Public Health and Medicaid Advisory Group December 9, 2016, 10:00am 3:00pm Topeka Library, Anton Room MINUTES Attendees: Sonja Armbruster, Aaron Davis, Kristina Helmer, Phillip Davis, Kasey Sorrell, Michelle Ponce, Fern Hess, Teri Caudle, Katie Mahuron, Cristi Cain, Edith Matthews, Nick Baldetti, Rachel Sisson, Beth Brown Gathering & Updates How can our work together strengthen the system that serves Medicaid beneficiaries through LDHs and PH/PC? Trauma Informed Systems of Care (TISC) (see accompanying slides) Discussion: Shawnee County, new school superintendent, Tiffany Anderson is working to create a Trauma Informed School District. Trauma-Informed Systems of Care Organizational and system approaches to creating supportive environments for EVERYONE Community Engagement Institute, Center for Public Health Initiatives will be providing a training during the second quarter at the KDHE regional meetings. Deeper Dive: Optum Pilot & MCH Medicaid Related Projects Rachel Sisson provided an overview of the CoIIN Initiative and the Optum Pilot CoINN Collaborative Improvement and Innovation Network is a multi-year national movement engaging federal, state and local leaders; public and private agencies; professionals; and communities to employ quality improvement, innovation and collaborative learning to reduce infant mortality and eliminate disparities. Kansas is formally participating in Smoking Cessation (before, during and/or after pregnancy) and Pre/Early Term Birth (utilization of progesterone and elimination of early elective deliveries). The Kansas comprehensive approach is receiving national attention and has advanced numerous strategic state partnerships. Rachel provided an overview of the Optum Pilot. The goal of this pilot is to improve birth outcomes among highrisk obstetric Medicaid beneficiaries through targeted home visitation services; OB care coordination and patientcentered medication management for 17P. Services are provided by Optum nursing staff through existing contracts with Kansas MCO s through established fee0for-service payment schedules. There are no associated costs for patients or providers. KDHE is working on coordination of this service with the Becoming a Mom prenatal program. Optum Pilot Feedback: o Phillip (Lyons), Fern (McPherson), Nick (Reno), Beth (Jefferson), Edith (Shawnee) all within 100 miles of the two Optum pilots that are proposed. Deeper Dive: United Vaccines Pilot Michelle shared updates about the partnership with United. United is offering LHDs a chance to partner. United will actively send lists of patients in their Medicaid MCO Plan who are not up-to-date on vaccinations to the LHD so that the department can conduct outreach and increase vaccination rates. Discussion: KARP (see accompanying slides) Started this work in June 2014.
Launch event in September 2014 with David Stone Cycle 1 12 months of 3 hour long meetings virtually Next Launch at Rolling Hills lessons learned from site visitors Cycle 2 Pre-webinars and 1 hour webinar monthly Pre-webinars can be found on KS Train 4 LHD are ready for accreditation Reno, Riley, Wyandotte, Plan to apply 2017 Riley and Reno Plan to apply 2018 Wyandotte Reno County s tipping point had to find someone that was passionate about the process. Giving authority to one person to move the process forward. Accountability was key! o http://www.phaboard.org/wp-content/uploads/considerations-for-assigning-an-accreditation- Coordinator-Tip-Sheet-March-2012.pdf Educate LHD s about accreditation Flint Hills won t apply because they are PCMH Strategic planning and QI. Go back to prerequisites Shawnee Since they have separated from clinic. They need to have a separate QI. They need direction on how to do the assessment. Using PHAB standards. Less than ½ of LHDs have strategic plans How does FPHS tie in with accreditation? Basic level project management training for LHD leadership. What does this look like? Technical Assistance for the 3 groups o Those who are getting ready to apply specific TA for those who are applying in the near future o Those who are thinking about applying o And those who are not interested in applying strategic planning, QI, project management, etc. Discussion: Informatics (see Accompanying Slides) AAron described three initiatives underway to strengthen the system, including strengthening the system that serves Medicaid beneficiaries related to informatics. An assessment is currently underway and when completed, appropriate technical assistance will be developed. Updates/Wrap Up/Q&A Leadership: Local Public Health Leadership Series: January-April Quarterly KDHE Regional Meetings (January March) Leadership Training Alumni Local Public Leadership Series Training June 2017 CHW Coalition Development
CPHI Medicaid Advisory Group Meeting December 9, 2016
Welcome!
