# Presentation: 869952

## http://www.mc.uky.edu/ruralhealth

***Kentucky Homeplace ***

## Late State Rep. Paul Mason, D-Whitesburg, left, and Hazard Mayor Bill Gorman, right, appear together here at a UK Center for Rural Health function. Mr. Mason, who died in 1998, was instrumental in the creation of the Kentucky Homeplace program.

**Late State Rep. Paul Mason, D-Whitesburg, left, and Hazard Mayor Bill Gorman, right, appear together here at a UK Center for Rural Health function. Mr. Mason, who died in 1998, was instrumental in the creation of the Kentucky Homeplace program.**

## UK Center for Rural HealthKentucky Homeplace

- Kentucky Homeplace was established in 1994 by the Kentucky General Assembly.  The program was originally developed by the UK Center of Excellence in Rural Health as a demonstration project, and was funded by the Kentucky Cabinet for Human Resources.

## Barriers To Health Care Access In Rural America

- Access to the Health Care System
- Lack of Understanding of How to Navigate the Health Care System
- Uninsured/Underinsured/Underserved
- Transportation
- Access to Primary Provider
- Access to Medications
- Health Literacy
- Education on Illness
- Communication (culture)

## Kentucky Homeplace Program at Conception

**Adair**

**Allen**

**Anderson**

**Ballard**

**Barren**

**Bath**

**Bell**

**Boone**

**Bourbon**

**Boyd**

**Boyle**

**Bracken**

**Breathitt**

**Breckinridge**

**Bullitt**

**Butler**

**Caldwell**

**Calloway**

**Campbell**

**Carlisle**

**Carroll**

**Carter**

**Casey**

**Christian**

**Clark**

**Clay**

**Clinton**

**Crittenden**

**Cumberland**

**Daviess**

**Edmonson**

**Elliott**

**Estill**

**Fayette**

**Fleming**

**Floyd**

**Franklin**

**Fulton**

**Gallatin**

**Garrard**

**Grant**

**Graves**

**Grayson**

**Green**

**Greenup**

**Hancock**

**Hardin**

**Harlan**

**Harrison**

**Hart**

**Henderson**

**Henry**

**Hickman**

**Hopkins**

**Jackson**

**Jefferson**

**Jessamine**

**Johnson**

**Kenton**

**Knott**

**Knox**

**Larue**

**Laurel**

**Lawrence**

**Lee**

**Leslie**

**Letcher**

**Lewis**

**Lincoln**

**Livingston**

**Logan**

**Lyon**

**McCracken**

**McCreary**

**Mclean**

**Madison**

**Magoffin**

**Marion**

**Marshall**

**Martin**

**Mason**

**Meade**

**Menifee**

**Mercer**

**Metcalfe**

**Monroe**

**Montgomery**

**Morgan**

**Muhlenberg**

**Nelson**

**Nicholas**

**Ohio**

**Oldham**

**Owen**

**Owsley**

**Pendleton**

**Perry**

**Pike**

**Powell**

**Pulaski**

**Robertson**

**Rockcastle**

**Rowan**

**Russell**

**Scott**

**Shelby**

**Simpson**

**Spencer**

**Taylor**

**Todd**

**Trigg**

**Trimble**

**Union**

**Warren**

**Washington**

**Wayne**

**Webster**

**Whitley**

**Wolfe**

**Woodford**

- 12 Counties fully served
-  6 Counties partially served

- The program started with a staff of 34 serving 18 counties

*Prepared by: UK Center for Rural Health*

## Family Health Care Advisors

- The plan was to hire people from the affected communities and train them to be Family Healthcare Advisors (FHCAs).
- Train these lay health workers in home visiting, safety, assessments, preventative care, diseases and access issues.
- These FHCAs would then provide a variety of health and social services to people living in their communities.

## Lay Health Worker Training includes:

- Home visitation
- Performing needs assessments
- Acting as liaison between clients and providers
- Establishing action plans for clients and families
- Data entry and use of MIS tracking system

## KY Homeplace Today

- 52 Employees ( including administrative)
- Expansion into 59 Rural Counties
- $1.9 Million annually from the Kentucky Cabinet of Health Services
- March 2002 received the KY Public Health Association Group Award
- Twice nominated for the Innovations in American Government Award
- Review by Brandeis University as a Model that works for the Center for Medicare and Medicaid Services (CMS)
- Participate in the National Survey of Lay Health Worker Programs conducted by Texas A&M University System Health Science Center for HRSA.

