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CCH Program Committee December 2015 Integrated Health – Dr. Cookson and Mary Lea Forington

December 10, 2015

CCH Program Committee on  Integrated Health  Mary Lea Forington  Operations Directorand Beth Cookson

 Program Committee meeting this Thursday, Oct.8 at 11:30 AM; the meeting location remains the same 2111 Champa ST, 2nd FLR Conference Room.  This month’s topic of discussion will include Rental Assistance.   

Tristzette Morton . Executive Assistant to John Parvensky, President . Colorado Coalition for the Homeless . 2111 Champa ST . Denver, CO 80205
T:303-312-9596 | f:303-293-2309 | * |

Brown, Jay” <>,
“” <>,

Evan Abbott, M.A., SPHR
Director, Organizational Development and Learning
Direct: 303.223.5339 | Mobile: 720.587.7563
MSEC, 1799 Pennsylvania Street, Denver CO 80203
Toll Free: 800.884.1328 | Office: 303.839.5177 |




charles – Jay   –   Daryl –  Mau  –  law school applications are where they were in the 70’s  

new chair of the Program Committee  few  people are attending this afternoon

Mandy May  Quality Assurance

Professor Commo  Viadia  nuevo de Chicago and Miami




Charles Savage


Jay Brown


Darryl Brown

Louise Boris  Program Officer


Dr. Cookson


Quality Data of Care Measures ANNUAL  REPORT  counting children who ONLY come to the Health Center

cervical cancer screening  80%  difficult to meet only 1 medical visit  PAP test  not desirable   struggle with 5 years  we have been running for 4 years.  They cannot count the results from other providers of services.  

CHILD AND ADOLESCENT  WEIGHT  CENSUS on the universe  weight assessment

another documentation  issue  we cannot correctly report the information

nutrition on exercise every child  –  Healthy PEOPLE  2020 performance improvement plan

David Otto  Medical Director – compared with other homeless providers



doing as well as healthcare grantees for homeless people 36%  –  80%  37.7 %


maximum that you are eligible to receive  HRSA  sets measurement and standards around the measurement.  Project Officer  Dave has adjusted some of this for the next three-year period.


HAVE THEY A CO-EFFICIENT on TRAUMA  a variable issue that skews  

Tobacco Cessation and drinking  reporting on the universe

asthma they meet expectations for outcomes

aspirin and other therapy they do what they have to to meet the standards


Colon rectal   cancer testing   they are struggling  22%  is average across the board  


Health Information Exchange  records from hospitals

colonoscopy  or  blood test cards  FOBT 


screening  and preventable measures how effective these measures are


hypertension and diabetes report outcomes


depression and no standard goals at this time


people have controlled blood pressure  controlled blood sugar levels




a lot of ask people want to know how traumatized  people are  extensive process  looking at different measures and circumstances


additional  HRSA measurements  these measures have changed  not relevant any longer





Carol is the dental care director


behavioral health care therapy primary care  patients who see all three care providers

Peer review is done on a quarterly basis


INTEGRATED CARE:  30,000′ view  Dr. Elizabeth Coookson


background   reports to Mary lea and Dave Otto  Joe Latto  Director of Medical Services


how services were structured:   all aspects of total health care  personnel are all in the same 4  suites.  change of the culture  – meeting primary health care and behavioral  referred to behavioral health  who don’t want primary care and who are reluctant to get primary care from anybody.  Structural barrier  Medicaid  system way it is set up regulations are rooted in how community health care centers are set up.  INTAKE may take a long time because of the Medicaid requirements for data and see a therapist for several visits.
Does not meet need for people who cannot keep appointments  creative tension that meets patient needs and desires  aware of financial constraints  – not billable as a psychiatrist as a physician  doing primary care.  


we are in the middle of a discussion about how to use medical coding to charge for procedures we are at the forefront in this  we do not know how long this will take


A LOT of patients simply want medications they do not want to talk.  many psychiatric care is psycho social care, vocational rehab and psychiatric care  we won’t treat you otherwise is not an option


LYON  operates with a required treatment for people  in a different  required treatment plan.


