ADVENTIST HEALTH VALLEJO

1. Top 10 Disparities

2. Equity Plan

HEALTHCARE EQUITY ACTION PLAN
Addressing Disparities in Medicare & Male Patient Readmissions
A review of hospital data identified two key disparities in 30-day unplanned psychiatric readmissions: (1) patients with Medicare as their expected payer and (2) patients whose sex assigned at birth is male. This plan outlines targeted strategies to improve discharge communication, ensure medication continuity, strengthen follow-up access, and expand step-down support.
Population Impact:
Medicare patients experience limited outpatient behavioral-health access due to insurance network restrictions, while male patients show higher relapse and crisis-driven returns. Improving clarity at discharge, ensuring reliable medication access, and strengthening community follow-up planning are expected to reduce readmission risk for both groups.
Objective:
Reduce 30-day unplanned psychiatric readmissions for Medicare and male patients by 10% within 12 months.
1. Strengthened Discharge Communication
Patients sign the facility’s discharge instruction page confirming that medications, follow-up expectations, and discharge information were clearly explained. Staff will provide enhanced clarification for Medicare and male patients, emphasizing medication purpose, dosing, relapse warning signs, and crisis/safety planning.
2. Improved After-Care Coordination & 7-Day Follow-Up
All Medicare and male patients will be discharged with a confirmed outpatient appointment scheduled within 7 days. Social Services will verify Medicare acceptance and identify alternatives when access barriers occur.
For medication continuity, prescriptions will be routed to a local pharmacy whenever possible. If pharmacy access or insurance delays occur, Gateway will deliver a 7–30 day supply of medications directly to the unit prior to discharge so the patient can take them home.
A county-specific directory of behavioral-health services, including Medicare-accepting psychiatrists, therapists, outpatient programs, PHP/IOP, crisis services, peer support, and substance-use resources, will be created and shared with all Social Services/Discharge Planners. The directory will be updated quarterly to support efficient and appropriate referrals.
Goal: =80% 7-day follow-up appointment completion.


3. Teach-Back to Validate Patient Understanding
Clinical staff will use the teach-back method to confirm patient understanding of medications, follow-up plans. Documentation will occur during the discharge process and is reinforced by the patient-signed discharge instruction page.
4. County-Based Resource Directory Supporting Both Disparity Groups
To address access barriers affecting both Medicare beneficiaries and male patients with higher readmission risk, the hospital will develop a county-specific directory of behavioral-health services. This directory will include Medicare-accepting psychiatrists, therapists, outpatient clinics, PHP/IOP programs, crisis services, peer support, substance-use treatment programs, and other community-based resources.
As part of equity-focused planning, the directory will also identify gender-specific or male-focused services in counties where they exist (e.g., men’s therapy groups, male-focused trauma programs, men’s wellness support, substance-use programs with male cohorts), as these resources may better support men at higher risk of relapse.
The completed directory will be shared with all Social Services/Discharge Planners and updated quarterly to ensure accurate, timely after-care referrals. This intervention supports continuity of care for both disparity groups by providing staff with an expanded network of appropriate and insurance-compatible follow-up options.

5. PHP/IOP Step-Down Program Integration
Clinically appropriate Medicare and male patients will be screened for PHP/IOP prior to discharge. Warm handoffs (virtual or in person) will be arranged, and next-day or same-week program entry will be offered when possible. Referral outcomes will be tracked to measure impact.
Goal: Increase PHP/IOP referrals for Medicare and male patients by 30% within 12 months.

Monitoring & Evaluation
Readmission rates, follow-up appointment completion, PHP/IOP referral outcomes, medication-continuity processes, and teach-back documentation will be reviewed every other month in the Performance Improvement Committee. Data will be stratified by payer type and sex assigned at birth. Interventions will be modified if improvement is not observed.


Unified Implementation Period:
October 2025–November 2026 (all interventions launched)
Evaluation Period: January–December 2026 (PI review every other month) **

3. Structural Measures

4. Web Address for Equity Report

https://www.adventisthealth.org/about-us/health-equity

5. Download Equity Measures Report

Click on the link below to download the equity measures report.

6. Looking for Related Reports?

• Hospital Supplier Diversity Plan
• Hospital Profile
• Hospital Fair Billing Policies