BUILDING A BUSINESS MODEL AROUND THE SOCIAL DETERMINANTS OF HEALTH PANELISTS: KITTY BAILEY, EXECUTIVE DIRECTOR, BE THERE SAN DIEGO MICHAEL HOPKINS, CEO, JEWISH FAMILY SERVICES ZARA MARSELIAN, CEO, LA MAESTRA Presented at the State of Reform Conference San Diego 11.28.18
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BUILDING A BUSINESS MODEL AROUND THE SOCIAL …...building a business model around the social determinants of health panelists: kitty bailey, executive director, be there san diego
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BUILDING A BUSINESS MODEL AROUND THE SOCIAL DETERMINANTS OF HEALTHPANELISTS:KITTY BAILEY, EXECUTIVE DIRECTOR, BE THERE SAN DIEGOMICHAEL HOPKINS, CEO, JEWISH FAMILY SERVICESZARA MARSELIAN, CEO, LA MAESTRA
Presented at the State of Reform Conference
San Diego
11.28.18
California Accountable Communities for Health Initiative
ACH Model
COORDINATED AND LINKED
COLLECTIVE ACTION
COMMUNITY ENGAGEMENT
healthy and vibrant community
Delivering Health for the
Community
Shared vision
and goals
Gover-nance
(partners & leadership)
Resident Engage-
ment
Back-bone
organi-zation
Data analytics
and sharing capacity
Wellness Fund & Sustain-ability
Portfolio of inter-ventions
Equity
Essential Elements
Parallel play Coordinated and aligned
Many unrelated Limited number outcomes of common outcomes
Silo’ed/Singular Systems thinkingfocus
FROM TO
What is a Portfolio of Mutually Reinforcing Interventions?
Sustainability Plan
Wellness Fund
Describes the value proposition, overall strategy and potential funding mechanisms to support two goals:
• Sustain the ACH infrastructure, including backbone organization and joint ACH functions, such as data sharing
• Fund the gaps identified in the Portfolio of Interventions: start new interventions for which there isn’t funding and spread and scale existing interventions, in order to enhance reach and depth
Vehicle (structure) for bringing together various public and private funding and resources
Wellness Fund &Sustainability Plan
Wellness Fund
FUNDPublic and
Private Contributions
GrantsSocial Impact
Investing
Corporate Support
Sustain infra-structure & backbone
Fill gapsin portfolio
of interventions
Blending & Braiding
Jointinvestments
e.g. data, campaigns
ACH
Gov
erna
nce
Portf
olio
of I
nter
vent
ions
Accountability
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San Diego’s ACHSD ACH Mission:To create a “wellness system” that ensures individuals, families, and communities in San Diego have access to all they need to create a lifetime of health and wellness.
SD ACH Vision:Health, wellness and equity for all of our communities, regardless of zip code.
SD ACH Values:Equity, Inclusivity, Neutrality, Accountability
SD ACH “Headlines” for 2020:“Zip Codes No Longer Predict Life Expectancy in
San Diego”“ACH Initiative has Eradicated Heart Attacks in
San Diego”“SDACH is Connecting the Dots and Touching
Hearts!”“San Diego Community Reclaims Their Overall
Well Being through ACH”
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Cardiovascular Protective Factors
EQUITY and ACCESS
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What Works?• Community Health Workers• Medical Legal Services• Entitlement Assistance• Food prescriptions w. Linkages• Volunteer Transportation Support• Vouchers for Gas and Transit• Appropriate linkages to Behavioral
Health and SUD treatment• Home based perinatal interventions• Addressing substandard housing• Faith based interventions• Pathways Community HUB model
• Health literacy programs• Linkages to housing services and
support• Supports for physical activity and safe
spaces• Coordination with community
pharmacists• Home interventions for asthma• Lifestyle classes, walking clubs• School based & Worksite
interventions for wellness• Support for interpersonal violence• Community screening events
But, can we align, coordinate and link these efforts to strengthen impact and create definable value?
Age-Adjusted AMI Hospitalization Rates by Year and Period for San Diego County and the Rest of California
110
120
130
140
150
160
170
180
190
200
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Hosp
italiz
atio
ns (p
er 1
00,0
00 re
side
nts)
California San Diego
Early post-BTSD Late post-BTSDPre-BTSD
One in Five Fewer Heart Attacks: Impact, Savings and Sustainability in San Diego County Collaborative, Health Affairs, September 2018Authors: Allen Fremont, Alice Y. Kim, Katherine Bailey, Hattie Rees Hanley, Christine Thorne, R. James Dudl, Robert M. Kaplan, Stephen M. Shortell, and Anthony N. DeMaria
2011 – 2016 Acute MI Hospitalizations Avoided: 3,8262011 – 2016 Cost Savings: $85.8 Million
Be There San Diego: Creating a Heart Attack and Stroke Free Zone
Key Clinical Partners:• Kaiser Permanente • La Maestra Health Center• Neighborhood Health Center• North County Health Services• San Diego Health Connect• San Ysidro Health Center• Scripps Clinic Medical Group• Scripps Coastal Medical
Group• Sharp Community Medical
Group• Sharp Rees Stealy Medical
Group• University of California San
Diego • Vista Community ClinicKey Community Partners:• AHA• County of San Diego, HHSA• SD Promotoras Coalition• United African American
Ministerial Action Council and 22 Partner Faith Based Organizations
• SD Pharmacy Coalition
La Maestra Circle of Care™ Addressing Social Determinants of Health through Outreach &
Integration of Services
Presented by: Zara Marselian
About La MaestraOur Mission: “To provide quality healthcare and education, improve the overall well-being of the family, bringing the underserved, ethnically diverse communities into the mainstream of our society, through a caring, effective, culturally and linguistically competent manner, respecting the dignity of all patients.”
History: Clinic formed in 1990 under La Maestra Amnesty Center. The need for culturally competent healthcare was identified by Student Council representing over 12,000 students who participated in legal residency and citizenship programs, ESL, VESL, job training at LMAC.
First Clinic, opened 1990 LEED Certified Gold Health Center, opened 2010
2017 Patient Demographicso At least 66% of Patients earned at or below 100% Federal Poverty Level
o 21% of Patients Uninsured, 77% have Medicaid or Medicare
o At least 60% of Patients preferred a language other than English
o 60% of patients were Female
o 3.8% of patients (1,866) were Homeless
66%
10%
2%
Income as % of Federal Poverty Level
<100%FPL
101-200%FPL
>200%FPL
21.8%
73.4%
3.2% 1.6%Patient Insurance
Uninsured
Medicaid
Medicare
PrivateInsurance
La Maestra Circle of Care™
Network goes beyond the field of medicine, bringing greater resources to our patients in the Circle of CareNew Skills, Independence, Self-Esteem, Helping and Teaching
Others, Working in Healing Environments
o Healthy Choices Food Pantry and nutrition education, eligibility assistance for CalFRESH (SNAP), Medi-Cal, energy bill discounts
o Supermarket Challenge
o Urban Community Gardens
o Exercise – Zumba, Yoga, Walking Clubs
Community Garden & Healthy Cooking ClassesFood Pantry
Wellbeing in the Circle of Care
Zumba
Comprando Rico y Sano
o Economic Empowerment:• Microcredit Program for Women • Blossoms - Flower Shop Social Enterprise • LM Printing - Print Shop Social Enterprise • Microenterprise Assistance• Job Skills Training and Placement
o Supportive Housing for those in Recovery /Re-entryo Help with Affordable Housingo Generations - Youth and Intergenerationalo Culture and Healing through Art Program