Urban Health Access Jenni Sevenich CEO Westside Healthcare

Urban Health Access Jenni Sevenich, CEO Westside Healthcare Association Milwaukee, WI

Overview � 1. What does “urban” look like? � 2. What is the problem? � 3. Why is there a health access problem in urban areas? � 4. What are the consequences? � 5. How can we address the problems? � 6. Questions

What is “urban”? � For some, urban means African American � High concentration of people � High percentage living in poverty � In Milwaukee, high number of Hispanics and African Americans � Concerns regarding crime, education, housing, unemployment, environment and other quality of life issues

What is the problem? � In its simplest version, the health care access problem is this: People who reside in urban areas cannot or do not attempt to access primary or specialty care, meaning they cannot find a primary care doctor who will see them or a specialist who will see them. � In reality the problem is much deeper

Why is there an access problem? � Example of Primary Care Access Study done in Milwaukee – physician shortage in city � Money – Many urban residents are uninsured or on Medicaid � Assumptions about population � Fear of the population

Why…(cont. ) � Cultural � Fear � Racism � Lacks differences prestige � Apathy

Consequences � Emergency room use for primary care � Chronic conditions go untreated, resulting in costly hospital stays, disability, health disparities, premature death, inability to work � Increased health care costs due to Medicaid/Medicare/uninsured cost shifting � Fewer minorities become medical providers

Consequences (cont. ) � Distrust of health care system � Health of population is spiraling out of control – it’s costing ALL of us

Addressing the Problem(s)-CHCs � Community Health Centers provide comprehensive care in their neighborhood (a “medical home”) ◦ Culturally competent care ◦ Lower costs – CHCs provide care at less cost and lower costs of health care overall because CHC have lower hospitalization rates and spend fewer days in the hospital when they are admitted (NACHC) ◦ Become part of community fabric, building trust

CHC Challenges � Not enough capacity for densely populated area � Patients suffering from major health issues – not enough resources to address them � Lack of funding for expansions � Recruitment challenges for physicians, midlevels, nurses, medical assistants � Funding holistic care

Addressing (cont. ) � Hold Medicaid HMOs accountable for access to providers, services and quality outcomes � Work with medical schools on curriculum and getting students and residents in CHCs � Work with other schools, including middle and high schools, technical and other colleges to garner interest in health field and community health

Addressing (cont. ) � Provide incentives for providers to work in urban underserved areas (NHSC, loan repayment, other incentive programs) � Work with non-profit health systems to distribute burden of cost, reimbursement issues � Engage community to research, develop and implement a major initiative to address root causes of chronic disease

Addressing (cont. ) � Look at health and health access in broader terms – poverty, education, housing issues, racism, political and economic issues cannot be denied if we truly want to reduce the gap in health care access in urban areas