SAINT JOHN’S HEALTH CENTER

1. Top 10 Disparities

2. Equity Plan

Saint John's Health Center is dedicated to advancing health equity and addressing disparities in care. Our primary focus is on reducing unplanned hospital readmission rates, particularly among the unhoused population facing unique challenges. In collaboration with Venice Family Clinic, we implement initiatives that ensure seamless transitions and referrals for both medical and behavioral health needs. Through strategic interventions and community collaboration, we are committed to ensuring that every patient receives the care they need and deserve. Priority Area 1: All-Cause Unplanned 30-Day Hospital Readmission Rate, by Behavioral Health Diagnosis (No Behavioral Health Disorders) - Disparity between Medicare and Other Insurance Types vs. Private Insurance Payor Types Addressing disparities in readmission rates among different insurance types, particularly Medicare versus private insurance, requires comprehensive solutions. Patients with Medicare often encounter barriers leading to higher readmission rates, including coverage limitations, reduced access to primary and specialist care, and financial constraints impacting follow-up care and treatment adherence. Our strategy emphasizes securing equitable follow-up care, aiming for a 15% improvement in appointment scheduling prior to discharge. Collaboration with Venice Family Clinic enhances access to behavioral health resources, allowing us to offer integrated services that significantly impact readmission rates. Additionally, advocacy for policy changes supports improved insurance coverage and access for underserved groups, aiming to reduce systemic disparities and create a more equitable healthcare environment. Priority Area 2: HCAI All-Cause Unplanned 30-Day Hospital Readmission Rate for Patients Aged 65 and Older and 50 and Older vs. Younger Age Groups The disparity in readmission rates between older adults and younger populations underscores the challenges faced by senior patients. Older adults, particularly those 65+, contend with chronic conditions, medication management issues, and coordinated care needs that younger patients may not require. Social determinants such as housing, transportation, and social support networks significantly influence healthcare outcomes for this demographic. Our strategy involves enhanced care coordination tailored for older adults, including comprehensive discharge planning, securing outpatient follow-up appointments, and medication management to prevent complications leading to readmissions. By empowering patients with tools for effective health management at home, we aim to enhance person-centered care and ensure continuous, compassionate support. Priority Area 3: HCAI All-Cause Unplanned 30-Day Hospital Readmission Rate for Patients with Medicare Insurance vs. Private Payor Insurance Reducing readmission rates for Medicare patients compared to those with private insurance involves addressing systemic barriers in access to care. Medicare patients often experience fragmented care and unmet health needs due to challenges such as limited coverage, longer wait times for appointments, and a lack of personalized care coordination. Our approach develops strategies for enhancing care continuity and follow-up appointment scheduling, targeting a 15% improvement in these metrics for unhoused patients. Collaboration with Venice Family Clinic is pivotal, providing seamless transitions and referrals for medical and behavioral health needs. This partnership allows us to leverage resources and expertise to offer comprehensive care addressing the diverse needs of Medicare patients, particularly those without stable housing. Our advocacy focuses on policy changes to improve coverage options and access to essential services for Medicare patients. Cross-Cutting Strategies and Initiatives: Our overarching strategies address common challenges and promote health equity across all domains: 1. Community Collaboration: Working with Venice Family Clinic and other partners enhances coordinated care and addresses social determinants of health beyond the hospital setting. 2. Data-Driven Decision Making: Outcomes data guide interventions and strategic planning tailored to meet the specific needs of our community. 3. Patient Empowerment and Engagement: Educating patients about their health conditions and involving them in care planning fosters engagement, empowerment, and shared decision-making. 4. Advocacy and Policy Change: Influencing policy changes at local, state, and national levels supports improved coverage and access to care for vulnerable populations. 5. Technology Integration: Utilizing technology for efficient care coordination and patient engagement with tools like telehealth, electronic health records, and data analytics.

3. Structural Measures

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 Fair Billing Policies
• Hospital Profile