Healthcare Reform: In the Cri3cal Path of Ending Homelessness in America. Dale Jarvis, CPA

Transcription

1 Healthcare Reform: In the Cri3cal Path of Ending Homelessness in America Dale Jarvis, CPA

2 My Hypotheses 1. Healthcare reform is unfolding in the U.S. (with or without the Affordable Care Act) 2. This will result in much bejer use of the $2.6 trillion we currently spend on healthcare 3. Vulnerable and Homeless Individuals and Families may or may not be part of the fix 4. Homeless Services Providers may or may not be part of the fix 5. The may or may not depends on the acwons of the people in this room over the next relawvely short period of Wme 2

3 Dale s 20 State Adventure

4 Three Simple Topics The Problem The Fix The Fix for Vulnerable and Homeless Americans 4

5 The Problem 5

6 The U.S. has a Sick Care System not a Health Care System Lack of Access: 50+ million uninsured Lack of Access: 2 specialists for every PCP Medical errors Overuse of unnecessary, high cost tests/procedures Underuse of prevenwon, early intervenwon, primary care, behavioral health All of the above = 30% of health care costs ($700+ billion per year) 6

7 Summarizing the Problem Poor Quality & High Cost 110 Preventable Deaths per 100,000 $7,285 Per Capita Health Expenditure 7 7

8 The Third Part of the Problem Americans with a Serious Mental Illness die, on the average, at age 53; for those with a co occurring Mental Health Substance Use Disorder, it s 45 High prevalence + high cost directly affect the quality and cost problems 8

9 A Root Cause Analysis Reveals Mechanisms by which Adverse Childhood Experiences influence health and well-being throughout life 9

10 A Root Cause Analysis Reveals 10

11 The Elephant in the Living Room 11

12 The Elephant in the Living Room (some call them silos of excellence) 12

13 The Fix CreaWng a Sustainable Healthcare System 13

14 Follow the Money (Deep Throat quote from Bob Woodward s account of Watergate) $ $ 14

15 We Have Strong Evidence that it s Possible to Flip the Triangle In Denmark, over the last few decades, the number of hospitals has dropped from 155 to 71 today. (Sources: Paul Grundy, Director of Healthcare, Technology and Strategic IniDaDves for IBM Global Wellbeing Services and Atul Gawande, physician, writer for the New Yorker) And in the US: Pilots in the U.S. include Geisinger's, which Grundy says has been remarkably successful, yielding a 12% reducwon in ER uwlizawon, a 20% reducwon in hospitalizawon, and a 48% reducwon in rehospitalizawon. (excerpt from David Harlow s Health Care Law Blog 9/15/2009) 15

16 Other Health Reform Doubles, Triples and Home Runs are Occurring in Camden, NJ Vermont North Carolina Atlanta Georgia Walla Walla Central Oregon Colorado SeaJle 16

17 The Group Health Coopera3ve Story : Move towards Medical Home your Doctor Online Medical Records Same Day/Next Day Appointment (Increased pawent access but also saw provider burn out and decline in quality scores) 2007: More robust Healthcare Home Pilot Added more staff (15% more docs; 44% more mid levels; 17% more RNs; 18% more MAs/LPNs; 72% more pharmacists) Shired to 30 minute PCP slots (Reduced burnout, increased quality scores, broke even in the first year) 17

18 Group Health can do this because they are an Integrated Health Care System a.k.a. an Accountable Care OrganizaWon 18 18

19 But for the other 90% of Americans, Current Funding Models keep the Sick Care System Locked in Place Fee For Service, Non Integrated Model: All the wrong incenwves and disincenwves 19

20 Thus, the push for Accountable Care OrganizaWons; a new/old Organizing Approach ACOs are provider groups that accept responsibility for the cost and quality of care delivered to a group of pawents that are cared for by ACO clinicians The core of this new enwty are Medical Homes/Healthcare Homes: Primary Care Clinics that Look and Act Differently 20

