Paul Gregerson, MD MBA CMO JWCH Institute, Inc. September 18th, 2013 Irvine, CA

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1 Paul Gregerson, MD MBA CMO JWCH Institute, Inc. September 18th, 2013 Irvine, CA

2 } Founded in 1960 } Private, nonprofit, FQHC } Operating budget of about $30 million and >300 employees

3 } The Mission of JWCH Institute is to improve the health status and well-being of underserved segments of the population of Los Angeles County through the direct provision or coordination of health care, health education, services, and research.

4 } Six Primary Care Clinics Largest is CCH (homeless)

5 } Provides healthcare to >11,000 unduplicated patients each year and >25,000 visits } Opened in 2009 Public Private Partnership } Previously located in same facility as Weingart Recup Care } Satellite clinics at DWC and SRHT sites } Mobile Unit at Pathways To Home

6 } 51,000 in Los Angeles } 18,000 in Orange County Source: LAHSA 2011

7 } Patients who are homeless who use DHS inpatient services each year: 2300 } Annual cost for inpatient services for patients who are homeless: $70 million ($30,000/ patient) } Average Length of Stay: 10.6 days (vs. 6.4 days for those who are not homeless) } Annual denied days for patients who are homeless: $6 million Source: DHS November 2012

8 } The high rates of hospital utilization, readmission, and even keeping the patients additional days has substantial cost implications for healthcare system

9 } In addition to providing care for the treatment of an illness: Nutrition, rest and recovery Opportunity to reflect and change Housing process may begin Connection to health care Mental health assessment and intervention Prevention (pneumovax, PPD, colonoscopy, etc) Benefits (health insurance, SSI/SSDI)

10 } Two Sites: 1. Weingart Center at 515 E. 6th Street beds funded by HUD 2. Bell Shelter at 5600 Rickenbacker Rd Opened in 2008 & expanded capacity by 30 beds

11 } Ten story building in the heart of Skid Row } Inhabited entirely by programs and organizations that serve the homeless } 1-2 blocks from CCH } HUD } Individual rooms

12

13 } Developed as a collaboration using shelter (Bell Shelter) to provide the facility, while JWCH (FQHC, homeless healthcare provider) provides the services

14 } Shelter-Based Model } Free-standing facilities } Motel Vouchers } Board and Care Contracts } Family Respite } Contracted service in a board and care facility

15 Models Of Recuperative Care M E D I C A L Shelter-base Respite unit Contract with Free-standing Respite unit S E R V I C E S Refer to Shelter Beds Non-health Care Care Facility Motel/Hotel Vouchers TYPE OF FACILITY Board & Care Facility Health Facility 15

16 } Both are similar to Freestanding, with the exception that the facility and beds are provided by an existing shelter and there are other shelter guests and activities taking place in the care location

17 Hospital Recuperative Care Health Care Services Entitlement programs Stable housing Shelters Primary Care Medicaid Permanent Supportive Emergency Substance Abuse GR, CalWorks, Food Stamps, CAPI Affordable Housing Transitional Mental Health SSI

18 } 20 HUD } 25 DHS } 5 Private } Contracts with 7 Private Hospitals and all 4 County Hospitals in LA County } $162 per night about 1/10 the cost to keep patient in the hospital

19 } Resolving the acute medical problems related to the hospitalization } Providing psychosocial assessments and case management including referrals for MediCal, MH, SA & SSI, as indicated } Initiating the process of stable housing placement } Placement into Primary Care Medical Home

20 } 1 Physician Assistant (.8 FTE) } 2 Registered Nurses } 7 Licensed Vocational Nurses } 3 Medical Assistants } 2 Case Managers } 2 Program Coordinators } Physician Oversight (8 hours/week)

21

22 } 24 hour care & 32 hours/week of provider time } Assistance with medications } Basic medical oversight of acute and chronic conditions } Connection to MH, SA or specialty care as indicated } Support in scheduling and attending follow-up appointments } Dressing changes and other aftercare tasks } Connections to supportive services and housing options (PSH) } Case Management including assistance establishing eligibility for public benefits } Three meals per day

23 } Who can make a referral? } A social worker, RN or healthcare provider (MD, PA, RNP) may initiate a referral and check for bed availability Individuals may not self refer

24 } Monday thru Saturday from 8-5 } Medical provider works 6-10 pm on Tuesdays and Thursdays (and Saturdays 8-5)

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