## Kentucky Homeplace Statewide Service Area

***October 2003***

**Adair**

**Allen**

**Anderson**

**Ballard**

**Barren**

**Bath**

**Bell**

**Boone**

**Bourbon**

**Boyd**

**Boyle**

**Bracken**

**Breathitt**

**Breckinridge**

**Bullitt**

**Butler**

**Caldwell**

**Calloway**

**Campbell**

**Carlisle**

**Carroll**

**Carter**

**Casey**

**Christian**

**Clark**

**Clay**

**Clinton**

**Crittenden**

**Cumberland**

**Daviess**

**Edmonson**

**Elliott**

**Estill**

**Fayette**

**Fleming**

**Floyd**

**Franklin**

**Fulton**

**Gallatin**

**Garrard**

**Grant**

**Graves**

**Grayson**

**Green**

**Greenup**

**Hancock**

**Hardin**

**Harlan**

**Harrison**

**Hart**

**Henderson**

**Henry**

**Hickman**

**Hopkins**

**Jackson**

**Jefferson**

**Jessamine**

**Johnson**

**Kenton**

**Knott**

**Knox**

**Larue**

**Laurel**

**Lawrence**

**Lee**

**Leslie**

**Letcher**

**Lewis**

**Lincoln**

**Livingston**

**Logan**

**Lyon**

**Mccracken**

**Mccreary**

**Mclean**

**Madison**

**Magoffin**

**Marion**

**Marshall**

**Martin**

**Mason**

**Meade**

**Menifee**

**Mercer**

**Metcalfe**

**Monroe**

**Montgomery**

**Morgan**

**Muhlenberg**

**Nelson**

**Nicholas**

**Ohio**

**Oldham**

**Owen**

**Owsley**

**Pendleton**

**Perry**

**Pike**

**Powell**

**Pulaski**

**Robertson**

**Rockcastle**

**Rowan**

**Russell**

**Scott**

**Shelby**

**Simpson**

**Spencer**

**Taylor**

**Todd**

**Trigg**

**Trimble**

**Union**

**Warren**

**Washington**

**Wayne**

**Webster**

**Whitley**

**Wolfe**

**Woodford**

- Purchase		16 counties

- South Central	10 counties

- Southern 		11 counties

- Northeast		13 counties

- Southeast	09 counties

*Prepared by: UK Center for Rural Health*

- Total		59 counties

## Lay Health Workers

- Step One - Home Visit
- Complete a family health care needs assessment.
- Complete plan of action
- Access primary providers, medications and/or medical supplies. (eye glasses and hearing aids)
- Provide or access education  on their illness
- Encourage clients to have regular medical check ups
- Encourage clients to seek Preventative Care

## HOME VISITING

## Slide 13

## Slide 14

## Kentucky HomeplaceCost Analysis per Client

## Slide 16

## Slide 17

## Slide 18

## A joint endeavor of:

**A joint endeavor of:**
**UK Center for Rural Health,**
**Harlan Countians for a Healthier Community, Hazard Perry County Community Ministries, and**
**Good Samaritan Foundation, Inc.**

## Southeast Kentucky Community Access Program (SKYCAP) Service Area

**Harlan County**

**Perry County**

**Leslie County**

**Knott County**

- Knott and Leslie Counties added July 1, 2002, sponsored by the Good Samaritan Foundation, Inc.

## Two unique features ofthe SKYCAP program are:

- Family Health Navigators (FHN)
- Management Information System (MIS)

## Family Health Navigators

- Increase access to the pharmaceutical, medical, housing, transportation, education and environmental needs of the under and uninsured.
- Develop care plans with the clients under the direction of the medical and clinical directors.

