Affordable Care Act Readiness Project Thursday, October 23, 2014 Meeting Summary

Transcription

1 Merced County Health Care Consortium Attendees: Representatives from Member Agencies: Brian Mimura, The California Endowment; Mary-Michal Rawling, Golden Valley Health Centers; Crissy Gallardo, Merced Organizing Project; Gabina Villanueva, Central California Alliance for Health; Alice Kieffer & Isaac Medina, Castle Family Health Centers; Susana Ramirez, University of California, Merced; Stacie Bradford, Building Healthy Communities; Griselda Vazquez, Livingston Community Health; Nai Saechao & Laverne Davis, Healthy House; Jeanine Aguilar, Planned Parenthood; Salvador Vazquez, Merced County Office of Migrant Education; Tracy Yoder, Merced County Community Action Agency; Ana Ibarra, Merced Sun Star; May Ly, Richard Heath and Associates; April Brewer, Mercy Medical Center; Myisha Reed, First 5 Merced County; Kathleen Grassi, Michael Johnson, Tim Livermore, & Karl Stahlhut, Merced County. Guests: Marlon Cuellar and Marisol Avina, The California Endowment; Kate Karpilow, California Center for Research on Women and Families. Consultants and Project Staff: Joel Diringer, Diringer & Associates; Rafael Gomez, Pacific Health Consulting Group; Sarah Baker, Merced County Public Health. Agenda Items Discussion Summary Resources / Action Items Welcome and Introductions Joel Diringer welcomed all and facilitated introductions. Joel Diringer Diringer and Associates Harnessing the Momentum: From Coverage to Care ACA Summit Re-Cap Joel Diringer Announcements May Ly - Certified Enrollment Entities should pay attention to updates that they receive on open enrollment from Covered CA. Notices are being sent out to members with renewal information and instructions on how to report changes. There will be two major CALHEERS system updates. The system will be unavailable and there are instructions for a workaround. Another update on active renewal and passive renewals is also available. Affordable Care Act Readiness Project Thursday, October 23, 2014 Meeting Summary Mary-Michal Rawling Do Certified Enrollment Counselors needed to collect authorization forms? May Ly - it is a required form and if prior enrollees come back for assistance, they will need to fill out the form. My Ly - There are three new activities implemented this year as part of the enrollment process, including: authorization for enrollment forms, identity proofing, and voter registration assistance. The ACA Summit, Harnessing the Momentum: From Coverage to Care, held on September 26 th with more than 130 participants. California DHHS Secretary Dooley spoke about expanding the health workforce by using physician extenders, not just physician assistants, etc., but folks in the community, which ties into place matters. Alan McKay, Central California Alliance for Health and Bobbie Wunsch, Pacific Health Consulting Group, presented on what happened in Merced County with new enrollees, 14,000 in Medi-Cal and over 8,000 in Covered California, cut the number of uninsured at least in half. Many of the Merced County population, 41%, are now on Medi-Cal and enrolled in the Alliance. Alan has said that 8% of the members in the Alliance account for about 75% of the costs. Many of these members have dual diagnosis, including mental health diagnosis, that contributes to those costs. That ties into the new local initiative to integrate mental health and primary care within the County. 1

2 2 Outreach/Enrollment Updates Crissy Gallardo, Merced Organizing Project Kate Karpilow, Ph.D. California Center for Research on Women and Families An outreach and enrollment summit panel spoke about effective strategies in trying to reach the disenfranchised hard to reach populations. Dr. Tony Iton, The California Endowment, spoke about how place matters; showing that you can identify very specific health trends depending on geographic location in communities. It is important to know that health is not just about providing care, but also changing social determinants of health. Outreach & Enrollment Subcommittee Update Crissy Gallardo The O&E Subcommittee met with Kate Karpilow and discussed how to reach women in the community. There was a strong sense of interest from partners to be creative in reaching out to women, who are typically leading their households and can push their family members into getting enrolled. The O& E identified strategies and will follow up with next steps at the next meeting on November 7 th. Women and Health Care Reform Pilot Kate Karpilow, Ph.D. The California Office of Health Equity was created to focus on health disparities; but there was no mention of women and girls. Gender is always included in national work on health disparities. The advisory committee of the Office of Women s Health came to Kate s organization, the California Center for Research on Women and Families (Center), and worked to create a women s policy summit to bring attention to some of the initiatives that policy makers, advocates, health and social workers should pay attention to. The Center has worked closely with the Office of Health Equity and have a very constructive partnership now. A current project will create a statistical chart book on women and girls that will be presented and released at the Women s Policy Summit January 14 th in Sacramento. The Center researched what was being done throughout the state and compiled some effective strategies to reach women. Their research led to the creation of the Women and Health Care Reform project. Kate met with the O&E to develop enrollment strategies to reach women. After a survey and a brainstorming session, they narrowed the list to the top strategies, which includes partnering with forprofit organizations that primarily serve women, conducting outreach at community events that target women, partnering with government programs or nonprofit agencies that primarily serve women, reaching out through women s associations, enlisting leaders involved in athletics (moms involved in their children s activities), and target communications to women, particularly stay-at-home moms. The Alliance committed to provide a monthly train the trainer event. Having a list of Certified Enrollment Counselors on paper, rather than online would be helpful. Promotoras would be a way for the message to be more visible in the community. Establishing a theme or a slogan would help unite the various organizations efforts and message. Kathleen - Merced County has a complementary project around chronic disease self management. The model brings a small group of individuals together for a series of classes and the participants all have extended families/networks. It would be an opportunity to reach more individuals. Joel -is the overall goal of this project to get people enrolled into coverage or to provide education? Coverage is the beginning, but health is the ultimate outcome. Kate - this started with a focus on Using a Gender Lens to Increase Health Care Enrollment

