What s Covered Today

Transcription

1 HEALTH SEMINAR FOR NEWER LEGISLATORS Access to Health Care Services What s Covered Today Challenges in accessing health care services State strategies to address challenges: Scope of Practice Oral Health Rural Facilities Community Paramedicine Peer Support Specialists Telehealth Roundtable Discussion 1

2 Session Objectives Understand key challenges and barriers to access to care Identify state strategies to improve access to health care services for underserved populations What s the Problem? More than 100 million Americans live in a Health Professional Shortage Area (HPSA) More than three quarters of the nation s rural counties are HPSAs HPSAs are geographic areas, or populations within geographic areas, that lack sufficient health care providers to meet the health care needs of the area or population. (CMS, 2014) HPSAs include primary care, oral health and mental health Find HPSAs in your state: 2

3 What s Causing Workforce Shortages? Aging workforce and retiring practitioners Low number of graduating students who want to practice in rural or underserved urban areas Declining interest in certain fields for some providers (e.g., primary care physicians) Comparatively low reimbursement rates for certain services especially from public payers Lack of adequate training for certain issues and populations Primary Care HPSAs About 6,600 primary care HPSAs in the U.S. It would take over 9,000 additional providers to remove the HPSA designation 3

4 Dental Care HPSAs More than 51 million Americans live in the approximately 5,500 oral health HPSAs 4

5 Mental Health HPSAs There are currently about 4,600 mental health HPSAs More than 106 million people live in a mental health HPSA State Strategies 5

6 Scope of Practice Scope of Practice: what a health professional can and cannot do to or for a patient Defined by state boards of medicine, boards of nursing, etc., often with guidance or instruction (via statute) from the state legislature Policymakers balance increasing access through expanding providers scope of practice, with ensuring patient safety and quality of care Scope of Practice Legislative tracking Nurse practitioners, physician assistants, dental hygienists and dental therapists 6

7 Oral Health Public Health & Prevention School-based sealants According to the Pew Charitable Trusts, sealant programs are more cost effective when targeted to low-income schools Cost of sealant: $31.70 per tooth versus extraction of decayed tooth: $ Community Water Fluoridation According to the Centers for Disease Control and Prevention, community water fluoridation saves $38 for every $1 spent Coverage and Financing Children s Health Insurance Program (CHIP)/Medicaid Oral Health Workforce Student Loan Repayment Programs Can promote a diverse workforce, or can strengthen existing workforce, in dental care HPSAs Midlevel Oral Health Providers Dental Therapists (ME, MN, VT) Dental Health Aide Therapists (AK, WA) Dental Hygienists 7

8 Rural Facilities Rural hospital: general acute, non-federal hospital that is not located in a metropolitan county; or a Critical Access Hospital. Critical Access Hospital: Designation given to rural hospitals (by CMS) that meet certain criteria, such as having 25 or fewer acute care inpatient beds, being located more than 35 miles from another hospital, and receive cost-based reimbursement. Federally Qualified Health Centers (FQHCs): outpatient clinics that qualify for specific reimbursement systems under Medicare and Medicaid. Must meet certain criteria such as serving an underserved area, offering a sliding fee scale, etc. Rural health clinics: clinics located in rural areas. Provide primary care services using a team of physicians, nurse practitioners (NPs), physician assistants (PAs), and certified nurse midwives (CNM). Receive enhanced reimbursement rates for providing Medicaid and Medicare services. Free-standing emergency departments: facilities that receive individuals for emergency care. Can be independent of a hospital system or be run by a hospital but is structurally separate and distinct from the hospital. Indian Health Service (IHS) and tribally-operated facilities: managed directly by IHS, tribes or tribal organizations under contract or compact with the IHS. Located mostly on or near reservations. Rural Facilities Strategies: Repurpose: urgent care, skilled nursing, outpatient care, emergency care, acute rehab, primary care Accountable Care Organizations (ACOs) and other partnerships, e.g., frontier health system model Telehealth Mergers with larger health systems Coordination between rural hospitals and other facilities, e.g., rural health centers or IHS providers Value-based payments, e.g., global budgets for rural hospitals 8

9 Community Paramedicine Community Paramedics are trained to provide nonemergency services to patients in their homes or other communitybased settings Perform an expanded role within their scope of practice Aim to connect high-risk and underserved patients (e.g., frequent emergency dept. utilizers) with primary care services Community Paramedicine Services may include: Assessment (e.g., blood pressure screening and monitoring) Treatment/Intervention (e.g., providing wound care) Referrals (e.g., mental health and substance use disorder referrals) Prevention and Public Health (e.g., immunizations) Many programs implemented as pilot programs Reimbursement challenges 9

10 Peer Support Specialists Services delivered by a person with similar life experiences and previous behavioral health challenges Support groups, peer recovery education, and peer-run services such as mentoring and case management May be able to better connect with patients and help them obtain treatment, social support and housing Optional certification programs: Mental Health America and others Increasingly, Medicaid and public mental health systems will pay for peer support services 10

11 Telehealth The use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration (HRSA) Primary, acute and specialty care Chronic disease management, home health and long-term care Oral health care Behavioral health care Four modalities: Live video, Store and Forward, Remote Patient Monitoring, mhealth Telehealth State activity bills each year Key policy issues: Reimbursement (public and private payers) Licensure Provider practice standards and patient safety 11

12 Key Questions to Ask What are the greatest barriers to access to care? Where are the greatest needs? E.g., workforce shortages, types of providers or services E.g., rural areas, certain underserved populations What state efforts are already underway to address access issues? What are the costs and benefits of these efforts? What has been successful? What new strategies are available to address access to health care services? What strategies presented today interest you most? What stakeholders (e.g., providers, patients, insurers, etc.) need to be at the table? What data do you need? Tools and Resources Telehealth Policy Trends and Considerations Incorporating Community Health Workers into State Health Care Systems Improving Rural Health: State Policy Options pdf Scope of Practice Policy: Oral Health: State Policy Options: Community Paramedicine Article: 12

13 Roundtable Discussion Six tables with an NCSL staff member at each table Scope of Practice Oral Health Rural Facilities Community Paramedicine Peer Support Specialists Telehealth Each discussion is 15 minutes Rotate three times to different topics/tables NCSL staff will tell you when to switch HEALTH SEMINAR FOR NEWER LEGISLATORS Cambridge, Massachusetts April 28-30,