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Community Access Collaboratives: Acting Locally and Advocating Regionally and Nationally to Improve Healthcare Access

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Community Access Collaboratives: Acting Locally and Advocating Regionally and Nationally to Improve Healthcare Access Touching Lives, Healing Communities ~ June 19, 2007 Catholic Health Association Whatcom County Community Outreach /Mission Integration Focus Areas

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slide1

Community Access Collaboratives: Acting Locally and Advocating Regionally and Nationally to Improve Healthcare Access

Touching Lives, Healing Communities ~ June 19, 2007

Catholic Health Association

slide3

Community Outreach /Mission Integration

Focus Areas

  • Needs of the poor, underserved and at risk populations
  • Collaborative programmatic responses to community needs
  • Integration of the social mission of St. Joseph Hospital/ PeaceHealth with the organizational goals and actions of the hospital
slide4

A Continuum of Organizational Involvement

Networking

Coordination

Cooperation

Collaboration

Exchanging information for mutual benefit.

Exchanging information and altering activities for mutual benefit, and to achieve a common purpose.

Exchanging information and altering activities, and sharing resources, for mutual benefit and to achieve a common purpose.

Exchanging information and altering activities, and enhancing the capacity of another,for mutual benefit and to achieve a common purpose.

Developer’s Guide to Community Health Networks

Washington Health Foundation

slide5

Community Benefit Core Principles

  • Emphasis on disproportionate unmet health-related needs
  • Emphasis on primary prevention
  • Build a seamless continuum of care
  • Build community capacity
  • Emphasis on collaborative governance
slide6

Acting Locally - Advocating Regionally & Nationally

  • Community Access Collaboratives and WAHA
  • Types of Advocacy
  • Health Policy Committee and the “community voice”
  • Communities Connect
  • Examples
  • Lessons learned
slide8

100% Access, 0% Disparity

  • Flows from Healthy People 2010
  • Bureau of Primary Health campaign
  • Federal Community Access Program (CAP) grants
slide9

Communities Access Program - CAP Funding

  • U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA) funding
  • Provides three years funding for communities and consortia of health care providers
  • Aimed at developing or strengthening integrated community health care delivery systems that coordinate health care services for individuals who are uninsured or underinsured
slide10

September, 2004: CAP Grant Rejected

November, 2004: WAHA Steering Committee commits to moving ahead with strategic direction outlined in CAP grant

slide11

Community involvement from the start

An alliance of Whatcom County community leaders and health care organizations committed to acting locally and advocating regionally to improve health care access

Summit attended by over 200 people including health care providers and patients, and representatives of the governmental, nonprofit and business sectors

slide12

Community Access Collaborative Roles

  • Neutral Convener
  • Organizational Sponsors
  • Community Stakeholders
slide13

Physician Recruitment

Physician Recruitment

Physician Recruitment

Physician Recruitment

and Retention

and Retention

and Retention

and Retention

Major Tracks, Initiatives, and Institutional Sponsors

Legislative Education

Legislative Education

Whatcom Project Access

Whatcom Project Access

Health Care Policy

Legislative Education

Whatcom Project Access

Coverage and care

and Advocacy

and Advocacy

Education

and Advocacy

  • Community assessments and long term planning
  • Collaborative recruitment
  • Business consulting services for eligible physician practices
  • Credentialing Improvement Group
  • Enrollment in public insurance programs
  • Access coordination / “medical home” advocacy and follow-up assistance
  • Specialty Care Access Network
  • Incentives for private practice involvement in community safety net care
  • Small scale pilots with DSHS aimed at reducing admin burden on physician offices
slide16

Whatcom County Safety Net Care

Non-profit public

  • 2 Community Health Centers
  • Tribal Health Clinics
  • Center for Senior Health
  • One hospital
  • Family practice physicians (FCN)
  • One large multi-specialty group (Madrona)
  • Medium sized and smaller specialty practices

Private

slide17

Trends in Use of Free and Reduced Lunch Programs, Whatcom County School Districts, 1998-2002

Source: Washington State OSPI

slide18

ED Summary Findings

  • Overall ED volumes are increasing
  • 40% “non-emergent”
  • Half of non-emergent are Medicaid/ uninsured
  • Medicaid/ uninsured tend to be young adults and children
  • Behavioral health and chronic disease patients represent 30% of total visits, (15% respectively)
access improvement project focus groups
Access Improvement ProjectFocus Groups

53 people interviewed - Fall 2003

  • Community Clinic leadership
  • Primary care physicians
  • Physician specialists
  • Managed care coordinators
  • Support staff
  • Hospital: Emergency Dept, Patient Billing; Social Work & Pharmacy
  • Social service and advocacy groups
  • Schools
  • Patients

Questions:

  • How do policies and practices limit care access?
  • What are the impacts?
  • What ideas do you have for improving the system?
access improvement project key findings
Access Improvement ProjectKey Findings:
  • Access to primary care and specialists is shrinking
  • People utilize high-cost emergency services for non-emergent care.
  • Cost savings by the State shifts costs to providers
conclusion the system is broken
Conclusion: The System Is Broken
  • Physicians are stretched and being forced to make choices between financial viability and providing health care for people who need it
  • Relationships are becoming strained
  • Fragmentation of care is disrupting patient-provider relationships, and reducing quality of care
slide22

Private physicians are for-profit small businesses who are expected to participate in a social contract to care for underserved at rates below costs.

