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Montefiore Medical Center Case Study: The low-income people are more in need of proper care as they are uninsured due to poor financial stability. The Montefiore Medical Center is involved in treating the low-income patients. This medical center is in New York city and its mission is promote and provide best healthcare services to the chronic illness patients. It is involved in serving the people of the Bronx and Westchester County where most of the people are suffering with various chronic illness and are uninsured. The objectives of the Montefiore Medical Center are ambulatory and primary care strategies for chronic diseases management, high care quality access, integration of care with the technology, and inpatient and outpatient data integration problems. Its vision is to enrich transformation by providing best care services irrespective of diversity and providing equal care to all. The challenges being faced are patient and payer mix financial problem, sustainability, and integration difficulties of technologies. It serves the people by technology data integration; its redesign help provide the best care and access extension irrespective of the traditional designs. The extension is with various governments, neighborhoods, schools, etc. in the improvement of healthcare services to the vulnerable populations. The medical center is involved in providing full spectrum of services to the sick population irrespective of payer mix and attracting the physicians to provide proper care. The implementation of Clinical Looking Glass technology (CLG) provides the ambulatory care with the physician clinical intervention to enhance the provider-patient communication for best care. Interpreting Services Program: One of the most common problems being faced by the American people is hearing loss and nearly 47 million Americans do not speak English. This program is being involved in promoting the health and disease prevention for deaf, blind, Limited English Proficient (LEP) patients and family members. It is involved in studying cause of the hearing loss (considers both cultural and medical) and find the alternate support services by auxiliary aids and interpreting services with the mandate from both the Federal and State governments under the Montefiore policy. Montefiore policy: It provides the patient and family centered care with the framed standards of Montefiore policy. Hospital Policy: It is the responsibility of the hospital staff to provide free auxiliary aids to the deaf patients or any family member of the Patient who is deaf and these responses must be documented. Resources Provided to assist the Deaf people: teletypewriter, closed captioning, communards, deaf talk -pocket talker. Gaps identified: 1. Limited English Proficient. Efforts to overcome the Gaps Identified: By customer service (different languages), Dual Handset Phones and Splitters and provide training for Medical Interpreters. Role of Interpreter: The main role of the Interpreter is to speak directly with the patient and explain the medical procedures, medication, treatment therapies and proving mental support to the patient. It is important to inform the patient about the usage of the interpreting services with all the necessary documents required for the patient’s assistance. Hence, this “Interpreting Services Program” helps the patients by providing free auxiliary aids and overcomes the gap by the help of medical interpreters with proper documents. Case Study High-Performing Health Care Organization • March 2009 The mission of The Commonwealth Fund is to promote a high performance health care system. The Fund carries out this mandate by supporting independent research on health care issues and making grants to improve health care practice and policy. Support for this research was provided by The Commonwealth Fund. The views presented here are those of the author and not necessarily those of The Commonwealth Fund or its directors, officers, or staff. For more information about this study, please contact: Deborah Chase, M.P.A. Issues Research, Inc.
[email protected] To learn more about new publications when they become available, visit the Fund's Web site and register to receive e-mail alerts. Commonwealth Fund pub. 1448 Vol. 53 Montefiore Medical Center: Integrated Care Delivery for Vulnerable Populations Deborah Chase, M.P.a. Issues researCh, InC. ABSTRACT: Montefiore Medical Center, an academic medical center in New York City, has created an integrated system of care for its primarily low-income patients. This patient- centered system of hospitals, community clinics, and school-based clinics uses innovative practices for managing chronic disease, provides access to high-quality specialty hospital care, and employs targeted care management and robust health information technology in support of integrated care. Although close to 80 percent of its payer mix is Medicaid and Medicare, Montefiore has been able to achieve financial and organizational sustain- ability. Factors that contribute to this success include: care management that allows for integration across the system; building successful primary care that combines traditional and new models; and medical systems that focus on population health and community accountability. OVERVIEW The health care safety net serves a critical role in ensuring that America’s most vulnerable populations—those with low incomes and those without health insurance—receive both emergency and ongoing care. According to the Institute of Medicine (IOM), however, there is a growing disparity between high-performing, economically successful safety-net providers and