AHF ACA Workshop: Dr. Baig, Clinicas de Salud del Pueblo

two other things that I missed on the housekeeping please turn off your phones in the bottom so that we don’t have interruptions and when we’re my hair when you have we’re not going to be having questions they quite a bit about to say and I’m missing the boat right now we’re not going to be having questions from now on because we run away so they panel at the end but what we do have them after the the rest of the speakers make sure you speak loud enough so that everyone in the back can hear you we don’t have a mic here and we’re recording this so that if anybody wants to marches afterwards it’s going to be on our website but again most importantly because there’s other people in the room that want to hear the question or maybe you want office expansion so if you ask it please just be plowing up when you do it and i will ask up our presenters to if you privateer that there’s kind of a tsunami volume to this region is repeat the questions from the audience can hear okay all right now we’re moving on our next presenter is dr. bag and this is our clinical sample equipment Thunder bag has been working it is in the key medical our intentions 1999 she is responsible for oversight planning and development of political operations such as a health care plan risk management I’ll disparity collaborative and emergency preparedness with a separate program really cuz i said well i mean i can’t think of anybody being here today that’s not familiar with so they are the safety net of comparability County so dr. ave is going to present the clinical perspective and probably in a lot of people’s minds it’s like we’ve been hearing the population that is not going to be covered which are the ones that have been less than five years california resident have been less than five years of the in the country and we need to know what we need to inform them when they come up with these questions a where do i go where do I fit and I think it’s a give us a little edge play a critical role in providing services to the population so please let’s give dr. day of warm welcome thank you and I really have to appreciate the area and her are my vision for their as well as broad and hodgkin and putting this thing together because as you have realized over the years yourself over a year at that we’ve been talking about health care reform yeah it is a sweeping reform and and not is not just a terminal serious serious changes that are taking place and they actually happened in response to the realization that that america spends a lot of money on the provision of healthcare we spend a lot of money in honor on our health care but the outcomes are not what we want we actually have poor outcomes than a lot of other countries that would be considered developed or in between category as every 96 america so having said that I think that that is one of the major motivations that let make changes of that made us realize that something had to be done and obviously whenever change happens it is not very comfortable people are used to the status code and you are utilizing services in a certain way and they may not like it but that’s what they know and it’s just easier to live with it health centers actually overall so I’m just going to give a brief overview of us community health center that’s what Tamika so that my charge in this presentation once to kind of like tied together health care reform and the role of Beverly qualified health center like him because the saloon and other entities that are charged to provide care to the underserved will play and having said that the realization did happen over the last few years that community clinics had a very important role to play in this actually the Carini clinics were started out as a response to the needs of the underserved clinica de salud started in point in raleigh in 1970 as it is gone to the farm workers movement realizing that there was not enough care or access to care for the indigent patients so and all the ports of these for deeds plus years that we have been in existence we actually have provided care to patients in Imperial County and riverside county

so we have grown from one center to 11 centers so as you can see that that the mandate is to bring everybody on board that did not have access to care or limited access to care so that you have been iced drunk from Robins of presentation and now we are going to see how it is that we are going to provide that care so again I mean I i think this forum is very good for you to educate yourself you will not have all the information yourself but Robin handed out our resources list so at the places patient education that we as a group can provide is telling them where to go for the exact information because you and I will not have all the resources or all that information that they carry on because as you can see from my from my presentation at they go on it’s very complicated and I don’t think all of us have have our own responsibilities as my responsibilities are the delivery of clinical care in our in our facility and that’s what I know best but as long as I know in a pitch and I realize that the patient means help I can refer them to different agencies that have that’s their all there’s their expertise so community clinics Veronica’s we address health disparities we address racial ethnic we know that there are this a lot of literature again going back to why this change was important is that the health care outcomes and what that means is that if somebody has diabetes and they have limited resources to reveal chances are that they are going to be sicker they might end up in the hospital more they might end up in vision or blindness they might end up having amputations at a higher rate compared to somebody that has a reasonable access to hear so basically that’s what we are talking about when we say improving healthcare outcomes I’m not going to say that the light is going to be perfect but if you have this need then my charge is to improve the quality of life that you have and learn or have resources to take care of whatever condition it is particularly so this is just to say you know that under the the Affordable Care Act the health centers are going to see a big increase because and again the understanding is at El Robin was talking about increasing the Medicaid population is we have been traditionally the ones that have been taking care of this population we need other providers to step up to the plate and that’s what the California Health & a group as well as Molina is going to be doing to try to increase and we are also working on increasing our capacity to make sure that its new population or this additional people that are going to be coming into the system will have adequate resources to go to little bit about the money that is going into the system a lot of it as I said you know united states of america spends a lot of money on health care but hopefully this started this targeted focused expense is going to generate the crispy the results that you’re looking at right now the money is going into the system or being sent or being spent on health care but we are not getting the results that we’re looking for so that’s that’s basically what what this slide is supposed to tell you is that you know they’re putting in like 9.5 billion dollars into healthcare operations republic and the understanding is that the health care centers are the ones that are going to be providing the majority of the access or trying to improve the patient care overall this is also the the it’s all graduated some things that have have happen as you know as you heard before that they this the act was actually implement was actually written into law few years ago in 2010 then it was upheld by the Supreme in 2012 so it’s an ongoing process and again I mean that is I think the charge for all of us to keep going to H our selves because when the pitchers come in we have to have a little bit of knowledge one of the important things