3 3 Upcoming State Initiatives What s on the horizon? Rafael Gomez, Pacific Health Consulting Group enrollment but it can evolve. Joel - education on how to use coverage could be the next step. Kate - wanted to know from the group if they were interested and felt that this approach was appropriate for Merced County. The feedback from the group was positive. Kathleen - this would be a worthwhile project; next year will require more innovation to get the hard to reach populations into coverage. It would also be helpful to know what drives the stigma around government programs; why those that are eligible for coverage choose not to enroll. In the last enrollment period, there were four thousand people who enrolled who were previously eligible for Medi- Cal coverage. Rafael Gomez - women are very effective in enrolling their families into coverage. The biggest challenge over the long run will be to educate people on how to utilize care. Griselda Vazquez - women were the majority of those that followed through with enrollment for their families. Stacie Bradford - mixed status families not only have a hard time understanding what their coverage options are but it is also uncomfortable for them to pursue enrollment when some family members would get coverage and some would not. Kate How should this project would continue? Crissy - make this an agenda item for the next O & E meeting on November 7 th. Focus on women as well as continue to enroll mixed status families. Rafael provided an overview of state initiatives under development: The last three years were spent focusing on insuring the uninsured and stabilizing the safety net. The next three years will be about transforming the health care system. Whole Person Care Whole person care is the combining of health, behavioral health, and social needs to address a person s overall wellness. This is geared towards producing better health outcomes and a more efficient use of resources. The whole person care model includes collaborative leadership, target populations, financial flexibility, shared data, and coordination of services across sectors, and patient-centered care. This is the right time to establish whole person care because of the Medi-Cal expansion under the Affordable Care Act. There is a big push to integrate services under managed care Waiver The Waiver basically allows the state flexibility to design demonstration projects that promote the objectives of the Medicaid program. The Waiver is typically approved for five years; the current waiver ends October 31, The new proposal must be presented in the next six months. According to a state DHCS concept paper, the renewal of the 1115 Waiver will be focused on improving and reforming the Medi-Cal payment and delivery systems and ensuring support for the safety net. This Upcoming State Initiatives, What is on the Horizon? PowerPoint

4 4 Moving forward in Merced County Kathleen Grassi, Merced County Department of Public Health would include strengthening primary care delivery and access, avoiding unnecessary institutionalization and services through an integrated delivery system, addressing the social determinants to health, using the Medi-Cal program as an incubator to test innovative approaches to whole person care, and finding synergy with the State Innovation Model (CalSIM). Health centers see that there is a push to change the way they are paid. An alternative payment model will be tested which will be value based. The pilot is risk adverse; they ve built in that the FQHCs will be paid at least the prospective payment system (PPS) rate. They will be testing this pilot payment program over the next few years. Section 2703 Health Homes The ACA created an optional Medicaid benefit for six care coordination services. The first two years they would provide a 90% federal match and then a 50% match thereafter. These services include comprehensive care management, care coordination and health promotion, comprehensive transitional care, individual and family support, referral to community and social services, and the use of health information technology data and evaluation. The state authorized 2703, provided no general funds were spent. The California Endowment contributed 10% match so the Medicaid benefit could be provided. The legislature also required that section 2703 focus on people with chronic disease, frequent users, or the homeless. California State Innovation Model (CalSIM) California has applied to CMS for a $60 million grant over four years; with the first year for planning. Grant announcement are expected in early The purpose of the grant is to test innovative payment and service delivery models to reduce program expenditures, while preserving or enhancing the quality of care. California s proposal has four big initiatives, maternity care, health homes for patients with complex needs, palliative care, and communities for health. The proposal also includes work on building blocks, such as building a nontraditional health workforce, health information technology and exchange, enabling authorities, cost and quality transparency database, public reporting, and a payment reform incubator. Kathleen thanked everyone for their participation in the ACA Readiness project over the last 18 months. The project was funded by The California Endowment Building Health Communities, Merced and the Blue Shield of California Foundation. The ACA is important because too many people lack health coverage and care and the current system focuses on treating disease rather than U.S. health care spending is unsustainable; $2.7 trillion is spent annually with 75% directly related to chronic health conditions that can largely be prevented. The U.S. spends a lot of money on health care but has poor life expectancy, in particular among low-income communities of color. The ACA focused on include getting more people covered, offering more benefits and protections, improving the quality and efficiency of care, and providing a greater focus on ACA Readiness Project PowerPoint Partnerships to Improve Community Health Overview

