In part 1 of this three-part series, we looked at the factors involved in the exceptional environment of collaboration among healthcare stakeholders in San Diego. In this article, we will look at some of the elements around efforts to advance population health management and care management initiatives in the San Diego metro area.
When it comes to managing the health of populations, the San Diego metro market has some advantages and some disadvantages. Not to be discounted is a fundamental advantage: the climate, which is one of the best in the continental United States, with 146 days of sunshine a year, making it the eighth-sunniest major U.S. city by one calculation, and temperatures that hover around 70 degrees year-round, with low humidity—a perfect climate for outdoor activities and personal fitness. Yet that very advantage is also inextricably connected with offsets and disadvantages. For one thing, the near-perfect climate also means that San Diego County has a very large homeless population of more than 9,000 individuals, with many more who teeter on the edge of homelessness. And that large homeless count has made the task of combating its recent and ongoing hepatitis A outbreak that much more difficult, as the disease has been spreading rapidly among its homeless population in downtown San Diego.
Meanwhile, San Diego’s beneficent climate has also attracted seniors from all over, and the county has an over-65 population of more than 11 percent (not among the highest senior populations in the country—some communities in Florida are more than 30-percent senior-age now—but still large). And the size of that senior population has helped to spur innovation in the Medicare Advantage market and to encourage the development of ACOs (accountable care organizations) both under the aegis of the Centers for Medicare and Medicare Services (CMS)/Medicare and that of private health plans.
Care management’s challenges and opportunities in an advanced market
All of this inevitably leads to discussions of population health management and care management. And the challenges are many, says Vicki DeBaca, R.N., vice president of health and provider services, at Sharp Rees-Stealy Medical Centers, the 500-physician employed medical group that is a component of the integrated Sharp health system. Looking at the issues, DeBaca says, those facing the leaders of Sharp Rees-Stealy and San Diego healthcare leaders are essentially the same as those across the U.S. healthcare system. “What I find when I participate in conferences,” she says, “is that the issues are all pretty similar. I don’t know that our market has giant differences in this area. You have the uninsured, you have the complex population, the patients who aren’t really actively engaged in their care. It’s really similar everywhere.”
What is different, DeBaca says, partly because of the geographic separation between the San Diego and Los Angeles metro healthcare markets, is that things have evolved forward somewhat differently in San Diego versus across the Los Angeles basin, with the San Diego market having evolved forward into and through capitated payment on a broader scale, and for a longer time. “We’ve been a highly capitated market for some time, unlike the case in Los Angeles,” she says. “So I think over time, the organizations in San Diego, because they’ve had a bit more flexibility with the dollars, have been able to focus and decide on how best to spend those dollars. So we might fund special diabetes programs, or special end-of-life programs, we have flexibility in terms of how we utilize resources.”
And health information exchange, as facilitated by San Diego Health Connect, has clearly been a part of that equation, DeBaca says. “Many of my staff use it,” she says, referring to the HIE’s capability. “Ad our providers have a link within the EHR [electronic health record], and are able to go right into the EHR to find that information. And members of my staff, who are largely case managers, can access that information as well. It’s been excellent in terms of getting patients connected back to their primary care physicians after ED visits and hospitalizations. And the goal of our care managers is really to support the patients, in whatever they need.” So, she says, the continuous loop of information and data has proven to be very important in advancing case and care management.
And in that, DeBaca says, “The goal of our care managers is really to support the patients, whatever they need. So their effort is to follow up with the patients; if they have a chronic illness—and their participation is voluntary—the care managers work with them. Largely, it’s explanatory, in helping support the patients, reminding them to get their lab checks or respond to questions about diet; referring them to services they might need, or around diet, or social services.”
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