Preserving the Safety Net. Presented by Zara Marselian, CEO at the National Health Policy Forum Session May 18, 2012

Transcription

1 Preserving the Safety Net Presented by Zara Marselian, CEO at the Natinal Health Plicy Frum Sessin May 18,

2 Abut La Maestra Missin: T prvide quality healthcare and educatin, imprve the verall well-being f the family, bringing the underserved, ethnically diverse cmmunities int the mainstream f ur sciety, thrugh a caring, effective, culturally and linguistically cmpetent manner, respecting the dignity f all patients. First Clinic, pened 1990 LEED Certified Gld Health Center, pened

3 La Maestra Health Services Clinic frmed in 1990 under La Maestra Amnesty Center. The need fr culturally cmpetent healthcare was identified by cuncil representing ver 12,000 students at the Center. 4 Medical & 5 Dental Centers in San Dieg Cunty 4 schl-based medical/dental clinics Mbile Clinic Mental Health services nsite at main clinic, high schl clinic, and at ther sites thrugh telemedicine. All services and prgrams have elements fcusing n educatin, case management and scial services Integrated Apprach 3

4 Annual Number f Patients /Visits Ttal Unduplicated Patients Ttal Visits 45,000 40,000 35,000 30,000 40,288 37,782 35,524 32,121 29,811 27, , , , , , , , , ,430 25,000 20,000 15,000 23,879 18,680 15,870 13, ,000 80,000 60,000 56,192 88,948 82, ,843 10,000 40,000 39,881 41,420 5,000 20, % f Patients were best served in a language ther than English in

5 Innvative Mdels at La Maestra Circle f Care - Integrated Services Medically Trained Cultural Liaisn Mdel Telemedicine Schl-Based Health Mbile Health Imaging Services Residents f Public Husing - Outreach & Health Fairs (educatin/screening) at Husing - Eligibility & Enrllment Assistance Transprtatin 5

6 Well Being & the Circle f Care Netwrk ges beynd medicine t address scial determinants f health: bringing greater resurces t ur patients Circle f Care Mdel New Skills, Independence, Self-Esteem, Helping and Teaching Others, Wrking in Healing Envirnments Fd Pantry with nutritin educatin and besity preventin Urban Cmmunity Garden Micrcredit Prgram fr Wmen & Micrenterprise Assistance Jb Training and Placement Fd Pantry Cmmunity Garden Zumba classes 6

7 Well Being & the Circle f Care Scial Services & Legal Advcacy Transitinal Husing and help finding Affrdable Husing Culture and Healing thrugh Art Prgram Senir Emplyment Trainee Micrcredit Participants Micrcredit Meeting Micrenterprise Transitinal Husing 7

8 Serving the Culturally Diverse Cmmunity Mst culturally diverse health center in Califrnia 22 languages and dialects spken by staff 91% f patients prefer t cmmunicate in a language ther than English Staff represents (is frm) the cultures served, ensuring cultural and linguistic cmpetency. Medically Trained Cultural Liaisns prvide valuable, nging supprt and educatin t lcal residents and identify new needs. 8

9 Languages Spken by Staff Achli Arabic Burmese Cantnese Chaldean English French Italian Karen Latian Luganda Mandarin Nuer Plish Russian Sicilian Sign Language Smali Spanish Sudanese Swahili Tagalg Thai Vietnamese 9

10 Integratin f Prgrams Cmmunity Outreach Enabling Services Eligibility, Medi-Cal & Healthy Families Enrllment Transprtatin Interpreting/ Translatin Medically Trained Cultural Liaisns Primary Care Adult Health, Wmen s Health, Pediatric & Teen Health, Senir Health Affrdable Husing Mental Health Mentring Ethnic CBOs Husing & Cmmunity Develpment Financial Literacy Micrenterprise Assistance Jb Training & Placement Oral Health Optmetry Pharmacy Labratry Imaging Telemedicine Patient Educatin Cmmunity Develpment Legal Advcacy Services Dmestic Vilence Referral Cmmunity Member / Patient Behavir Mdificatin Referrals Cunseling & Linking t Prgrams Childcare Clthing & Fd Healthcare Training Scial Services Cntinuus Patient Fllw-up and Case Management 10

11 Medically Trained Cultural Liaisns & Prmtras Partnerships Outreach & Health Prmtin Mbile Outreach Prvide Guidance Case Management & Navigatin Patient Health Educatin Patient Supprt Preventin Screening at Health Fairs 11

12 Telemedicine Telemedicine started in 2005 at main clinic Began prviding Mental Health t satellites & rural sister health centers Cntinuing t expanded netwrk f specialists t bring specialty care t medical hme By 2010, equipment installed at all satellites grants & cllabratins 12