5 5 Merced County s ACA Readiness project goals were to increase health care access through coordination of enrollment opportunities, to assess local health care provider capacity, and to plan for service integration within and across health care institutions. Outreach and Enrollment Accomplishments Prior to January 2014, it was estimated that 18,700 Merced County uninsured would qualify for Medi-Cal, 18,850 would qualify for Covered California subsidies, 4,400 would qualify for Covered California without subsidies and 8,750 would be ineligible due to documentation status. From January to June 2014, 2,243 people enrolled in Medi-Cal that were previously eligible for benefits, 13,805 newly eligible people enrolled in Medi-Cal, and there were 3,159 pending Medi-Cal applications. There were 8,000 people who enrolled in Covered California in Merced County. This is an astounding number of enrollments and credit goes to the coordinated outreach and enrollment efforts that the O&E and partners made happen throughout the community. Health Care Services Assessments A provider assessment revealed that there is sufficient primary care capacity in Merced County largely because of the Federally Qualified Health Centers (FQHCs) and Rural Health Centers. There is insufficient specialty care capacity, which has been an ongoing problem. Through a second Blue Shield of California Foundation grant, a gap analysis of primary care and behavioral health integration will be undertaken. Some FQHCs have already integrated those services within their organizations. Expanding and New Projects Public Health along with the Alliance, community clinics, and the hospitals are working together to run the Chronic Disease Self-Management Program, which is a Stanford developed, evidence based model that works with individuals diagnosed with a chronic health condition to help them manage those conditions and to help mitigate poor health outcomes. After the first six months of the ACA, the Alliance saw emergency department use go up. Now that people have coverage, there will be efforts to educate on how to use health benefits appropriately. Health information Exchange is a platform that collects data from provider electronic health records to get an aggregated picture of population health and other functions. The Central California Health Information Exchange has just begun in Fresno, Tulare, Kings, and Madera currently participating. Merced County will be getting additional information about their HIE and assess interest locally. Merced County recently received a federal grant from the Centers for Disease Control and Prevention called Partnerships to Improve Community Health. There are four strategy areas, including reducing exposure to tobacco and second-hand smoke, increasing healthy food options, creating physical activity opportunities, and expanding access to chronic disease prevention resources that will roll out in 2015.

6 6 Health4All Campaign Marlon Cuellar and Marisol Avina, Healthy California, The California Endowment Brian Mimura introduced Marlon Cuellar and Marisol Avina, with The California Endowment s Healthy California initiative. The initiative supports a focus on the importance of expanding health coverage for undocumented Californians as part of the Health4All campaign. Marlon Cuellar the ACA focus has been health care for the remaining uninsured. The majority of the remaining uninsured are citizens and legal residents who have not accessed coverage; but, the undocumented are left out of the health care expansion. Health4All hosts a statewide public education campaign to push for a statewide solution to health care for those not eligible for the ACA. TCE has heavily invested in communications as well as investing in non-profit and advocacy organizations to support this message including social media, newspaper ads, TV ads, bus shelter ads, ads in the Sacramento airport, billboards as well as promotional items. Campaign messages include: it makes economic sense, it is the right thing to do, and undocumented individuals are the fabric of our community. Research has been done by universities and other organizations on the health care access issue for undocumented individuals. Recently the Health Access Foundation has released a report about the health disparities left for the remaining uninsured. The UCLA Labor Center/Dream Resource Project held a statewide peer-to-peer survey led by immigrant youth to gather their experiences on what it has been like for them to access health care. Marisol Avina telephone interviews were done with registered voters statewide to get a sense of how many support expanding access to affordable health coverage through Medi-Cal and Covered California to include those not currently eligible because of their immigration status. Overall 54% of Californians supported and 41% opposed the expansion. In the Central Valley, 44% supported and 52% opposed the expansion. The numbers are encouraging; with the right framing and messaging, they believe voters can be moved to supporting coverage for the undocumented. Crissy - were the voters contacted high frequency voters? Marisol - they were likely voters. April Brewer - I was contacted for the survey and it stirred up a lot of emotion. She thinks that making sure people know that they aren t proposing taking insurance from one person to cover another and that the expansion would simply redirect the costs they are already paying for emergency room care to instead provide those folks with coverage is the key to getting voters on board. Marlon invited anyone interested to sign up for the Health4All list serve to stay informed about the campaign. Healthcare for the Remaining Uninsured PowerPoint