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Here is an excerpt from an interview with Irene Kaufmann, Executive Director of the Bronx Partnership for Healthy Communities (BPHC). BPHC is comprised of more than 200 community-based organizations, including SBH Health System and Montefiore Medical Center, and helps implement and manage the New York State DSRIP Program.
DSRIP offers us the opportunity to transform the delivery of healthcare in the Bronx by changing our focus and by changing what people in the healthcare system do – it’s about making deep changes, something that’s very difficult to accomplish. With its focus on wellness, health promotion and prevention, DSRIP will bring a new view of what a community healthcare provider is and how that provider’s care can successfully integrate with other community services.
We are confident we will achieve our goals for two reasons: First, because SBH leadership strongly believes in this change and is sitting behind the wheel to help drive it. Senior management understands that these changes will benefit not only the SBH organization, but the community itself. Second, we can accomplish this transformation because of our size. Being lean allows us to be nimble, and to implement new ideas more quickly, and perhaps more successfully, than larger healthcare systems.
There is a palpable sense of energy and potential around BPHC that I don’t sense when I meet with other Performing Provider Systems (PPS). But while we’re very eager and enthusiastic, big change can also be a very scary thing. We are about to enter this new world and, understandably, there is some anxiety about what it all means. It comes at a time when we are learning how to embrace partnership with two very different types of partners: our patients and our community.
The Patient
Healthcare transformation requires a great deal of patient participation. Here’s one example. There is a requirement now for creating patient care plans, but rather than physicians telling a patient what they should want, it’s incumbent on the patient to express his or her own health goals. This level of empowerment recognizes the patient as a true partner. We’re simply a supporting character in helping them reach their goals.
What does this mean on a practical level? In the case of a patient with diabetes, the physician might have once said, “My plan is to lower your A1C.” The patient may be able to relate to that. Yet, if creating her own care plan, she is more likely to say, “My goal is to be able to go to my daughter’s wedding this summer and I want to wear that nice dress. So tell me how can I do that?”
That’s a very different way of looking at wellness, a very different motivational factor. The clinician and care team need to look at a health goal the way the patient expresses it. This changes the dynamic and puts the patient in charge of where the care plan is going and why.
Our Community
In the past, we invited community organizations to come to the table and participate with us – to be members of committees we run. That’s changed. Now, as more care and wellness services move into the community they’re voice and leadership is critical and they’re coming to the table as co-chairs and as leads. This means that now we learn to work with them as partners who are not subservient to our cause because they’re smaller and/or not clinical.
Presently, we’re involved in a health literacy initiative with our community organizations. When you speak to people in healthcare they acknowledge that these organizations have a cultural competency that serves the community better than we can. They’re better attuned, they speak the language, and they provide niche services effectively to specific community populations. Instead of pulling cultural competency from them into hospital programs, it seems to make more sense to build on the competency they already have and support them to educate our community to better navigate the healthcare system and get the most out of available services.
We’ve seen a disconnect between our changing system and our community’s expectations of care. Who’s educating our community about the new care system being built? Well, we’ve stepped to the plate and started to collaborate with our community organizations on ways to educate and prepare their clients to access and make better use of redesigned services. The idea is to educate before individuals are in a time of crisis and need, and provide them with guidance at a time when they’re more relaxed and can absorb information better.
We’re teaching community organizations about basic health literacy and the navigation skills their clients will need in this new environment. This includes answering the questions: What’s a primary care provider? Why do you need one? When do you use a primary care provider as opposed to one who provides urgent or emergency care? Before patients need a care plan, they should understand what it looks like, what information it includes and how they can use it. Maybe the first time somebody sees a care plan shouldn’t be when they’re in front of a physician.
We’re also working to engage provider organizations in our PPS in a logical sequence – starting with primary care, then following with behavioral health and social services and finally with long-term care and home care providers – and helping to support them as they adopt and implement evidenced based processes and workflows that can help standardize care across the PPS, improve quality and forge more robust connections between organizations. While DSRIP offers us opportunities to integrate and improve patient care, it also helps us to support these linkages with more efficient information sharing tools and processes which will help people collaborate better within and across partner organizations. It’s a journey that will take time, but one that we believe will certainly be worth the effort.
Steve Clark