Frontiers of Health Services Management - Spring 2014 - (Page 14)

to move from part-time volunteer clinics to full-time clinics with employed physicians. This move significantly increased the number of patients served in both communities. The board of trustees also committed funding for Baylor and HTPN to open new clinics on the Baylor hospital campuses in Garland (BCC-Garland) and Fort Worth (BCC-Fort Worth) and to expand the partnership with Irving Interfaith Clinic. The Garland and Fort Worth clinics became operational in 2010. In southern Dallas, Baylor opened the Diabetes Health & Well[We hope to encourage] ness Institute (DHWI) in 2010, an innovative other healthcare organizations and providers model designed to improve diabetes care through to join the push for a more healthcare, education, and equitable healthcare system research. DHWI focuses on prevention and treatfor the United States. ment and offers a wealth of programs, ranging from exercise and healthy eating classes to a weekly farmer's market where local residents can access healthy fruits and vegetables. Additionally, DHWI has a full-time primary care clinic located at the center, adding to the BCC network. By the end of 2010, the BCC program had grown to seven primary care sites and an annual budget of $5 million. During this time of growth, the BCC was busy developing a number of supportive programs to improve the effectiveness of the community care strategy. In 2009, the Merck Company Foundation awarded the OHE a $2 million grant to replicate a successful diabetes education program originally developed and operated at the Central Dallas Ministries clinic. The program used specially trained and certified community health workers (CHWs) to provide culturally competent, one-on-one self-management education to uninsured diabetics. The grant spread the program to four additional clinic sites. Evaluations of the program consistently demonstrated its ability to improve blood glucose control and other important clinical metrics for enrolled patients. CHWs played another critical role in Baylor's community care strategy. The BCC team hired and deployed CHWs to several hospital campuses to improve transitional care for patients referred from hospitals to BCC clinics. This effort was the result of poor connection rates caused by patients simply being told by hospital staff to contact the clinic for follow-up care. Using that method, approximately 25 percent of referred patients attended a confirmed appointment with a BCC clinic provider. Today, more than 70 percent of eligible referred patients have a confirmed appointment within 14 days of hospital discharge when navigated by the community care navigation team. Baylor's experience with CHWs has proven to be a cost-effective and culturally competent strategy, and it solidified CHWs as critical members of the multidisciplinary care team responsible for underserved patients. In 2012, the Medicaid UPL program concluded and was replaced by the Medicaid 1115 Waiver program. The 1115 Waiver, along with the recent passage of the Patient Protection and Affordable Care Act, brought significant change and a level of uncertainty about funding for programs such as BCC, DHWI, and PAD. The 1115 Waiver introduced increased accountability for hospitals while giving them incentives to build and expand infrastructure for underserved populations in order to qualify for funding. As Baylor and other hospitals in the Dallas-Fort Worth area planned for implementation of the 1115 Waiver, priorities for funding shifted. Hospitals increasingly looked to build and expand internal programming, ultimately leading to the closure of the countywide PAD program. 1 4 * f ro ntier s o f h ea lt h s e rvic e s m a na g e me nt 30 :3

Table of Contents for the Digital Edition of Frontiers of Health Services Management - Spring 2014

Frontiers of Health Services Management - Spring 2014
Contents
Editorial
Baylor Health Care System’s Journey to Provide Equitable Care
In Pursuit of High-Value Healthcare: The Case for Improving Quality and Acheiving Equity in a Time of Healthcare Transformation
Ending Healthcare Disparities: An Urgent Priority and a Growing Possibility
Expanding the Evidence Base for Health Equity
A Historical Perspective on Disparities as Context for Our Work Ahead

Frontiers of Health Services Management - Spring 2014