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

10

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”

11

Cardiovascular Protective Factors

EQUITY and ACCESS

12

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?

13

Interventions by SD ACH DomainClinical Community

Clinical-Community Linkages Policy/Systems/Environmental

Physical activity

29Wellbeing

42

Nutrition

30Healthy weight

25

Blood sugar

13Blood

pressure

19

Choles-terol

13

Smoking

8

Blood pressure

16Choles-

terol

14

Blood sugar

14Nutrition

16

Wellbeing

15Healthy weight

15

Physical activity

15

Smoking

7

Blood sugar

8

Nutrition

12

Wellbeing

17

Smoking

11

Blood pressure

10

Physical activity

11Choles-terol

7Healthy weight

8

Wellbeing

14

Blood pressure

4 Blood sugar

3

Healthy weight

5

Smoking

3

Nutrition

7Physical activity

7

Choles-terol

2

Clinical interventions

Behavioral interventions

Wellbeing interventions

14

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

Annual Number of Patients & Visits

29,81132,121

35,52437,782

40,288

44,57043,129

40,07441,317

44,661

47,866

0

10,000

20,000

30,000

40,000

50,000

60,000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

60% of Patients indicated best served in a language other than English in 2017

Total Unduplicated Patients

102,843

122,564

138,070

165,872174,430177,432

188,112

218,312

200,307

224,725

187,623

0

50,000

100,000

150,000

200,000

250,000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Total Visits

17

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

Microcredit Entrepreneurs – Catering & Handmade Items

Generations

Senior Job Trainees in Blossoms Social Enterprise

Microcredit Weekly Group

Culture and Healing through Art

Wellbeing in the Circle of Care

Social Determinants of Health

Social Determinants of Health

Social Determinants of Health

Jewish Family Service of San Diego

Purpose: Jewish Family Service is a client-centered, impact-driven organization working to build a stronger, healthier, more resilient San Diego.

• JFS services are designed and delivered to equip individuals and families across the lifespan with the building blocks to thrive.

• JFS does this by providing programs, services and advocacy focused on key social determinants of health that promote and sustain wellbeing.

Basic Needs & Stability

Economic Stability

Health & Safety

Community & Social

Theory of Change - Services

WINS:- Clear organization-wide Theory of

Change centered around Social Determinants of Health

- Contract with a health plan in Riverside County to provide housing and case management for individuals with significant barriers

- Engaged in promising conversations with Independent Physician Groups

Looking Forward….

OPPORTUNITIES:- Modify, improve “back of the house”

operations to support healthcare partnerships

- Continue to modify specific services to be more attractive to health plans (e.g. medically tailored meals)

- Continue conversations with health plans to explore how JFS services can support shared goals