## Ambulatory CareSensitive Diseases 

- Asthma
- Diabetes
- Heart Disease
- Hypertension
- Mental Illness

## Benchmarks Identified for Target Population Case Review

- Emergency room utilization
- Hospitalizations
- Pharmaceutical Access
- Health Outcomes
- Environmental Factors

## Results of Case Management

- Medical Home Established
- Access to Pharmaceuticals
- Quality of Care Improved
- Reduced ER Visits
- Reduced Hospitalizations

## Functions of Management Information System

- Links providers
- Tracks target population
- Implements a common client record
- Provides data to measure outcomes
- Multiple data entry points
- Holistic Tracking of Health, Environmental, Social, and Educational Issues

## Pharmaceuticals = $2.270,683
Primary Care Visits =243,116
Dental Visits = $14,930
Eye Care = $10,192
Medical Supplies = $6,605
Housing/Living Assistance $8,313
Total = $2,880,441

- Pharmaceuticals = $2.270,683
- Primary Care Visits =243,116
- Dental Visits = $14,930
- Eye Care = $10,192
- Medical Supplies = $6,605
- Housing/Living Assistance $8,313
**Total = $2,880,441**

## Disease Self-Case Management Reported By Primary Care Disease

| Disease  | Open Cases Level I | Open Cases Level II | Open Cases Level III  | Closed Cases | Total Case
Management  |
| --- | --- | --- | --- | --- | --- |
| Asthma | 4 | 13 | 62 | 32 | 111 |
| Diabetes | 20 | 39 | 154 | 103 | 316 |
| Heart Disease | 26 | 32 | 136 | 94 | 288 |
| Hypertension | 15 | 32 | 203 | 97 | 347 |
| Mental Illness | 12 | 9 | 124 | 56 | 201 |
| Total | 77 | 125 | 679 | 382 | 1,263 |

## Disease Self-Management Cases Reported by Disease *Client s reflect more than one disease reported

| Disease | Open Cases  | Closed | Total |
| --- | --- | --- | --- |
| Asthma | 135 | 82 | 217 |
| Diabetes | 298 | 151 | 449 |
| Heart Disease | 324 | 186 | 510 |
| Hypertension | 522 | 268 | 790 |
| Mental Illness | 253 | 110 | 363 |
| Other | 472 | 98 | 570 |
| Total | 2004 | 895 | 2899 |

## Impact of SKYCAP ServicesHarlan ARH ServicesHarlan County, KY

| Time Period | Closed
Harlan
County | Total
Patients
Utilizing | Total
SKYCAP
Patients
Utilizing |  Average
Visit
Per Patient  | Average
Visit Per
Closed
SKYCAP
Case |
| --- | --- | --- | --- | --- | --- |
| 1/1/2001 - 6/30/2001 | 165 | 103 | 484 |       4.70  |       2.93  |
|   |   |   |   |   |   |
| 7/1/2001 - 12/31/2001 | 183 | 115 | 413 |       3.59  |       2.26  |
|   |   |   |   |   |   |
| 1/1/2002 - 6/30/2002 | 241 | 157 | 500 |       3.18  |       2.07  |
|   |   |   |   |   |   |
| 7/1/2002 - 12/31/2002 | 243 | 137 | 521 |       3.80  |       2.14  |
|   |   |   |   |   |   |
| Average | 208 | 128 | 480 |       3.82  |       2.35  |

## Impact of SKYCAP ServicesHazard ARH ServicesPerry County, KY

| Time Period | Closed
Harlan
County | Total
Patients
Utilizing | Total
SKYCAP
Patients
Utilizing |  Average
Visit
Per Patient  | Average
Visit Per
Closed
SKYCAP
Case |
| --- | --- | --- | --- | --- | --- |
| 1/1/2001 - 6/30/2001 | 108 | 63 | 317 |    5.03  |    2.94  |
|   |   |   |   |   |   |
| 7/1/2001 - 12/31/2001 | 130 | 76 | 301 |    3.96  |    2.32  |
|   |   |   |   |   |   |
| 1/1/2002 - 6/30/2002 | 156 | 89 | 438 |    4.92  |    2.81  |
|   |   |   |   |   |   |
| 7/1/2002 - 12/31/2002 | 169 | 85 | 333 |    3.92  |    1.97  |
|   |   |   |   |   |   |
| Average | 141 | 78 | 347 |    4.46  |    2.51  |

## Slide 32

## Slide 33

## Slide 34

## Slide 35

## Working together we can find solutions to improve access to health care, housing, education and social services for the under/uninsured population.

**Working together we can find solutions to improve access to health care, housing, education and social services for the under/uninsured population.**