS
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Health Leads envisions a healthcare system that
addresses all patients’ basic resource needs as a standard part of quality care
THANK YOU