1. Downtown Health Plaza of Baptist Hospital Mission Statement The Downtown Health Plaza is committed to providing quality and compassionate care to all we serve.

3. In Forsyth County the percent of people below the poverty level has increased over the last five years from 9.9% in 2002 to 13.9% in 2007. Twenty-two percent of people under the age of 18 live in poverty, and 25.7% of children under age 5 do as well.

4. FY 09 ADULT MED%OB/GYN%PEDS% Personal Pay9,03035.0%10,38153.4%5473.4% Medicaid6,60225.6%7,63839.3%14,42090.1% Medicare7,79730.2%3151.6%30.0% Managed Care2,3699.2%1,0965.6%1,0296.4%

6. WHEN YOU ARE WELL Downtown Health Plaza will help you - - - Manage chronic diseases Diabetes Asthma Hypertension Receive preventive and diagnostic services Annual physical exam Immunizations Blood and urine tests Pap Smears Mammograms Obtain prescriptions Referral to specialists Support and Information Educational materials Support groups Answer questions

7. Downtown Health Plaza Services On Site Pharmacy On Site Laboratory On Site Radiology Financial Counselors Spanish-Language Interpreters Specialty Services On Call Services 24/7 Ob/Gyn Pediatrics CareNet Pastoral Counselors

8. METHODS - Telephone survey of adults in 7 countries, using the answers to 4 questions – (1) the adult has a regular doctor or place of care – (2) doctor(s)/staff always or often know important information about the patient’s medical history – (3) the place is easy to contact by phone during regular office hours – (4) the doctor/staff at the source of care always or often help coordinate care received from other doctors or sources of care. Toward Higher-Performance Health Systems: Adults’ Health Care Experiences In Seven Countries, 2007 Schoen et al. Health Affairs 2007.

9. RESULTS – The USA stands out for cost-related access barriers & less-efficient care. – 75% of adults viewed having a source of care that knows them and helps coordinate care as very important. – Having a medical home was associated with less difficulty accessing care after hours, improved flow of information across providers, a positive opinion about health care, fewer duplicate tests, and lower rates of medical errors. Toward Higher-Performance Health Systems: Adults’ Health Care Experiences In Seven Countries, 2007 Schoen et al. Health Affairs 2007.

11. CHARACTERISTICS OF A MEDICAL HOME Accessible Family-Centered Thorough Continuous Coordinated Culturally Competent

12. What Patients with Chronic Illnesses Need A “continuous healing relationship” with a care team and practice system organized to meet their needs for: Effective treatment (clinical, behavioral, supportive) Information and support for their self-management Systematic follow-up and assessment tailored to clinical severity More intensive management during high risk periods Coordination of care across settings and professionals

13. 1: Access and Communication 2: Patient Tracking and Registry Functions 3: Care Management 4: Patient Self-Management Support 5: Electronic Prescribing 6: Test Tracking 7: Referral Tracking 8: Performance Reporting and Improvement 9: Advanced Electronic Communication Standards and Guidelines for the Patient-Centered Medical Home

14. PPC 1: Access and Communication - The practice has standards for access to care and communication with patients, and monitors its performance to meet the standards YESNON/A 1. Scheduling each patient with a personal clinician for continuity of care X 2. Coordinating visits with multiple clinicians and/or diagnostic tests during one trip X? 3. Determining through triage how soon a patient needs to be seen X 4. Maintaining the capacity to schedule patients the same day they call X 8. Providing urgent phone response within a specific time, with clinician support available 24 hours a day, 7 days a week X

15. YESNON/A 9. Providing secure e-mail consultations with physician or other clinician on clinical issues, answering within a specified time X 10. Providing an interactive practice Web siteX 11. Making language services available for patients with limited English proficiency X 12. Identifying health insurance resources for patients/families without insurance. X

18. The Adult Medicine Clinic staff also presented a poster at the United Healthcare Consortium (UHC) conference on the use of the iPod touch to enhance patient education, improve patient flow, and address educational needs of complex patients. Audio/Video educational modules about such topics as warfarin therapy, diabetes, inhaler techniques, and test preparations have been developed and implemented by the staff. Patient response has been positive, and many older adults have been intrigued by the use of handheld devices.

19. Future Plans  National certification as a Patient-Centered Medical Home  Possible extended clinic hours for primary care.  Offer improved patient access with modern technologies such as internet use or texting: Trials planned for 2010.  Community Garden Project: Partnering with Goler CDC and Goler Manor Apartment residents to promote healthy eating and community activity.

20. Continued Challenges  Growing number of working families without access to affordable health insurance  Assuring mental health follow up for the 15% Medicine patients with severe psychiatric issues  Patients' ability to access needed medications  Increasing cost of healthcare  Increase in Forsyth citizens living in poverty with no insurance  Growth rate of Hispanic population and resulting language, cultural issues