Quote from McKinnon, Sr. Communications Manager on February 10, 2022, 8:45 am

Posted on behalf of Manager Cynthia Valadez.

Dear Board of Managers,

As we deliberate and review the staff and consultant work on the Strategic Systems of Care Planning leading to an “Equity-focused Service Delivery Strategic Plan” I am raising the following three points:

1. I have requested and continue to request that we have an overview of previous Central Health, Seton, and the CCC’s efforts from 2012 to to date to provide an integrated delivery health care system for uninsured and underinsured Travis County patients. The reason for this is that if CH had previously contracted to complete similar work (as was done with Navigant, now part of Guidehouse) then were the previous results and recommendations used in THIS effort to modify our Systems of Care using that collected data as a comparison/contrast to measure changes/disparities gaps?  The CCC was established as a new multi-provider, integrated delivery system that was launched in 2012.  According to documents, “the CCC was established to integrate safety net providers in Travis County in a “Accountable Care Organization (ACO)-like model where providers would come together to give high quality care to our patients especially the chronically ill. Patients would receive navigated, patient-centered care that was supposed to lead to better health outcomes, increased satisfaction with the system, efficient delivery of services, and lower costs. The focus of which was Central Health’s patient population chronic disease needs by developing critical infrastructure to support the CCC’s goal of providing an integrated delivery system”.  The CCC thus access federally available dollars, DSRIP, taxpayer monies and dollars provided by Seton to this venture.  My interest is to know what lessons were learned from the CCC’s $850 million investment from 2013 to 2021 into the development of the integrated delivery health care for relevance to our current planning efforts as we develop a new “Equity-focused Service Delivery Strategic Plan”?   Simply, what were the lessons learned and how was the then-current system improved via incorporated changes from those projects to the benefit of patients in an effective and efficient way?
2. Fast forward to the current project recommended to us by our CEO and the UT consultant to review the work to date on the development of an “Equity-focused Service Delivery Plan to build a comprehensive, high functioning health care system to improve the health of Central Health’s patients.” I have asked for the “equity lens/plan” that is being used to analyze the data/information being received and presented to us as BOM members.  I have not seen any validated equity measures being used in the proposed plan.  Effective equity measures require accurate and complete collection of key sociodemographic data (for example, race/ethnicity, language, educational attainment levels, income, and geography). If we do not know this, then how is it that systems can identify and act on disparities?   Data quality is critical to the development of appropriate policy incentives; and demographically appropriate (to OUR CH targeted population) patient engagement should be used to improve documentation based on data, not at random.   Central Health’s targeted patient population has higher levels of health care needs and costs because of disparities in healthcare quality and because of their inability to access healthcare as necessary for their improved quality of life.   If we are really talking about an Equity focused Service Delivery Plan, then we should have a solid understanding and documentation of disparities in outcomes; a review of proven interventions that can be effective in reducing disparities; and performance measures and assessment of gaps in measures that can be used to determine the extent to which stakeholders are utilizing those effective interventions to reduce disparities buy closing those gaps.   I would like to see these “Four I’s for Health Equity” (developed by equity experts) included in our plan.  These are:

 

• Identify and prioritize reducing health disparities
• Implement evidence-based interventions to reduce disparities
• Invest in the development and use of health equity performance measures
• Incentivize the reduction of health disparities and achievement of health equity

 

In addition to patient-level data, addressing disparities will require collecting neighborhood-level data on social risk factors to better understand the characteristics of the places in which people live, work, and play. The Equity Focused Service Delivery Plan should provide guidance for addressing a wide spectrum of disparities based on age, gender, income, race, ethnicity, nativity, language, sexual orientation, gender identity, disability, geographic location, educational attainment levels, and other social risk factors. It should emphasize the importance of cultural competence, demographically representative community engagement, and cross-sector partnerships to reduce disparities.  Data on social risk factors is limited and Central Health will need to partner with public health agencies to collect these data.  I haven’t seen any data on disparities and gaps in quality, access, and/or health outcomes between the group with the highest social risk factors and the group with the highest quality ratings for the measure.  I also have not seen the comparative breakdown of patient wait-times, per chronic illness and their demographic information, which would have also been an indication of whether CH/CUC was actually improving patient services.  It appears as if The Voice of the Community report did not assess data on social risk and equitable access to healthcare to advance health equity, as access is a key to understanding and analyzing disparities. The Community Health Needs Assessment does show gaps in healthcare workers’ accessibility to populations, and the report doesn’t address financial access and the need to continue to improve access to health insurance and ensure that premiums, deductibles, and co-pays do not create barriers to care.  Is Sendero included in the planning process to address the systemic improvements which can be implemented ‘In house”?

 

3. As stated before, this timeline is very aggressive. We are getting important reports a day or two before we are being asked to discuss in a board meeting. This is a multi-million, multi-year project and all questions should be welcomed, and the community should be able to weigh in on all of this planning work throughout the process. I do not believe that we should rush this project to meet someone’s timeline for the budget process.