Memorial Hermann Community Benefit Corporation

Addressing the need for a "medical home" for the uninsured and underinsured, Memorial Hermann Community Benefits partners with five school districts, Houston--the largest in Texas, Pasadena, Lamar Consolidated, Alief and Aldine for its Health Centers for Schools program designed to provide a "medical home" for uninsured children and a secondary access point for insured children, grades k-12th. The Health Centers for Schools program provides primary healthcare, mental healthcare, nutritional care, navigation support and dental care to medically underserved, at-risk children. The program began in 1996 with two school-based health centers servicing three schools. Today, Memorial Hermann operates Health Centers on-site at nine campuses in the greater Houston area providing access to healthcare for students at 80+ schools. "Feeder" patterns are accommodated, making it possible for a child to receive continuity of care from pre-kindergarten through twelfth grade. All services are provided at no cost to families. The Health Centers for Schools operate Monday through Friday, 7:30 am to 4:00 pm, 12 months a year. The primary goal of the Health Centers for Schools program is to bring increased health care to children who will otherwise not obtain it and to keep children healthy and in school so they can learn the skills they will need for a brighter future. 60% of the children served at the clinics do not have any type of healthcare coverage. 29% have some form of Medicaid. The remaining 11% are children who would not obtain healthcare due to transportation issues, working parents unable to accommodate time off from work, high private insurance deductibles or simply a lack of parental involvement. 95% of students served through the program are on the free/reduced lunch program, and 39% are more comfortable speaking, reading and writing in a language other than English. The scope of services offered includes immunizations, general and sports physicals including well woman and man care, acute, chronic and minor injury care, mental health therapy, social service counseling and referrals, health education, and nutritional guidance as well as other specific care to meet students' needs. Staffing at each center consists of a nurse practitioner, licensed clinical social worker, licensed vocational nurse, and a receptionist, with medical clinic oversight provided by a family practitioner. Two dietitians and a certified community health worker rotate amongst the nine centers. The dietitians deliver the healthy eating and lifestyles program (HELP) designed to educate health centers for schools' students and their families on the importance of proper nutrition and exercise. The HELP program is intensive and individual, meeting the student and family where they are on the "stage of change" continuum. The navigator supports in health and social service applications and referrals. The three mobile dental clinic vans rotate among the health centers for schools and are staffed by a dentist and one to two dental assistants. The vans provide services that include periodic oral examinations, diagnostic x-rays, prophylaxis, fluoride treatments, oral hygiene instructions, sealants, composite fillings, extractions, stainless steel crowns, and pulpotomies. This program has served as a "dental home" to uninsured students since 2000. An evidenced-based program, Memorial Hermann Health Centers for Schools benchmarks are derived from the National Association of School Based Health Centers, pre/post data, and Healthy People 2020. Outcomes in 2023 include: 2.9% of Health Center students used an ER for primary care purposes versus 10.5% of the general primary care pediatric community; asthma exacerbations, emergency room visits, hospitalizations and absenteeism were reduced by 92%; 97% of students with 3+ clinic visits for acute or chronic reasons receive a bi-annual physical; and 85% of students returned to their classroom on the same day. Although our behavioral health program suffered high turnover with 70% of staff opting for remote work opportunities, students who received therapy from licensed clinical social workers improved their respective overall grade point averages from an average of 3.0 to 3.2; days absent remained the same at 2.5 days per student; and suspensions/detentions remained the same at half a day per student. Lack of consistent staffing contributed to no improvement in absenteeism and suspension/detention data; however, it should be noted that these indicators did not worsen. In a typical year, desired trends are for the grade point average to rise, and for days absent and suspension/ detentions to decline. Furthermore, 85% of students with 4+ mental health therapy visits realized meaningful and reliable improvement on the CAFAS (Child and Adolescent Functional Assessment Scale). For the dental program, 29.5% of students ages 4-11 as well as 9.9% of students age 12+ experienced caries at recall. Healthy people 2020 called for the proportion of children with one or more caries to be no more than 49% and 48%, respectively. Moreover, 99% of children aged 6 to 9 received dental sealants on one or more of their permanent first molar teeth compared to the Healthy People 2020 target of 28.1%.