NURSE TRIAGE  was started in November  SYSTEM  getting people who say they simply want a certain intervention.  some , head scratching and wonderful outcomes  I got off the bus last week i have no medication   and they come in and get the person medication within 48 hours   BP is high and how about seeing a physician.


sleep apnea  comprehensive plans for their diabetes  goes to every consultation schedule seen every person who they are required to see the whole health care of the patient addressed.


start a program to drink  less manage their pain with less medications anxiety depression dealing with grief taking care of general health  improving the health of diabetic patients


looking at the whole person  –   many many staff were engaged.


chronic care management in medical side  construct involved and invested in patients  dealing with the crisis  persons get services from all arms of CCH    health literacy  investment across the board  


PODS  associated with prisons   SUITES are a better fit  –  really hard to do  historically different CULTURES  helping a primary care provider why we need staff meetings to discuss patients diagnosis changes three times,  go to other primary care  silo  issues,  some improvise some are more conflicted  time is an issue on many levels   staffing is concentrated.  


high incidence of psychiatric disorders behavioral long-term has much higher stability  we have less than required staffing on the medical  provider side. primary care physicians do espirt  analysis comprehensive screening and staffing


3  suites   staffing is a difficulty  we need



two more physicians   there is a demand for the fourth  suite


move more effectively with patient flow  plan for the fourth  suite.      


MAXIMUM   CAPACITY with peer navigators and case managers


fabulous feedback  how does it work  it is a system but it is a comforting place and place of care and compassion


every day is jam-packed  it is hard to plan  we could be close to this  triage plan has been going on for three weeks   1 million to open the suite  it requires a lot of personnel equipment  and make it work.  


70%  have Medicaid  not all services are not separately  paid for   that do not involve doctors


2016  reporting will improve  within one building we are managing three distinct practices


1 large practice  set up in 2011  much has been changing  since the initial operations  report writers  reporting quarterly.  Number for provider panels  difficult people working part-time.


billable stream of income

help from board  would come in a million +  dollars

schedule has to be kept open  scheduling a huge issue.   


different cultures scheduling appointments ahead of time and if people cancel appointments then what do you do?



Gillian  woks on scheduling   Thursdays is the least busy day and has the most staffing


ability to request  an appointment with a patient portal  they can miss fewer appointments   80%  medical show for appointments


flexibility  is key   big challenges  when do you make appointments when are MA’s free  medical appointments  when they are possible.  Maximize  health care operations meeting every Wednesday  all managing staff  high utilizer group  frequent flyers read missions  large group meeting all the time educate them all of the time.


tough with homeless people  a lot of the patients have access. lessons on how to use the portal  it is surprising how successful first stage of the care is working.


some health centers that we have throughout the region they can get their medical care and HOP


Homeless Outreach Program  is a specializes.  on going patient management


measure and address being effective and efficient  in     the  main center in  South Carolina,




dental director in 2 years   1,100  4ooo      –   2,400 8100 encounters in two dental areas   in  


eye clinic new  optomologists   see 1,000  patients annually


payment models – Pete Stoller  

medicare is how I am paying  for health care  all the nuances for each funding stream  makes a lot of differences


DRAGON  dictating software do you have what you need to do your job


they prolong our lives and make it possible for us to succeed.  Healthcare is a cumulative support system  


pharmacy system  has been astounding


Elizabeth  13 years  Mary Lea  came from C  

turn over rate  –  left health center  some staff have been there since the beginning   

burn over rate  –   medical staff  higher


compensation  is a lot less than for the larger medical and behavioral health care


write-up all of this  which is astounding

we experience that we benefit from  since the beginning  we have much to contribute on best practices


publishing on the model that is being used to understand the quality of care that is offered.

need to do all of the research   who can accomplish this  and get these papers published?


more evaluation INTERNS in the Department  Partnership Opportunities that we have to get support in writing and research


cultural competency Council  second Thursday in January  2016  Suzie  
















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