13 Schl Based and Mbile Health 2009: Opened Medical and Dental Clinic at Hver High 2010: Opened Central Elementary Medical Clinic 2011: Opened Mnre Clark Middle Medical Clinic 2012: Opened Rsa Parks Elementary Medical Clinic 2012: Mbile Clinic with 2 dental peratries, 1 medical exam rm Bringing Oral Health t at least 9,000 students and their families per year N cnstructin cst f building n campus Health screenings, mental health, health educatin, telemedicine and teledentistry cnsults 13

14 Quality Imprvement Patient Centered Medical Hme pursuing accreditatin -Facilitates partnerships between patient and persnal physicians/care team, and patient s family t prvide cmprehensive preventive care -Care crdinated with utside prviders via Health Infrmatin Exchange, registries -Aligns with State Health Insurance Exchange plan requirements. 14

15 Quality Imprvement Electrnic Health Recrds/Practice Management NextGen: Primary Enterprise Practice Management System and EHR. Used fr all patient registratin, billing, electrnic prescriptin requests, and medical dcumentatin. -Streamlines prcess fr imprved patient care -Prviders can care fr mre patients -Imprves accessibility f patient infrmatin -Integrates all relevant clinical infrmatin abut a patient within a single, integrated electrnic recrd, allwing clinicians t make evidenced based clinical decisins, reducing errrs 15

16 Quality Imprvement Electrnic Health Recrds/Practice Management -Reduces billing and cllectins csts -Reduces claim denials -Imprves revenue thrugh autmated recall plans -Autmated task management and prductivity reprting imprves verall prductivity -Reduced cst/labr assciated with paper recrds 16

17 Revenue Surces Payr Surce by # f Patients ,444 3% 5,984 14% 280 1% 1,564 4% 7,609 17% 631 1% 26,066 60% Medi-Cal Healthy Families Self-Pay Cunty Indigent Medicare Private Insurance Episdic: State/Cunty/Grant 17

18 Current Scenari fr Califrnia FQHCs Prspective Payment System (PPS): PPS cvers minimum cst f care fr Medicaid patients Des nt cver case management, care crdinatin, health educatin, health navigatrs, health screenings, enabling services, translatin, transprtatin, eligibility Same-day visits nt reimbursed Within the Fur Walls challenge 18

19 Current Scenari fr Califrnia FQHCs Healthy Families: State finally starting t pay wraparund in May 2012, fr visits since Octber 2009 $1.9 millin due t La Maestra frm State f CA fr adjustment t interim rate, which we applied fr 5 years ag. State wes La Maestra ver $2 millin frm recnciliatin reprts fr past 5 years 19

20 Current Scenari fr Califrnia FQHCs Effects f Ecnmic Dwnturn and Challenges: Unemplyment - Mre Uninsured Mre hmeless Veterans Release f drug related ffenders Brder Zne Challenge frm ICE Public Health Issues Human Trafficking Fundatins have less $ fr grants because stck lst value Budget cuts n cverage fr adult dental, little fr mental health 20

21 Current Scenari fr Califrnia FQHCs N Cunty Hspital, nly Safety Net and Emergency Rm Cunty Funds have strict eligibility mandates NEW: San Dieg Cunty Selected fr the Dual Demnstratin Prject Grwth (Medi-Medis) 21

22 Future Scenaris/Implicatins 1. Health Insurance Exchange 2. Medicaid expansin f childless adults 3. Basic Health Plan fr Califrnia 4. Increase desperately needed fr FQHCs t cntinue serving as the Safety Net fr 19 millin peple natinwide 5. Since 1960s, cmmunity health centers have been taking care f uninsured ppulatins. 22

23 Future Scenaris/Implicatins Accuntable Care Organizatins (ACO) Perceptins/Miscnceptins: Risk factrs will impede success f ACOs. ACO mdel resembles managed care plans. Facts: Mdel mandating inclusin f an FQHC wuld wrk. Califrnia FQHCs are already experienced with managed care: high vlumes f managed care members 23

24 Future Scenaris/Implicatins Refrm What has cmmunity seen as benefits s far? Increased cverage fr children up t 26 years ld under cmmercial plans. Eliminatin f prir cnditins under cmmercial plans 24

25 Suggestins fr FQHC Sustainability 1. Mre direct funding frm Federal gvernment 2. Supprt the Safety Nets/FQHCs by hlding firm n PPS rates r imprved alternative reimbursement rates. 3. Encurage ACOs t include FQHCs with their PPS rates as FQHCs prvide mre cmprehensive patient care vs. private prvider practices/grups 4. Direct grants t health centers are always best: Earmark funding is abslutely essential fr safety net FQHCs 25

26 Mdels that Sustain FQHCs 1. Medical Imaging Services 2. Pharmacy 3. Nn-medical: diversificatin f revenue streams 26