According to an emergency department use study, published in June 2013 and conducted by the university of Texas school of public health, 46% of all patients treated and released from emergency rooms in Houston were treated for primary care related illnesses or injuries. Based on this data which represents a consistent trend, the Memorial Hermann Health System Nurse Triage Center dba the Nurse Health Line was established and designed to improve access to care and ensure more efficient use of the emergency rooms in Harris and the surrounding counties. The study highlights the need for patient education about appropriate emergency department use. Healthcare consumers are uncertain about where and when to go for treatment. The Medicaid 1115 waiver DSRIP program allowed Memorial Hermann to launch and operate a 24-hour nurse triage call center to assist patients with their level of care decisions. The goal of the program is to be a regional resource that Houstonians can call to discuss their health concerns, receive recommendations on the appropriate setting for care, and connect to appropriate resources. The call center is staffed with registered nurses and certified CHWs 24/7 and is available to callers, free of charge, regardless of insurance status, language, physician alignment or hospital affiliation. Callers with questions or concerns regarding medical conditions are encouraged to call or fill out a 'contact us' form at [email protected] and get help from a registered nurse who provides nurse triage, health education/information, suggestions on the urgency of the need for treatment, and the appropriate level of care from 911 to home care advice. Memorial Hermann patients are given discharge instructions (from hospitals, clinics, surgery centers, and doctors' offices) to contact the nurse health line for assistance with medical concerns, questions post-discharge. Conversely, callers are referred to EDs, urgent care centers, virtual visits, clinics, or contact their physician for follow up in accordance with the appropriate treatment setting needed. Patients are also referred to community health centers, Pharm D poison control hotlines, dentists, and mental health hotlines/facilities. Vouchers are available to be sent electronically for a free neighborhood health center clinic visit. Referrals to home health, the Memorial Hermann Community Resource Centers and dietitians are initiated as needed, free to callers. The FY23 data shows that: 98% of the triage line callers followed the advice of the nurse and 57% that would have sought care in an ER setting were redirected to urgent care, primary care or home care. The 24/7 call center is a credible and available resource for assistance with medical concerns and questions. Callers that are uninsured and/or do not have a primary care physician are given resources to connect with a primary care home close to their home. The service is promoted through electronic ads, health fairs, wellness events, not-for-profit social service agencies; school districts; college campuses, city of Houston agencies, churches, and federally qualified health clinics, and partners programmatically with the Harris county emergency corps (HCEC), northwest community health (NW), and city of Houston Ethan-emergency telehealth and navigation program. Intended for the community at large, 46% were Medicaid/uninsured. The cost avoidance for the Houston area ED's is just over of $ 4.6 million, using the assumption of $500 per ER visit, for FY23. Memorial Hermann Health System COVID calls are being transferred to the COVID hot line. The COVID hot line is being managed by the nurse health line (NHL).

Compounded by Texas' lack of medicaid expansion, are people who cannot afford private insurance; who are eligible but not enrolled in government sponsored programs, and who are recent or undocumented immigrants. A growing number obtain their health care in ers. A houston study conducted by the university of tx school of public health indicated that roughly 46% of er visits are used for non er conditions. In november, 2008, when uninsured rates for the nation and the houston area were 15% and 32%, respectively, the Memorial Hermann Community Benefit Corporation launched a patient navigation program to address primary care related er use at Memorial Hermann southwest hospital. Overall objectives were and continue to be: (1) to connect patients with medical homes that are the right location, the right cost, the right hours of operation, and the correct services for each individual; (2) to reduce primary care related er use; and (3) to reduce primary care related costs, at least to the point of covering the cost of the program. Today, er navigators are located in all Memorial Hermann health system ers. The study design is based on pre/post data; and the intervention includes patient navigation, conducted by bi-lingual, state certified Community health workers (chws) trained in peer-to-peer counseling. During the er visit chws meet with patients to: explore all access issues (access is more than having health insurance); coach on how to access healthcare and Community resources; and, educate on the importance of finding and maintaining a medical home. All patients leave the er with some sort of follow-up instructions from the medical team--the chws make sure they have a place to go. After the er visit chws: follow up with patients, usually within one week; monitor/review/resolve ongoing patient needs; and, continue to follow-up until the case is closed. Essential to the process is continuing to build relationships with hospital staff and Community based organizations. In partnership with Memorial Hermann er business, clinical and care management teams, the program annually results in 12- month, pre-post decline in er visits of 62%. Research data indicates that social determinants of health (sdoh) have a profound impact on the health status of individuals, and in order to improve population health, health care systems will need to consider addressing sdoh. The er navigation program incorporates food insecurity screening and pantry/snap referral into the navigation intervention process. Most recently, a multi-visit patient (mvp) implementation coaching program has begun with the objective of identifying and mitigating the root causes of recurrent utilization for non-clinical purposes - homelessness, social isolation, hunger, mental health. The focus is on emergency department patients not only across the Memorial Hermann system but shared with harris health and methodist. Hospital teams serve as change agents and support the vision of the program. External partnerships include houston recovery center, council on recovery, and coalition for the homeless. To further align efforts of addressing social determinant issues and increase the opportunity for our program to build bridges to health care and Community resources we have implemented Community resource centers, a new model for working with partners on medical/social needs at our Memorial Hermann southwest, greater heights, and northeast hospitals. Memorial Hermann Community resource centers support Community members with navigating the health and social service systems, while becoming more engaged in their own disease prevention through decision-making and self-management. Through an intake screening tool which addresses food insecurity, transportation, health literacy, access to and understanding of medications, financial strain, housing, employment, education and emotional well-being, Community health workers identify the appropriate partners to support each individual client. The program builds collaborative partner capacity through provision of access to services (medical home connections, application assistance, encouragement for follow-through); wrap-around support (nmdoh); education (health literacy); and bridging people to social supports.

Physicians of Sugar Creek

Support of Community Health Centers