The title for my submission is as follows “Integrating innovative platforms for healthcare reform into Community Based Organizations to empower these organizations to create interdisciplinary teams to tackle high rates for chronic and mental illnesses in large Urban Communities.” This would require the utilization of existing and creation of small clinics in communities in need; where the patient can receive care and have all needs met by an interdisciplinary team of physicians, specialists, social workers and psychologists. The community based platform would make healthcare more accessible and individuals who often struggle with mental health issues as a result of chronic illnesses will be able to access social services and mental health services in one place. This program would be a “one stop” for all healthcare needs and social service needs and wo uld have significant measurable outcomes in both benefit and entitlement access and healthier individuals. The core of the current problem is that most individuals with chronic illnesses go to the hospital for treatment when they have Medicaid or are a dual eligible. Often times the individual may wait long hours may leave out of frustration and often times lack any consistent care in regards to physician or provider. Additionally many individuals living with chronic illnesses may develop mental health problems, such as depression as a result of their chronic illness. They may not be able to work any longer and need help applying for disability, fighting a denial from disability, applying for foods stamps. These items are often not addressed in large City hospitals where the chronically ill population may go for care, especially individuals who do not have an HMO or PPO. Integrating a team of professionals will address all individual needs of a community and could truly gro w to be a model program. Many “one stop” social service programs exist that assist with basic benefits and entitlements and referrals for mental health services or physicians but clients often do not follow up with the healthcare providers. If these services are in one place patients can access an all-encompassing approach to treatment, care and social services The outcomes would be measured by patients medical outcomes and control of chronic illness and success access to all benefits and entitlements.