that I would want against all numbers all money that is gone into the system so you know just just FYI touch but what I would really want for you for you as you are talking to people is to emphasize that the partnership with the patients get the families is what’s going to actually make this whole thing work and i can say that as as a doctor that is if I have a family working with me trying to understand what I’m trying to convey to them and being an equal partner we are going to have the results at you looking for a lot of times I mean so if somebody gave me an example and I think that was very much feeding that on an average patient goes to see their doctor or us of 3.5 times in a year so on an average they are spending an hour hour and a half two hours with their health care providers the rest of the time they are on their own and that’s what determines the outcome what I do as a doctor in my two hours of contact over the period of a whole year may have a lot of value but the sustaining of my advice or the personal responsibility of the patient and the family is once going to ultimately determine the outcome okay and end to me at the doctor I can’t repeat that enough I mean that is something that I really want us to tell our patients that the system is being set up the infrastructure is being set up so that you will have all the support that the system can give you okay but in order to have this thing work it has to be a partnership so very good actually open up a new access to the center last December and it’s called growing up in Access Center and that was done in response to the association of inappropriate conversation of emergency not every emergency room visit is an emergency visit so that was after-hours access that was one of the barriers to care patients needed care when they need it here you know I mean I’m a pediatrician so I’ll say constipation irit but these are not emergency room visits but the kid is is is uncomfortable or other child is in pain I want her to try to be taken care of now so in response to that need we actually applied and in our finding and we offered opening of the Royal open access center which is provides immediate care and primary care so we took both immediate care meaning that we will fast-track patients depending on the need but sometimes we have patients that have chronic diseases and because we have now we have electronic health records we can see their needs across the clinics they don’t have to be going to give particulars and excite we can see what their needs are and try to address them when they are there then even with a mytouch hummingbird for a cold or other here also this is just to say all the other things that are being done to expand access to care use for based clinics are being offered and there are other agencies that are taking advantage other other entities in Riverside counties that are actually going into schools and to reduce school based health centers to take to take the health care to the patients make it easier for them this is something again I mean you can see it be a part of the Council of community clinics and also I know recently to 11 program has come into the country in Perry County via in the process of partnering and so this slide was actually taken from a presentation that the council and the 2 11 people in San Diego put together so this is what I mean when I say we can’t have all this information I can just say that different people different groups of people depending on their where they fall according to their income and resources according to the federal poverty guidelines but I can’t carry all the information that’s when I need social services so that’s what I’m trying to play in this slide is it it’s very complicated if this is not my

