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Strategy for Implementation and Celebrating our Success

Strategy for Implementation and Celebrating our Success. BRTF informing Health Management Associates Recommendations.

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Strategy for Implementation and Celebrating our Success

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  1. Strategy for Implementation and Celebrating our Success

  2. BRTF informing Health Management Associates Recommendations • “The Blue Ribbon Task Force has brought the key players to the table” and “there appears to be a willingness by most stakeholders to move to [the] next step” of a “focus on the delivery system[s].” • “The County should take the lead in fashioning a new, sustainable and creative approach to healthcare delivery” … …developing a health care network that “makes use of the County’s own delivery system and programs as well as brings commitment from the private sector providers.” • HPSM is “well positioned to play a primary role in the administration of the coverage initiative <which is designed as the BRTF pilot>.” “Medical services… should be prioritized and coordinated around a chronic disease management approach as the central focus.”

  3. Health Management Associates Informing BRTF Implementation Structure Health System Redesign Initiative: • County Manager’s Office • Health Department • San Mateo Medical Center • Health Plan of San Mateo Community Health Network for the Underserved: • Commitment and participation from all key delivery system partners • Opportunities for improved alignment of community resources

  4. Community Council Prepared to “Take On” Local Revenue Strategy Creation of the Community Council: • Peninsula Interfaith Action • Central Labor Council • Legal Aid Society • ACORN

  5. Framework for Implementation to Allow Coverage Expansion to 36-44,000 Adults • requiring a sustained long-term effort • Strong Delivery System Allows for: • Increased and Appropriate Access • Financial Viability • Leverage Competitive Advantage of All Partners for Community Goals • Seamless Coordination • Ease of Use for Clients • Capacity for Incremental Expansion (to more adults) • Maximized Coverage in Existing Programs Moving towards Coverage Expansion for Adults Unified and Coordinated System is Visible Appropriate Use of Health System Roles Community Exploration/Organizing of Public/Political Support for Long-Term Revenue Generation Community Coalition Leads Revenue Generation Mechanism Identified Sustainability and Capacity of Delivery System Implementation of BRTF Recommendations: “Unified Administration for Coverage” “Delivery System” Health Care Redesign Team: County Manager’s Office. San Mateo Medical Center, Health Department, Health Plan of San Mateo Implementation of BRTF Recommendations: “Coverage Expansion to 36-44,000 Adults” “Revenue Generation and Financing” All Health System Members Responsible: Health Care Redesign Team Monitors Implementation of BRTF Recommendations: “Coordinated Care Management” “Delivery System” Health Care Redesign Team: County Manager’s Office. San Mateo Medical Center, Health Department, Health Plan of San Mateo PHASE II: YEAR 2-3 (2009-10) San Mateo County’s Strong Safety-Net and Community Health Network for the Under Served “the house is in order” PHASE I: YEAR 1 (2008) Absent State-wide Reform, the entire local delivery system must be coordinated for sustainability “getting the house in order” PHASE III: YEAR 2-3 and beyond (2009-10) Safety-net and Delivery System Can Handle increased Volume with Appropriate Care and Access “full expansion viable”

  6. Celebrating our Successes

  7. Delivery System, Provider Capacity and Access • Kaiser has agreed to accept up to 360 pregnancies per year for prenatal care and delivery at Kaiser Redwood City • Palo Alto Medical Foundation (PAMF) has agreed to take up to 1500 HPSM members in all lines of business (the previous number of members assigned to PAMF was 500) • The San Mateo Medical Center and Ravenswood Family Health Center, as a partnership, were awarded the Kaiser Permanente Specialty Care Initiative Grant (for $150,000) in order to foster and strengthen community-based solutions to increase access and reduce demand for specialty care

  8. Unified Administration and Care Management • The HPSM established all processes and protocols required to serve as the Third Party Administrator (TPA) for the San Mateo ACE Program. • The HPSM TPA services began on February 1 allowing for: Uniform Information and Protection for Participants, Independent Financial Reporting and Quality Monitoring, Utilization and Care management • On February 5, the Board of Supervisors confirmed the County’s decision to continue its role in the delivery of healthcare services. If approved by the relevant governing boards, the County would direct its contribution to the Adult Coverage program (WELL and WELL-Fee Waiver) through the Health Plan of San Mateo.

  9. Coverage Expansion • San Mateo County was awarded a Health Coverage Initiative (HCI) grant from the State of California’s Hospital Financing Waiver ($7.5 million/year) • This program was named the San Mateo Access and Care for Everyone (ACE) Program. • The California Endowment (TCE) awarded a two year evaluation grant focused on: • the system roles, integration and effectiveness of the San Mateo ACE Program as the BRTF pilot • to make recommendations on the opportunities for further expansion

  10. Community Engagement and Consumer Voice • Peninsula Interfaith Action, the Central Labor Council, ACORN, Legal Aid and Ravenswood Family Health Center awarded funding through Silicon Valley Community Foundation, Blue Shield Foundation of California and The California Endowment to pursue local health reform • Chambers of Commerce and SamCEDA increased their participation in local health policy decisions, committees researching and considering their positions on health issues

  11. Sustainability and System Improvements • Health System Redesign Initiative created • The Initiative’s charge: “ Within two years, design and implement a new, sustainable and creative approach to healthcare delivery that incorporates key recommendations of the HMA Phase 2 Final Report and the recommendations of the Blue Ribbon Task Force on Adult Health Care Coverage Expansion”

  12. Keeping the BRTF Updated and Informed • March 25 HMA Implementation Strategy to Board of Supervisors • May 20 BRTF Planning Phase Recommendations to Board of Supervisors • October 2008 Update to Task Force • March 2009 Full Report Back to Task Force

  13. Places to “Weigh In” • Hospital Board Meetings • HPSM Consumer Advisory Committee • Mental Health Advisory Board, Commission on Disabilities, Commission on Aging • Peninsula Interfaith Action Health Allies

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