the larger group of struggling systems.1 The IOM has also cited a need for increased fed- eral tracking of the changes in the health care safety net.2 To address this gap, The Commonwealth Fund has increased its efforts to study the safety net to identify examples of high-performing systems and to offer a broader look at emerging strategies for delivering, financing, and managing care for vulnerable populations.3 This case study describes how Montefiore Medical Center, a not-for- profit academic medical center in the Bronx borough of New York City, has cre- ated a patient-centered system of care that tailors its access, delivery, and infor- Case Study Integrated Safety-Net Health Care System • October 2010 2 The CoMMonwealTh FunD mation systems to the unique needs of the primarily low-income, vulnerable populations it serves. In recent years, the medical center has sharpened its focus on the needs of the community and the patient and redou- bled its emphasis on performance improvement. At the same time, Montefiore has achieved financial stability. These achievements have been realized in a commu- nity where one of four adults is uninsured, most patients have low incomes and complex needs, and insurance coverage is predominantly through Medicaid and Medicare (which together make up more than 75 percent of system revenues). Specifically, the innova- tions undertaken by Montefiore: • focus on better management of chronic diseases through ambulatory and primary care strategies that extend access to multiple points in the com- munity; • provide access to high-quality specialty and hospi- tal care; and • create greater integration of care delivery through the application of targeted care management and robust health information technology. It is hoped that the insights offered in this case study will be useful to safety-net systems, aca- demic medical centers, and other stakeholders as they struggle to deliver and finance care for vulnerable populations. MONTEFIORE’S COMMUNITY, STRUCTURE, AND ORGANIZATION Established in 1884 as a hospital for patients with chronic illnesses, most notably tuberculosis, Montefiore Medical Center serves 500,000 residents of the Bronx and adjacent Westchester County. The Bronx is one of the poorest urban counties in the nation, where one-quarter of the adult population is uninsured and carry the burdens of disease associated with poverty: obesity, hypertension, cardiovascular disease, asthma, hepatitis C, and HIV. More than 400,000 of the Bronx’s approximately 1.4 million resi- dents are children, almost half of all residents identify themselves as Latino/Hispanic, and nearly 36 percent identify themselves as African American (Exhibit 1). In addition, hundreds of thousands of undocumented persons live in the borough. As evident in its stated mission, vision, and values, Montefiore addresses the intense challenges Exhibit 1. Selected Population Characteristics for the Bronx and New York City Indicator Bronx New York City Poor or fair health Low birthweight Teen birth rate (per 1,000) Uninsured adults Children in poverty Single-parent households Black or African American Hispanic or Latino Disabled Speak language other than English at home Median family income Families below poverty level 27% 9.6% 52 25.6% 38% 23% 35.6% 48.4% 28.4% 52.7% $30,682 28% 16% 8.0% 28 19% 20% 10% 15.6% 16.4% 11.2% 28.9% $50,643 14.2% Sources: County Health Rankings, Snapshot 2010: Bronx, http://www.countyhealthrankings.org/new-york/bronx. U.S. Census Bureau, American FactFinder, http://factfinder.census.gov. MonTeFIore MeDICal CenTer: InTegraTeD Care DelIvery For vulnerable PoPulaTIons 3 faced by its patient population through a commitment to patient-centered care that meets the access challenges and social needs of vulnerable populations. Although Montefiore’s size makes innovation and integration difficult, it also gives the system the power to reach thousands of patients. The system includes four hospitals, with a total of 1,491 beds: Henry and Lucy Moses Division (620 beds); Jack D. Weiler Hospital and Albert Einstein College of Medicine (396 beds); Children’s Hospital of Montefiore (106 beds); and North Division, acquired in 2007 (369 beds). These four hospitals account for 86,500 inpatient discharges, 301,000 emergency department visits, and 7,100 births annually. Montefiore also includes 21 community-based primary care clinics (including five federally qualified health centers) that are located throughout the borough and provide 830,000 visits annually; 17 school-based clinics that provide medical, mental health, and dental services, with a total of 65,000 annual visits to 40 schools (many schools, particularly high schools, are clustered at the same site); and a care management organization with 150,000 enrollees in capitated contracts that provide a fixed payment per enrollee. Exhibit 2 provides a map showing the location, type, and penetration of Montefiore services in the Bronx and Westchester County. Montefiore employs 17,382 staff, including 3,070 nurses, 1,625 physicians, and 1,200 medical residents and fellows. There are an additional 1,000 voluntary (independent, community-based) physicians on staff. The health system employs the faculty of Albert Einstein College of Medicine, who practice, teach, and conduct research. The Albert Einstein College of Medicine, founded with a commitment to biomedical science, education, and social justice, has been affiliated with Montefiore since 1967. In 2009, a new 10-year affiliation agreement was signed between Montefiore and the medical school, with the goal of creating an institutional partnership that aligns teaching and research efforts. Given the poor and