Memorial Hermann Community Benefit Corporation

Programs: 4a. Addressing the need for a "medical home" for the uninsured and underinsured, mhcbc partners with five school districts, houston--the largest in texas, pasadena, lamar consolidated, alief and aldine for its health centers for schools program designed to provide a "medical home" for uninsured children and a secondary access point for insured children, grades k-12th. The health centers provide primary healthcare, mental healthcare, nutritional care and dental care to medically underserved, at-risk children. The program began in 1996 with two school-based health centers servicing three schools. Today, memorial hermann operates health centers on-site at ten campuses in the greater houston area providing access to healthcare for students at 72 schools. "feeder" patterns are accommodated, making it possible for a child to receive continuity of care from pre-kindergarten through twelfth grade. While medicaid eligible services are billed, all services are provided at no cost to families. The health centers for schools operate monday through friday, 7:30 am to 4:00 pm, 12 months a year. The primary goal of the health centers for schools program is to bring increased health care to children who will otherwise not obtain it and to keep children healthy and in school so they can learn the skills they will need for a brighter future. 56% of the children served at the clinics do not have any type of healthcare coverage. 30% have some form of medicaid. The remaining 14% are children who will not obtain healthcare due to transportation issues, working parents unable to afford a day off, high private insurance deductibles or simply a lack of parental involvement. More than 93% of students served through the program are on the free/reduced lunch program, and 31% are more comfortable speaking, reading and writing in a language other than english. The scope of services offered includes immunizations, general and sports physicals, acute, chronic and minor injury care, mental health therapy, social service counseling and referrals, health education, and nutritional guidance as well as other specific care to meet students' needs. Staffing at each center consists of a nurse practitioner, licensed clinical social worker, lvn and a receptionist, with medical oversight provided by a family practitioner. Two dietitian and certified community health workers rotate among the ten centers. The dietitians deliver the healthy eating and lifestyles program (help) designed to educate health centers for schools' students and their families on the importance of proper nutrition and exercise. The program is intensive and individual, meeting the student and family where they are on the "stage of change" continuum. The three mobile dental clinic vans rotate among the health centers for schools and are staffed by a dentist and one to two dental assistants. The vans provide services that include periodic oral examinations, diagnostic x-rays, prophylaxis, fluoride treatments, oral hygiene instructions, sealants, composite fillings, extractions, stainless steel crowns, and pulpotomies. This program has served as a "dental home" to uninsured students since 2000. The memorial hermann health centers for schools program is continually evolving and in 2016-17, complementing memorial hermanns initiative to screen patients for food insecurity, the school-based health centers have been a collaborative partner with the houston food banks scholarship pantry at sharpstown high school, the build health challenge food prescription (fvrx) program in north pasadena, and wholesome waves fruit and vegetable prescription program throughout the houston region. Each venture has been an opportunity to provide access to healthy food to food insecure families. Food insecurity contributes to unhealthy eating habits and obesity. To complement the dietitians nutritional guidance and the healthy food collaboratives underway, the happy (healthy attitudes promoting positive youth) boot camp for students meeting bmi requirements was piloted in 2015 and continues to be refined. Each camp day includes a medical evaluation with the lvn and mid-level provider, 1-hour of exercise with a certified fitness instructor, a 45 minute nutrition consultation with a registered dietitian and a 45 minute group counseling session with a licensed clinical social worker. The curriculum is designed to promote a healthy lifestyle through guided practice. An evidenced-based program, memorialhermann health centers for schools benchmarks are derived from the national association of school based health centers, pre/post data, and healthy people 2020. Outcomes in 2017 include: 4. 7% of health center students used an er for primary care purposes versus 10. 5% of the general primary care pediatric community. Asthma exacerbations, emergency room visits and hospitalizations were reduced by 91. 3%. 92. 1% of students returned to their classroom on the same day. Students who received therapy from licensed clinical social workers improved gpas, reduced days absent, and reduced detention/suspension incidents. 78. 5% of students with 3+ clinic visits for acute or chronic reasons receive a bi-annual physical. 6. 5% of students age 4-11 as well as students age 12+ experienced caries at recall. Healthy people 2020 calls for the proportion of children with one or more caries to be no more than 49% and 48%, respectively. 90. 2% of students age 6-9 and 92. 9% of students age 13 to 15 received sealants. Healthy people 2020 requires sealant placement to be 28. 1% and 21. 9%, respectively.