speciality as long as I know where to send the patient I feel like that is my responsibility I got it you would have more but I don’t know and I can i but but I feel like we are all responsible to making sure that patient gets to where they will have appropriate information that that is really really important because as you can see there you know if you fall in hundred thirty percent of of credit already got a level that’s a fear that what it stands for you qualified some things you want to keep your fifteen hundred four hundred these are all different you know groups but again we have to make sure that the patient is pointed in the vice so these are the present ones that we have right now but again we are going to be increased and that’s that’s how you’re going to get a bigger group of people so these are this is a list of some of the benefits that are going to be coming down with because of the changes are happy they are going to be increasing the access to care right now we don’t have the dental we don’t have some of the preventive diseases of preventive conditions like cancer screening or our colonoscopy screening a bit they are not included and so they will be included with with without popping some salmon have Kobe basically what we are going to be doing is trying to move the patients that are using the emergency room as a as their regular provider of care into a family care place where they are going to be providing what’s called patient-centered medical home that is the term that you might have heard before but one is the patient-centered medical home the patient-centered medical home concept actually came about from American Academy of Family Practice practitioners as well as the american academy of pediatrics and the concept initially was because there’s a lot of research to show that if there is coordination of here there is one place where the patients can can don’t you and this place has all the information about all the different resources or the different places where the patient needs help the outcomes are better so to use clinic as an example in high of a patient-centered medical home patient comes in patient has diabetes they might need to see a specialist for their diabetes we can only do so much as a primary care level they need an eye specialist for to make sure that their eyes are being monitored on a regular basis the Dean if they might need to see a nephrologist because diabetes that’s all the different parts of the body but what happens in a present system the patient is responsible or the family is responsible for making sure all those different things with the concept of a patient-centered medical home actually the responsibility is given to an entity to an organization or actual entities okay so we are supposed to take care of all this information and keep it in one place so they see I doctor knows what the kidney doctor knows and the primary care doctor who is just taking care sometimes the patient comes in for a call and you have to take care of the goal if you know and and so you when you’re looking at the medications you have to make sure that you’re not writing any medications that are going to interfere with the diabetes medications medications or patients here fine and actually what clinical sister loot is doing right now is we are in the process of getting certified as a patient-centered medical home and the organization which is if it is recognized by the by the federal government is NCQA which is National Committee for Quality Assurance so one of the things that that has to be emphasized is that the access of care under these all these new rules and regulations that are coming it’s not

only access of care it is access to care with the accountability part of it to make sure that it is not subpar lick here it is scare that is the standard of care that anybody can go get the just because somebody is getting cleared care in a community clinic or because they have Medicaid their level of care is different and so that’s why the federal government is requiring that one that one of the things that was required is the home our implementation of electronic health records which clinicals has has now all of our clinics have electronic health records but that means is that implication is seen in our calexico clinic and then decides for whatever reason to slot in a night in clinic the information is accessible not like before then when there was just paper charts so if somebody showed up in one clinic then like either you’re calling or you saying you know sell me what happened the last time around so beautiful very very fragmented so the goal ultimately is that regardless of where the patient is they have bill the information or whoever is taking care of the patient to make appropriate decisions so that the patient is not having things done for them that might not be appropriate it’s a lot of times and in one of the of the things that that I think about is that patients use emergency room and they get this clear that it’s appropriate for that time but because of the fact that the doctors that the patient goes to regularly the nurse practitioner the physician assistants and the patient goes to regularly may not have all the information that happened in the emergency room they might end up making a decision that does not hurt emergency room is determined to give an example patient went in because they have blood pressures out of control the doctor appropriately you know did whatever and then say you know what if you’re on right now it’s not working because or they may not even know the medicine they are not because the patient may not have taken the medicine you may not know the name of the medicine that they are taking so the doctor in the emergency room decides to prescribe a medication patient comes home takes the medication that the doctrine emergence you don’t prescribe takes the medication that the regular doctor prescribed and actually runs into trouble because now they are overdosed or arbitrary decides like all try together you know maybe I won’t but the other thing that’s happening is something that’s called health information exchanges I guess a lot of moving pieces to this whole health care reform thing the health information exchange again clinica is is article also is helping us is working on where our patient shows up in emergency room at pioneers Hospital guess that’s our closest entity that we work with we are also working with El Centro Regional Hospital and with any hospitals and in riverside with their local hospitals that whatever it happens in those hospitals we even have access to that information so that we are not actually the tell the patients you know bring in your medication list you know what happened between your last visit with us but patients may or may not remember to do that so if we have direct access to that information we can make better information better decisions for those patients for our patients mostly it’s let me know so we know again of the course of all these years that research has been done but certain populations are high risk for something to even we have obesity diabetes heart disease several temperature as one of the things what happens is this terminal cancer and heart disease we can come between negative entities but gravity’s does cause heart disease also but is that sometimes is it’s delayed identification right I mean I don’t have many money I don’t have anybody Cal like I don’t want to go in because I papers and so when I go in and use emergency room or going to see a doctor it might be the disease may have progressed along a lot and so you know I mean earlier intervention is always better whatever the condition may