Preserving Private Medical Practice Involvement in the Community Safety Net Care

Major Driver

slide24

Whatcom Alliance for Healthcare Access

From informal workgroups to non-profit corporation…

slide25

Leadership Board

  • Private physicians
  • Payers
  • Hospital
  • Faith Community
  • Community and tribal health centers
  • Public health department
  • Area Agency on Aging
  • Schools
  • Patients
  • Philanthropy
slide27

WAHA Objectives

  • Connect people to health insurance and care
  • Support ongoing private practice involvement in the community safety-net
slide28

Incremental improvementAND System Overhaul

“Covering the uninsured…is the dominant but unexamined moral frame for those seek health care reform… I propose that we frame reform in terms of the system, not symptom, along these lines:

Create the system we never built”

John Glaser, STD

ACCESS

COST

QUALITY

slide29

Programs & Initiatives

  • Insurance and Care Connection
  • Whatcom Project Access
  • Ongoing assessment of workforce
  • Collaborative recruitment
  • Nonpartisan analysis
  • Convene community leaders, stakeholders and elected officials
slide30

WAHA Connection Services

Hospital /

ED and PBS

  • Screen for Medicaid and Basic Health
  • Provide commercial insurance information
  • Offer assistance with application paperwork
  • Help securing a medical home

Schools

Small Businesses

Medical Practices

slide33

Whatcom Project Access

  • Equitably distributes referrals
  • Provides nurse to coordinate specialist care w/ CHC
  • Provides for ancillary services & affordable Rx
  • Collects value of donated care
  • Recruits volunteer physicians
  • Provides medical oversight
slide35

Meeting client needs and advocating for system change

Accomplishments “on the ground”

Effect at the policy level

slide36

Health Insurance & Care Connection Services

  • Schools
  • Hospital ED
  • Small Business
  • 3.0 FTE (includes Coord.)
  • 1.0 FTE DSHS Out Stationed
  • Financial Services Specialist

Project Access

Nurse care coord .75 FTE

Service coord .50

+ WCMS contract Medical Director

Leadership Board of Directors

Health Policy Education

Executive Committee

Leadership and Development Facilitators Sue and Chris

Community Engagement, Evaluation and Strategic Planning

Program Manager

Admin Coordinator .75 FTE

Physician Recruitment andRetention .6 FTE

WAHA Volunteer and Internship Program

SHIBA HelpLine .50 FTE

Special projects .75 FTE

15 Volunteers & interns

slide37

Types of “Advocacy”

  • Securing resources
  • Community voice to large legislative issues
  • Helping shape state agency policy implementation
slide38

Provide information for decision makers about legislative impacts in our community

  • Educate the community about policy issues effecting health care access for people in Whatcom County

Health Policy Committee

  • Focus on impacts of legislation
  • No position on candidates or ballot initiatives
slide39

Legislative Impacts for Elected Officials

  • Conduct briefings
  • Sponsor study groups
  • Develop comprehensive policy papers
  • Organize public testimony upon request 
slide40

Policy Engagement with the Community

  • Community Forums
  • Op Ed page
  • Public access television
  • Web site
  • Electronic newsletter
slide41

Statewide association of community-based access coalitions

  • Promotes the sharing of best practices across the state
  • Articulate effect of state policies on local access with combined voice of 28 of the 39 counties in Washington State.
slide43

Medicare Reimbursement

  • The impact is having a ripple affect in our community in several ways:
  • Physicians are being asked to treat more Medicare patients when they don’t have the capacity to meet the needs of the current Medicare population
  • Eroding physician access is forcing people into high cost emergency rooms
  • The area’s low reimbursement rates are affecting the community’s ability to recruit and retain needed quality professionals
slide44

Why weigh in on the big issuese.g., Medicare reimbursements?

  • Accumulation of input will reframe discussion from special interests to public interests
  • Lends voice to annual drive to roll back (default) Medicare cuts
slide45

Supporting private practice involvement in safety net care:B & O Tax Credits

  • Private physicians would be on par with other healthcare providers caring for the same population (e.g., non profit hospitals)
  • Cost effective way of acknowledging the contribution of private providers who maintain community safety net involvement

“WAHA did more in one year on this issue than we did in four”

WSMA member

slide46

Community Healthcare Collaborative Grant Program

  • $1.2 million in new grant funds
  • Significant local match
  • WAHA received $200,000

“When its all said and done, what we do is fund things… and solutions to the health care mess will come from the local level”. Republican Senator

“The Community Collaboratives help us understand the unintended consequences of state bills on communities” Democratic Representative

slide47

Why they like us

  • We’re not whiners; we offer solutions
  • Community voice lends political cover for positions they’d like to take but are constrained by party
  • Constituent service
  • Direct feedback on impact of agency rules and legislation
slide48

Helping Shape State Agency Policy Implementation

SB 5093 Cover All Kids

  • Eligibility Changes Workgroup
  • Outreach, health education and system linkages
  • Medical home and performance based contracting
  • Program Effectiveness/Audit
  • SCHIP Expansion and over 300% buy in program
  • SCHIP Reauthorization/federal issues
slide49

What makes it work

  • Community vs. special interest view
  • Groups working together locally that don’t on a state level
  • State-wide reach
  • Bi-partisan in spirit and action
  • Credit given is better than credit taken
  • Leverages public/private resources
  • Acting locally…
slide51

8 Critical Activities

Safety Net Care that Costs Less and Provides Better Care for More People

  • 1. Outreach for publicly subsidized health insurance programs
  • 2. Provide medical homes and coordinated services
  • 3. Guarantee affordable prescription drugs
  • 4. Ensure chronic disease management services
  • 5. Work with business to offer coverage for low-wage workers
  • 6. Organize donated health care services
  • 7. Prioritize prevention and wellness services
  • 8. Assess health status, disparities, and effectiveness of services