1	Community Partnership for Patient Activation Santa Cruz Experience Wells Shoemaker MD September 29, 2008
2	3 Messages, Thinking 2015 Flogging the “usual suspects,” the delivery system, will help for diabetes and heart disease… and we will keep it up…but only help a little bit. (HEDIS is a narrow view.) Public Health thinking and customized, broad community initiatives are essential. Patient activation is the key to the garden… and we can turn it
3	Bumper Sticker Wisdom Think Globally Act Locally …and…Get all the help you can!
4	DIABETES PYRAMID
5	Primary Care Workforce Crisis New entrants now << 50% of 1995 New kids can’t buy houses here Leaving CA—hassles, regulations, no “life.” …and seeking niches if they stay. Overwhelmed with “WYODI’s”—impossible Disaffected, to say it politely Think FTE’s, not “heads”—they’re getting gray, part time; we’re in deep trouble
6	What can be done? Expand capacity of each doctor—practice redesign, teams, community supports, information systems, outreach Respond to reimbursement disparity, including novel payment for chronic care Improve job satisfaction and personal life balance—delete stupid time waste
7	Think Local: Santa Cruz County Small county with natural geographic boundaries. Mix: urban, residential, ag Population 260,000, fairly stable Microcosm of Pacific Coast demographics, with ethnic clusters University & Junior College Liberal politics Both collaboration and friction Severe PCP recruitment handicaps
8	Two Grass Roots Collaboratives Health Improvement Partnership—Executives of all health “Usual Suspects” Regional Diabetes Collaborative—”Worker Bees” in diabetes care, education, advocacy Diabetes Health Center
9	Patient engagement resources Diabetes Health Center—non-profit, local, ethnically attuned, community engaged… and struggling for nickels and dimes Hospital based programs “pt education” Group & clinic-based programs Entrepreneurial programs “if you got the money, honey, I got the time”
10	What can Plans do to help? Participate in regional collaboratives Seek and pay for local patient activation services that work Flexibility in criteria for vendors Protect these in limited benefit products Openness to novel chronic care reimbursement strategies
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13	Santa Cruz background Following slides for background—not likely time for presentation 9/29
14	Health Improvement Partnership Executive representation, monthly meetings: Public Health Dept & HSA 3 hospitals 2 private sector medical groups The Alliance—Medi-Cal managed care Hospital staffs & Medical Society ERs 3 Community Foundations Cabrillo Junior College
15	HIP: Cross-Cutting Targets Healthy Kids launch ER Frequent Users Program Diabetes Program support Students & health professions Electronic connectivity Area 99 injustice Community forums & “United Nations” Grant magnet
16	Regional Diabetes Collaborative Santa Cruz, Monterey, San Benito Counties 800,000 people total 7% diabetes prevalence à 50,000 + “Worker bee” professionals from Public health, medical groups, Comm Clinics, Alliance Hospitals (7) diabetes education staff Diabetes Health Center—non profit, ethnic ++ Advocacy organizations & Seniors CA Diabetes Program Cal State Monterey Bay, Cabrillo, UCSC
17	Three Thrusts of RDC Clinical Care Improvement Patient education…morph to self- management support, culturally appropriate, community focused Public information and Policy And liaison with related organizations, i.e. Pediatric Obesity, CCCN
18	RDC Activities Quarterly general meetings—best practices, education, networking Annual conference Health fairs Multiple local engagements Lawmaker outreach Public information & speakers AHRQ grant conduit 2004-7 Amplifier of messages
19	Highlights HIP adopted diabetes formal goal 2003 IOM Presentation 2004 AHRQ grant Registry project 2004-7 Annual tri-county diabetes forum with “hot” speakers, lots of pub, political push Expansion, solidification of RDC Coordination with others Still playing catch-up
20	Take Home Local resources potentially powerful Can reach further than “medical” alone Bake sale economics to start Grant funding appealing but can be disruptive High degree of customization needed Leadership cultivation required Costs real $ to launch and maintain Easy to fall back to silo thinking