Dr. Mark Redding is a pediatrician in Mansfield, OH and the Ohio Chapter CATCH Facilitator. As the Executive Director for the Community Health Access Project (CHAP), he received funding from CATCH to develop the Children's Community Health Access Initiative (CCHAI). In this initiative Mark worked with his wife Dr. Sarah Redding to establish community-wide linkages between agencies and health care providers that serve children ages 0-3 years in the community. With funding from the CATCH grant and assistance from the Richland County Youth and Family Council, they collaborated with more than 70 different health and social service agencies across Richland County.
The community-wide linkages were developed using the Pathways Model of outcome production developed by CHAP. Pathways are a tool used to shift the focus of health and human service providers from activities to outcomes. Pathways are unique in that the outcomes are tracked at the level of the individual. The Pathway provide a step by step guide for the care manager (nurse, social worker, community health worker) to work through a specific client problem focusing on achieving a positive result. Each step of the Pathway addresses a clearly defined action towards problem resolution. The steps of the Pathway define patient education, social and access issues such as transportation, in addition to the medical care. The Pathway is not considered complete until an identified problem is successfully resolved. Completion of a Pathway may involve more than one agency and/or health care provider. One client may have many different Pathways depending on the problems identified. For example a high risk child behind on immunizations is identified in the community without; health insurance, medical home transportation or other basic resources. The Immunization Pathway for this child is not complete unless these issues are worked through and confirmation is made that the immunizations are up to date.
The following Community Pathways were developed through CCHAI: Health Insurance; Medical Home; Developmental Screening and Referral; Immunization Screening and Referral; Lead Exposure; and Pregnancy. This initiative required broad community participation and time commitment in developing the Pathways. In addition, the agencies and providers involved agreed to track Pathways progress through a central tracking system. Reports were developed to show agency and community-wide increases in successful outcome production. Initial reports have already shown many barriers to care in the community as well as high levels of duplication of services. This initiative has been the springboard for several other grants.
In addition, Mark and Sarah work with CHAP to employ, train and support Community Health Workers (CHWs) to improve outreach to communities most at-risk for poor health outcomes. The model of Pathways serves as the outcome focused care management tool for Community Health Workers. CHAP has developed contracts which help change the financial focus of this work to outcomes. CHAP does not receive payment for services through County Jobs and Family Services contracts unless specific individually tabulated outcomes are achieved. In addition to demonstrating outcome improvements including Low Birth Weight, Immunizations, Lead and others this contractual model has demonstrated a significant increase in efficiency in the number of outcomes produced by each CHW. Linking payment to outcomes recently received attention from the Ohio Governor's Task Force to Reform Medicaid. In their report to the Governor this February outcome focused care management models like ?Pathways? were recommended to increase accountability and focus on outcomes. Outcomes which in many examples (such as Low Birth Weight prevention) could have a substantial cost savings impact on the Ohio Medicaid budget.
Mark and Sarah's work with CHWs has resulted in partnerships with many others in Ohio to build a new profession for the CHWs. More than 300 Community Health Workers in Ohio have been trained with college credit (supported by HRSA and the Ohio Department of Health) through the college curriculum developed by CHAP. With legislation supported by Senator Bill Harris, CHWs will receive Ohio Board of Nursing credentialing starting February 2005. The Osteopathic Heritage Foundations, Ohio Department of Job and Family Services, Ohio Department of Health, Ohio AAP and more than 15 CHW programs from across the state have worked to support and develop this profession in Ohio.
The health and social service system in the United States is currently driven by and held accountable for service activities. Accountability is focused on the number of hours of service, lab tests, home visits etc. without accountability for achieving positive results. The steps required to achieve positive outcomes, including barriers in access, client education and receiving high quality clinical care, can be held together in outcome focused care management models like Pathways.
If outcomes are to improve and spending to decrease, the fundamental structure of the health and human service system in the United States must change. "We need to define the outcomes that are needed and then focus on one individual at a time, addressing both their health and human service needs, while holding the system accountable for producing positive outcomes."
More information about CHAP and Pathways is available by sending an e-mail message to: firstname.lastname@example.org or you can call #419/525-2555.