be earlier we find out that’s why all these screenings that are recommended so we have enough information we have enough proof that the screenings health in earlier identification and earlier identification improves the outcomes for patients and so the trip these changes that are taking place we will be able to get patients into the system I have a very low rate and again we’re talking about Oh clínicas because of we have a federally qualified health centers have a lot of reporting requirements so I know a lot of my patients need cancer screening colon cancer screening but they don’t get it even though we tell them to and because that’s all we are able to do at this time we can advise them to do it but they don’t go because you don’t have any sort but as as the changes are happening some of these cleaning programs are going to be paid for without a copay so that’s how we will be able to over the course of time improve health care and have lower costs because as we know that people going and get a sticker there’s more to the higher off of here so you get things earlier on and you will be everything that you will be make sure that they are taught in time and taking care of appropriately and any patients hopefully they’ll have a better quality of life these are my resources I international community clinics pink slides and then her Chaka Khan is a major major resource for education so basically what I’m going to emphasize is this to educate yourself because as Sylvia preliminary it’s a very short time and there’s a lot of information so the more we know the better we will be able to guide anybody asks as a question and approach and appropriately send them to appropriate places for further information you know I mean so they will be better prepared as a doctor I women put a plug in that as much as we can help educate the patient’s I would also emphasize the patients also know what it is that they have to listen be responsible for because ultimately that that’s when the college system will work we are one of the things that silica is doing for for education is that actually there was fun Britain federal federal funding available which we were able to access and we have community outreach workers in Imperial County as well as a Riverside County is the grassroots initiative to educate or to contact people that have not been part of their in short group for a decal or otherwise and bring them into the first step one end and get them to the appropriate places where they visit our information which they need because a lot of time is the patients don’t even know me as I said clinical has been in existence for 40-plus years and sometimes I was still here is like we didn’t know we could go to you yeah so education education education is the key to this whole thing I think I wanted to let people know that I’ve heard in a lien that I was at last that’s Wednesday is that clinic as is expanding their hours for Saturday’s you want to talk about that and I think you met Sunday stroll open access training is open saturdays and sundays right now we are actually because of we have to point your new facility so our clinic is open till six o’clock and in raleigh all our times open at least till six o’clock with embroiling we have open access clinic and that is open from five till ten or whenever patients don’t need us anymore and then all this saturday and a whole day sunday but once we have a new facility actually grows hours but weekday hours after teaching are going to be ecstatic right now so it will be another full service clinic yeah full service clinic is just Raleigh and as the other clinic sites and and the other thing that we are doing thanks Sylvia think I’m okay is is open access

it’s a shame they’re scheduling so patient comes in because one of the things that frustrates people and one of the reasons why they say they go to the emergency room and it will be like oh I go in there and they see me and I come to you and I have to sit in wait until Don gets very frustrating for the score report patients and their families so one of the things that we do is an honor clinics is sanely schedule instead of just walking in and waiting pallets and we will tell you what time to go man and so you will be seen that same day but it will be a little bit better for you and we we can tell you like okay we have a space at this time so come in because again i miss one of my experiences in one of the major reasons why we have long waiting times is because patients come in and so if i come in and have two or three people ahead of me to be seen then i just have to make account and that can get attention so that is one of the things that we’re going across the clinic’s having stained in scheduling you call in and we call them open access thoughts and so we can we can take you that same day but it’s a little bit more control for you as well as as making sure that that we have that we have the clinicians and also the other thing that you’re working on and this time patient-centered medical home is that you get to see who is your designated clinician your nurse practitioner you’re in the your PA so interesting the same person majority of the time they are going to be times when you do not see the same person but as much as we can prevent it we want you to see the same person so you know and you don’t have you don’t feel like a hatchery tea myself thank you very much