21 The Fix for Vulnerable and Homeless Americans 21

22 Houston, we have another problem For many people, especially those in the safety net, good healthcare is not enough Consider a mom with depression and diabetes Add to this scenario the facts that she is the head of household of a family of three, has lost her job, is experiencing domeswc violence and she and her children are on the brink of homelessness 22 22

23 The 3 Part Fix 23

24 The Fix is Occurring in Atlanta Fulton County Georgia s ObjecWve: create health neighborhoods that contain one stop centers where people receive a holiswc set of services under one roof that are customized to the needs of the neighborhood Neighborhood Union Primary Care Partnership 24

25 A New Vision: The Healthcare Neighborhood One Stop The Next GeneraWon Safety Net Healthcare System The Fulton County Georgia (Atlanta area) Neighborhood Union Primary Care Partnership s One Stop: Well pawent care Sick pawent care OB/GYN services Travel immunizawon services Communicable disease intervenwon WIC/nutriWon educawon Oral health services Behavioral health services A daycare center for pawents children Employment assistance Disability and vocawon rehabilitawon services Foreclosure prevenwon services Housing assistance A reading room/informawon center that offers ESL classes A farmer s market A community garden A walking trail 25

26 This requires tackling the Silos An ACO that address the social determinants of health must be designed to focus on the needs of the populawon in a community, with a special emphasis on addressing the social determinants of health such as poverty, unemployment, homelessness, poor housing, neighborhood violence, etc. 26

27 Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) Community Mental Health and Substance Use Disorder Treatment Providers Recovery, Peer and Wellness OrganizaWons Public Health Departments Hospitals Members Includes Social Service Agencies Child Welfare Providers and Family Resource Centers Housing and Homeless Services Providers Oral Health Providers Pre Schools and Schools Job Training and Employment Support OrganizaWons 27

28 Purpose of an Community Care OrganizaWon A core objecwve of the ACO is to develop an integrated network of community groups that see themselves as hospital and inswtuwon prevenwon organizawons; helping prevent admission and readmission to: acute care and psychiatric hospitals; nursing homes; youth residenwal treatment faciliwes; jails prisons, and juvenile juswce faciliwes; and other restricwve, high cost, noncommunity based inswtuwons. 28

29 The Work of the Community Care OrganizaWon 29

30 The Role of Housing and Homeless Services Providers Ensure that your organizawon has a mission to address the whole health needs of the populawon its serving. Be a founding member of a Community Care OrganizaWon in your community. See your staff as part of a virtual care team where each client has one problem list, one medicawon list, and one care plan that is shared by the team; and each client has only one care manager 30 30

31 High Performing Specialty Providers Are you seen as the Mayo Clinic of housing and homeless services in your community and widely recognized as a high performing, cost effecwve provider of quality services that addresses the health and wellness of those you serve? Are you able to demonstrate your effecwveness with data? 31

32 Ensure that your organizawon is using a Next GeneraWon Approach to Ending Homelessness Recent changes in federal law support this emerging approach 32

33 Next GeneraWon Approach 33

34 New Service Delivery Paradigm Mainstream and homeless systems recognize homelessness and share responsibility New roles, skills, and braided funding required 34

35 Emerging 2 Part Typology BeJer match housing and service responses to varying levels of needs and risks instead of one size fits all 35

36 Emerging 2 Part Typology BeJer match housing and service responses to varying levels of needs and risks instead of one size fits all 36

37 RevisiWng My Hypotheses 1. Healthcare reform is unfolding in the U.S. (with or without the Affordable Care Act) 2. This will result in much bejer use of the $2.6 trillion we currently spend on healthcare 3. Vulnerable and Homeless Individuals and Families may or may not be part of the fix 4. Homeless Services Providers may or may not be part of the fix 5. The may or may not depends on the acwons of the people in this room over the next relawvely short period of Wme 37

38 Final Thoughts 38