Pilot programs seek health care reform

Improving health care delivery

Pilot initiatives funded through the 1115 Medicaid Waiver are intended to help close local health care gaps, including lack of accessibility and of specialty care services such as mental health, gastroenterology and pulmonology. The 1115 Medicaid waiver is a federal reform of Medicaid that changes how funds are allocated to encourage more affordable and efficient treatments with better health outcomes.

In 2012 health care agencies in Travis County such as Travis County's Central Health district and CommUnityCare—a network of clinics serving the underinsured and uninsured population—began planning five-year-long initiatives to change the way health care is delivered as part of a federal effort called the Delivery System Reform Incentive Payment, or DSRIP, regional projects.

These pilot health initiatives—which are taking place in Bastrop, Hays, Lee and Travis counties—are performance-based, and participating agencies must attain metrics and milestones to receive funding from the 1115 Medicaid Waiver to keep them alive.

CommUnityCare is responsible for 11 DSRIP projects, half of which take place at the North Austin location at the corner of Braker Lane and Parkfield Drive.

Projects include expanded clinic hours and specialty services; hepatitis C treatment and telepsychiatry, or psychiatric services delivered to patients through videoconferencing. CommUnityCare also provides mobile care at sites throughout Travis County. The units provide primary care, diagnostic testing and screenings at sites such as schools and fire departments, said CommUnityCare CEO George Miller.

"The benefit [of mobile units] is that it's a way for services to be provided in areas that [are] maybe not served now," Central Health Chief Operating Officer Larry Wallace said. "If we, through this experience, discover there is more need, then it positions us to have a greater response. It's sort of testing the market before [making] a huge investment."

St. David's Foundation, a nonprofit partner of St. David's HealthCare, funds initiatives to address health care disparities in areas including near Rundberg Lane. The foundation operates a mobile program to deliver dental services to low-income children and adults. The program has provided dental services to 2,900 people in the Rundberg area, St. David's Foundation CEO Earl Maxwell said.

"We watch [health care] trends," Maxwell said. "Our money follows the movement of low-income people. Certainly Rundberg is one of those hot spots."

Patient and physician demands have also led to the expansion of other services in the area, including a new pediatrics wing opening in December at St. David's North Austin Medical Center, St. David's NAMC CEO Allen Harrison said. Staff analyzed data and sought opinions from nearby physicians to determine whether to open the pediatrics wing. St. David's NAMC additionally wanted to provide care to babies it delivers, Harrison said.

Rundberg Lane population needs

Part of the Restore Rundberg project, a resident-led effort to revitalize the Rundberg Lane neighborhood, involves studying health care access and disparities in access to clinics and specialty care.

In July the Restore Rundberg team asked Latino HealthCare Forum for help to assess and develop a plan to address health needs in the area. LHCF Executive Director Frank Rodriguez is spearheading the assessment, which includes identifying available services and barriers for people in accessing health care, such as transportation, poverty and housing, in Rundberg Lane and surrounding neighborhoods.

LHCF is studying data to measure gaps in care and the number of doctors needed to serve the area's population. It will also solicit opinions about existing needs from community members, leaders and advocates.

To reach the Spanish-speaking population in Austin, LHCF developed a mobile application to help people be more in control of their health. Functions allow users to email their doctors and set up reminders to take medication as well as find nearby doctors and information about health insurance.

LHCF received $95,000 in funding from St. David's Foundation and the Austin/Travis County Health and Human Services Department for the assessment. However, Rodriguez said LHCF needs additional funding to execute the plan.

"We're looking at getting quantitative data, hard data, qualitative data, opinions, observations [and] anecdotes from the community," Rodriguez said. "Based on all of that we will set some health care priorities. For example, we'll identify the top 10 health issues in the area and then develop a plan to address those."

Capital Metro is collaborating with the Restore Rundberg team to address community concerns and is upgrading several bus stops in that area, including adding shelters to some of the bus stops.

"If there are more needs in the community for transportation beyond just the traditional work and school patterns, our charge for the future is to look at the possibility of a frequent route network that would improve the frequency of several routes," said Roberto Gonzalez, Capital Metro's manager of service planning.

Capital Metro is aware of additional service needs and is working on a plan for an additional station with MetroRapid services in the North Lamar Boulevard and Payton Gin Road area, Gonzalez said.

Mary Jo Hernandez, a retired physician and community health representative on the Restore Rundberg team, visited all clinics in the North Austin area to review capacity and services. Citing a report she wrote for Restore Rundberg, Hernandez said the community needs additional services, including drug and alcohol rehabilitation, mental health, emergency and primary care, and health education. Community engagement is crucial to meeting those needs, she said.

"I think people need advocates," she said. "Our eventual aim is to get the community empowered to take over [health initiatives] because we can't say what [they] need."