Health Leads Health Leads - Maine Quality Counts

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Apr 1, 2016 ... 2016 Health Leads, Inc. Health Leads envisions a healthcare system that addresses all patients' basic resource needs as a standard part of ...
4/1/2016

April 2016

Health Leads Changing What "Counts" as Healthcare Maine Quality Counts

Better Health. One Connection at a Time. healthleadsusa.org

© 2016 Health Leads, Inc.

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OUR VISION

Health Leads  envisions a healthcare system that 

addresses all patients’ basic resource needs as a standard part of quality care 

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OUR APPROACH

EDUCATION

KNOWLEDGE‐SHARING

CONSULTING XXX hours TECHNOLOGY

DIRECT SERVICES

 20 years of pattern  recognition and best practice  identification around  integration of social needs  into care delivery  Broad network of clinical  partners to collaborate around  program improvements and  innovation   Flexible tools and workflows  for different populations and  clinical environments

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HEALTH LEADS’ TECHNOLOGY PLATFORM  Community resource management • 10,000 resources (public and private) in  current resource database spanning 7 geos  and 11 categories • Integrated feedback loop ensures database  gets more impactful over time as used by  clinics and patients

 Case management  Workforce management • Built‐in tools to enable coordination of both  traditional & alternative workforces

 Performance management • Performance dashboard tracks ~20 measures  impacting population and clinical factors • Information generated enables data informed  community health insights and reporting © 2016 Health Leads, Inc.

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HEALTH LEADS’ SAMPLE SOCIAL NEEDS DASHBOARD ENABLING PROVIDERS TO TRACK SOCIAL NEEDS PROGRAMS AND DRIVE QUALITY IMPROVEMENT

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IMPLEMENTATIONS DRIVE POWERFUL DATA & INSIGHTS Actionable Insights Developed from Social Needs Data Collection: • Community resource database  1% of resources account for 51% of successful  connections, and 10% of resources account for 90% of successful connections • In a typical year, 40% of community resources change their information and  another 10 ‐ 20% are brand new • Following up at least twice within two weeks increases the odds of a successful  resource connection by 18 – 23% • Half our patients opt into text messaging – we send and receive over 3,000 text  messages per month with our patients • Patients who text with us are less likely to disconnect from Health Leads services • Patients give Health Leads a Net Promoter score of 75%, and 79% of patients are  more likely to recommend their clinic because the clinic offers Health Leads

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EVIDENCE OF CLINICAL IMPACT  Patients with chronic conditions are more  likely to suffer from unmet social needs: o Have a greater prevalence of depression,  diabetes and hypertension o Are more likely to have poor glycemic and  cholesterol control o Are more likely to be frequent ED users and  have frequent "no‐shows" to clinic  appointments.

 Addressing social needs is associated with  clinically meaningful improvements in  patients' LDL cholesterol and blood  pressure ‐‐ at a level greater than the  threshold the FDA sets for a new drug.

1. Berkowitz, S.A. 2015 presentation at Society of General Internal Medicine Conference: “Addressing Basic Resource Needs in Primary Care Improves Blood Pressure and Cholesterol  Control: A Pragmatic Intervention.”

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HEALTH LEADS’ CURRENT PARTNERS AROUND INTEGRATION OF SOCIAL NEEDS • Boston Medical Center

• Sutter Health

• Mass General Hospital

• University of Utah Medical Center

• Catholic Health Initiatives

• Codman Square Health Center

• Providence of Sacred Heart

• Children’s Hospital Wisconsin

• The Dimock Center

• Dayton Children’s

• Denver Health

• NYC Health and Hospitals  Corporation (multiple locations)

• Kaiser Permanente of Colorado

• Dignity Health

• Denver Health Medical Center

• Gundersen Health System

• DAWN Clinic University Hospital

• Henry Ford Health System

• University of Colorado at Denver

• Kaiser Foundation Health Plan

• Community Health Net

• Seton Health

• Genesis World Mission

• Sutter/Palo Alto Medical Foundation

• MetroWest Free Clinic

• UMass Memorial Healthcare

• Kaiser Permanente – Southern CA

• Partnership Health Plan of CA

• Healthcare Without Harm

• Kaiser Permanente – Northern CA

• Rocky Mountain College

• UCSF

• University Hospitals  Cleveland

• Connecticut Children’s Medical  Center

• Center for Healthcare Strategies

• Hasbro Hospital • Johns Hopkins (multiple locations) • Children’s National Medical  Center • Contra Costa Regional Medical  Center

• Kish Health

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• Bon Secours

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Rebecca Onie Co‐Founder and Chief Executive Officer Health Leads To learn more, contact: [email protected]

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