Public health restored in New Orleans
It was a task that extended beyond hammers and nails. After the blow of Hurricane Katrina in 2005, the greater New Orleans area was faced with the challenge of rebuilding its internal public health structure - beyond the material repair of roofs and floors, waiting rooms and patient rooms.
"We say down here that New Orleans is a preeminent laboratory for innovation and change, and it has been since we lifted ourselves up after Hurricane Katrina," said New Orleans City Health Commissioner Karen DeSalvo.
So with many of the physical sites of its health community inoperative, leaders at the Louisiana Public Health Institute were faced with the question: "What do we want our community's public health system to look like moving forward?"
"There were two major pieces of how the system was built: One was a focus on providing care close to where people live and work, so it developed a community health center approach," said Anjum Khurshid, director of Crescent City Beacon Community (CCBC) and director of the Health Systems Division at Louisiana Public Health Institute (LPHI). "This approach focused on providing access to the most necessary primary care services in the neighborhoods of greater New Orleans."
The second facet was LPHI's work to incorporate the new technology that was beginning to mark the healthcare field into its primary care practices, and coordinating with providers to learn and utilize the latest advancement in IT, DeSalvo and Khurshid both emphasized.
Aligning the rebirth of its public health upon the axes of community engagement and advanced technology made the greater New Orleans area "a strong candidate to demonstrate how these things can work together to improve health outcomes," said Khurshid.
And such a candidate was exactly what the Office of the National Coordinator (ONC) was looking for when it christened the greater New Orleans area "Crescent City Beacon Community (CCBC)" in 2010. The ONC-funded program is a federal initiative designed to emphasize how health IT and patient-centered care can lower cost and improve a community's health; it provides 17 selected communities throughout the country $250 million over three years to build IT infrastructure, develop new approaches and convert health IT investments into lower costs and care improvement.
As a Beacon, CCBC has built upon the already-established bases of patient engagement and put an emphasis on IT implementation, says Nebeyou Abebe, project manager for the Crescent City Beacon Community and associate director of LPHI's Health Systems Division.
"I can't underscore the importance of community collaboration and engagement enough," he said. "This is not an LPHI initiative, this is a community initiative. I think that's one of the reasons we've been so successful."
CCBC is marked by three distinct goals: the improvement of care for chronic disease patients in patient-centered medical homes, the reduction of healthcare costs through streamlined care and the wielding of health IT to engage consumers in their health.
Among an array of methods, engagement between patients and their health - and the fostering of patient-centered medical homes - is being triggered by LPHI through the introduction of the city's first health information exchange system, an information service known as txt4health, and consistent coordination with community members.
The 14-week txt4health program highlights CCBC's solidified engagement with consumers. The program is designed to inform users about their risk for type 2 diabetes.
The program itself was crafted with input from an advisory board composed of community providers, sponsors and consumers, said Abebe. "So from the very beginning, this community advisory board - which was very diverse, had public, private and government representatives - was working together to curb the diabetes epidemic in Greater New Orleans, and now we're planning to scale it up statewide."
Because CCBC operates with this sort of heightened communication between community members and designers, DeSalvo and Khurshid draw upon the term "collaborative environment" to describe the beacon's strengths. By working alongside users and beneficiaries in the design and planning processes of CCBC, Khurshid says, they've established trust; players in the realm of New Orleans' public health know the changes are tailored to their use and benefit.
"We've been engaging with powerful work to change the way we deliver care and work with each other," said DeSalvo. "The Beacon Program is a national layer underneath that to make sure that we can advance the culture change and the data opportunities to improve the health of everybody."
Khurshid is looking to extend the very model of CCBC to other communities - even across the nation - as a true beacon built on community engagement: "Now we have developed in New Orleans what I would consider potentially one of the most advanced systems to coordinate care that engages the patient," he said. n