4b. Compounded by texas lack of medicaid expansion, are people who cannot afford private insurance; who are eligible but not enrolled in government sponsored programs, and who are recent or undocumented immigrants. A growing number obtain their health care in ers. A houston study conducted by the university of tx school of public health indicated that roughly 46% of er visits are used for non er conditions. In november, 2008, when uninsured rates for the nation and the houston area were 15% and 32%, respectively, the memorial hermann community benefit corporation launched a patient navigation program to address primary care related er use at memorial hermann southwest hospital. Overall objectives were and continue to be: (1) to connect patients with medical homes that are the right location, the right cost, the right hours of operation, and the correct services for each individual; (2) to reduce primary care related er use; and (3) to reduce primary care related costs, at least to the point of covering the cost of the program. Today, er navigators are located in texas medical center, southwest, greater heights, southeast, northeast, memorial city, sugar land and pearland ers. The target population consists of uninsured individuals between 18 months and 64 years, who utilize the er for lower acuity conditions. The study design is based on pre/post data; and the intervention includes patient navigation, conducted by bi-lingual, state certified community health workers (chws) trained in peer-to-peer counseling. During the er visit chws meet with patients to: explore all access issues; access is more than having health insurance coach on how to access healthcare and community resources educate on the importance of finding and maintaining a medical home; all patients leave the er with some sort of follow-up instructions from the medical team--the chws make sure they have a place to go. After the er visit chws: follow up with patients; usually within one week monitor/review/resolve ongoing patient needs continue to follow-up until the case is closed. Essential to the process is continuing to build relationships with hospital staff and community based organizations. In partnership with memorial hermann er business, clinical and care management teams, the program annually navigates 16,200 patients. A 12-month, pre-post analysis of navigated patients resulted in a 74% decline in er visits. The savings associated with reducing primary care related er visits are greater than the costs to implement the er navigation program. Research data indicates that social determinants of health (sdoh) have a profound impact on the health status of individuals, and in order to improve population health, health care systems will need to consider addressing sdoh. The er navigation program began addressing sdoh in fy 16 incorporating food insecurity screening into the navigation intervention process and learned that nearly 20% of patients screened were found to have food insecurities. With large numbers of memorial hermann patients subsequently referred to area food pantries, the program is giving back to the food pantries, churches and libraries through community health and outreach initiatives that include health literacy, expectations of primary care providfers, and diabetic care education. To further align efforts of addressing social determinant issues and increase the opportunity for our program to build bridges to health care and community resources, community-based care coordination services are being piloted with a focus on screening, referrals, community service navigation, and community partner alignment for sdoh needs falling in one of four categories: food insecurity, housing, transportation and utilities. Both of these initiatives, community outreach and care coordination provide innovation opportunities while also enhancing population health.

4c. According to an emergency department use study, published in june 2013 and conducted by the university of texas school of public health, 46% of all patients treated and released from emergency rooms in houston were treated for primary care related illnesses or injuries. Based on this data which represents a consistent trend, the memorial hermann health system nurse triage center dba the nurse health line was established and designed to improve access to care and ensure more efficient use of the emergency rooms in harris and the surrounding counties. The study highlights the need for patient education about appropriate emergency department use. Healthcare consumers are uncertain about where and when to go for treatment. The medicaid 1115 waiver dsrip program allowed memorial hermann to launch and operate a 24-hour nurse triage call center to assist patients with their level of care decisions. The goal of the program is to be a regional resource that houstonians can call to discuss their health concerns, receive recommendations on the appropriate setting for care, and connect to appropriate resources. The call center is staffed with registered nurses and chws 24/7 and is available to callers, free of charge, regardless of insurance status, language, physician alignment or hospital affiliation. Callers with questions or concerns regarding medical conditions are encouraged to call and get help from a registered nurse who provides nurse triage, health education/information, suggestions on the urgency of the need for treatment and the appropriate level of care. Patients are often given discharge instructions (from hospitals, clinics, surgery centers, and doctors' offices) to contact the nurse health line for assistance with medical concerns post-discharge. Conversely, callers are referred to ers, urgent care centers, clinics, or their physician for follow up in accordance with the appropriate treatment setting needed. Patients are also referred to pharmacies, poison control hotlines, dentists, and mental health hotlines/facilities. The fy17 data shows that: 92% of the triage line callers followed the advice of the nurse and 55% that would have sought care in an er setting were redirected to urgent care, primary care or home care. The 24/7 call center is a credible and available resource for assistance with medical concerns and questions. The call volume for fy17 was 76,705. The service is promoted through electronic ads (i. E. Google, citygrid, facebook, yellow pages), health fairs, university wellness events, and an affiliation with the houston fire department, united way and harris health (the county health system)s ask my nurse advice line. Of patients served in 2017: 24% were medicaid or medicaid-medicare dual eligible and 30% were uninsured or underinsured; 97% rated the service as excellent or good; and 99% would use the service again.