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Kristen West CHOICE Regional Health Network October 2003. Maximize Access and Coverage. A portfolio of best practices to provide better health for more people at less cost. Washington State. Mason. Grays Harbor. Mason Co. Department of Health Services.

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maximize access and coverage

Kristen West

CHOICE Regional Health Network

October 2003

Maximize Access and Coverage

A portfolio of best practices to provide better health for more people at less cost

our regional members

Washington State

Mason

Grays Harbor

Mason Co. Department

of Health Services

Grays Harbor Co. Health and Social Services Department

Mason General Hospital

Thurston Co. Health

& Social Services Department

Grays Harbor

Community Hospital

Peninsula Community Health Center

Mark Reed Hospital

Sea Mar Community Health Center

(Clinica de la Comunidad)

Thurston

Providence Centralia Hospital

Pacific Co. Public Health

& Social Services

Department

Willapa Harbor Hospital

Lewis

Providence Health and Education Center (RHC)

Pacific

Morton General Hospital

Lewis Co. Health Department

Our Regional Members

Providence St. Peter Hospital

Lewis Co. Department of

Health & Social Services

Morton General Hospital

16 000 low income people show us how broken the system is
16,000 low-income people show us how broken the system is

2003

2002

2001

Sad stories without happy endings

Happy Endings

play medical deity
What can geographic regions really do?

Focus on care delivered within region.

Be an experiment for fundamental restructuring of finance and delivery.

Assume existing limits.

Assume no limits.

Who do you target?

Every resident.

Low-income under age 65 below 250% of FPL.

Uninsured.

Where do you start?

How much money do we have to spend?

What service does everyone have a right to regardless of their ability to pay?

What improves health status?

How do you make insurance work better?

How bold and how soon?

Relieve immediate suffering.

Allow the system to collapse as quickly as possible and prepare to implement something brand new.

Sequential steps, growing in magnitude over a long planning horizon.

Play Medical Deity
by 2008 we will achieve 100 access to services we agree everyone has a right to
By 2008, we will achieve 100% access to services we agree everyone has a right to
  • 85,000 low-income people
    • 35% currently uninsured
    • 65% are in an unstable mix of public programs
    • 75% live in a home where one adult works
  • Access to prioritized services
    • Use health outcome evidence
    • Fully fund enhanced primary care and prevention from a community pot
    • Purchase catastrophic insurance
  • Will cost $187 million a year
    • Organize what’s currently spent: 80%
    • Reduce costs: 10%
    • New revenue: 10%
slide6

With Project by mid-2006

Medical Home, Full Access

Phased In Over Time

Medical

Home,

Full Access

Medical Home,

Not Full Access

Medical Home,

Not Full Access

No Medical

Home

No Medical Home

Without Project

100% Access

2008

six interdependent principles for achieving 100 access
Stabilize the safety-net.

Get small employers participating.

Deliver evidence-based and patient-focused care through health teams.

Enroll people with limited incomes in a medical home.

Reduce costs and redirect savings to cover more people.

Purchase services of greater value to the community.

Six Interdependent Principles for Achieving 100% Access
the power of the portfolio

The Power of the Portfolio

Intersect, align and reinforce contributions (like a Lego set)

slide11

Buncombe/Spokane Project Access

Muskegon 3-Share

Galveston Jesse Tree

CHOICE RAP

Arizona PCAP

Seattle Kids Get Care

Portfolio of Best Practices

Kentucky SKYCap

Utah Access Health

slide12

Buncombe/ Spokane

Project Access

Galveston Jesse Tree

Muskegon 3-Share

CHOICE RAP

Arizona PCAP

Organize care, acknowledge practitioners contribution and enhance well-being and access as a negotiable community asset

Creates a local infrastructure for 100% access

Human service providers use a common web-based, highly leveraged community resource referral system

Incent small employers to

financially contribute for low-wage workers

Facilitate enrollment in programs and access to medical home, specialists and interpreting services

slide13

A system emerges

Project Access

Care coordination, billing and accounting, provider contracting

Quantify and use value of donated resources as a negotiable asset

Assess-ment

Client enrollment

and coordinated referrals along the continuum

Jesse Tree/ 211

Disease mgmt

Rx assist

ER case mgmt

3-Share

Universal application, complex casework, referral directory

Outreach

Employer/ employee coverage advice

CHOICE Regional

PCAP

slide14

Health Policy

What services does everyone have a right to?

How will we pay for this?

Integrate funding and programs then move decisions to the community level

Develop and recognize local capacity

Community resource referral system integrated

Patients easily connected to programs and services

Small employers

financially contribute voluntarily

Practitioners each treat their fair share of low-income

Health outcomes improved

Cost of direct care reduced

Parallel and interdependent processes

What mix of best practices exist or need to be implemented to strengthen your local capacity?

you can pay for 100 access if you
You can pay for 100% Access if you…
  • Combine and use what’s already being spent:
    • Directly, through public programs
    • Indirectly, through uncompensated care
  • Reduce the cost of care and capture savings:
    • Less fragmentation
    • Less administration
  • Augment with new revenue:
    • Additional Medicaid reimbursement
    • Employers
    • Consumers
get started today
Get started today!
  • Be in action campaign mode:
    • Create abundance through offers and requests
    • Be clear about the what and let go of the how
    • Don’t let criticism veto action
  • Guide resources to local activity.
  • Protect the vision.
  • Boost local champions.
group discussion questions

Group Discussion Questions

What portfolio of best practices could you put together?

Are you willing to declare yourself the portfolio manager?

What do you need from whom to get started?

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