Trauma-Informed Systems of Care (TISC)
FY17 Task Order C. Development & Implementation of Statewide Evidence- Based Public Health Programs that Ensure and Improve Local Access and Delivery of Kansas Medicaid services through Local Health Departments. 2. Promote Trauma Informed Policies and Practices within the Public Health System in Kansas: CEI will support efforts to create Trauma Informed Systems of Care (TISC) across the Public Health System to improve the delivery of Medicaid Services.
Deliverables TISC Organization Development (max of 3 orgs) TISC Presentations/Trainings regarding impacts of Adverse Childhood Experiences and implementation of TISC (6 max) TISC TA
Adverse Childhood Experiences Vimeo Link: https://vimeo.com/139998006 6
Public Health Approach Universal Precautions Trauma- Informed Treatment/ Intervention Trauma- Informed Systems of Care ACEs
So what does it mean to be trauma-informed? Realizes Realizes widespread impact of trauma and understands potential paths for recovery. Recognizes Recognizes signs and symptoms of trauma in clients, families, staff, and others involved with the system. Responds Responds by fully integrating knowledge about trauma into policies, procedures, and practices. Resists Seeks to actively resist re-traumatization. Source: SAMHSA s Concept of Trauma and Guidance for a Trauma-Informed Approach 8
TISC in Organizations Values Culture Practices Policies 9
What s involved Identification of an implementation team Determination of readiness Organizational Assessment Staff conversations Training of entire staff on impacts of trauma and TISC Principles Review of policies and practices Ongoing coaching and TA
Areas of focus Early Screening and Comprehensive Assessment of Trauma Patient Voice, Choice, and Collaboration Workforce Development and Best Practices Safe and Secure Environment Data Collection and Performance Improvement
Progress to Date GraceMed Wichita and Topeka Intro to TISC training for medical and dental providers Technical Assistance for provider training by ComCare (co-located staff) in December Barton County Health Department Interested in becoming first org and leader of work in their community (Training today!) MCH Council Meeting in January focused on TISC in Primary Care Settings Development of communication materials in process
What other information do you need? Suggestions for making progress on the work plan?
MCH Medicaid Related Projects & Optum Pilot Rachel Sisson, KDHE
United Vaccines Pilot
Kansas Accreditation Readiness Project
# of Attendees 12 10 8 6 4 KARP Learning Collaborative Attendance 2015-2016 8 10 7 8 7 6 5 11 7 6 4 4 2 0
Points in Time Confidence in Ability to Understand Domain Pre Confidence in Ability to Understand Domain Post D10 D11 D12 5 D1 D2 4 3 2 1 0 D3 D4 D9 D5 D8 D7 D6
National Public Health Accreditation in Kansas Already applied, 1% Do not plan to apply, 60% Already accredited, 3% Plan to apply but unsure about date, 32% Plan to apply in 2017, 2% Plan to apply in 2018, 2% Note: No health departments report planning to apply for accreditation in 2016.
KARP Now What?
Informatics
Informatics Activities Informatics Workgroup PHPP/PHSG KALHD Informatics Subcommittee KDHE/CEI Medicaid Contract
Informatics Activities State-level System Analysis 1. Relational Metadata Inventory Database (data catalog) 2. Informatics System Assessment Based on capability & capacity 3. Informatics Savvy Health Department Assessment 5 departments to pilot Informatics Workgroup PHPP/PHSG
Informatics Activities Collective Informatics voice for LHDs Association stance on systems & utilization Collective requests for information System Feedback Loop becoming the it person On the ground system assessment KALHD Informatics Subcommittee
Informatics Activities Individual Department Technical Assistance Opportunities WebIZ interface System/Software opportunities Process analysis & improvement KDHE/CEI Medicaid Contract
Updates
Leadership Competencies Survey At the KALHD Annual Meeting the Community Engagement Institute surveyed participants regarding the Leadership Competencies and their corresponding dimensions. The results from this survey will inform training sessions begin provided at Regional KDHE Meetings and design the alumni training for KALHD s mid-year meeting.
Leadership Competencies 9 7 6 6 Inspire a collective purpose Test multiple interpretations and points of view Get used to uncertainty and conflict Experiment beyond your comfort zone
CHW Update
Kansas CHW Symposium June 8, 2017 Wichita State University
Texas CHW Timeline 1999 Texas Legislature passes HB 1864, directing the Texas Health Department (TDH) to establish a committee to explore and evaluate options for creating a CHW training curriculum and certification process. TDH creates the Promotora Program Development Committee (PPDC). 2002 The Certification Advisory Committee confers its first certifications. 2016 CMS grants a 15 month extension of Texas s 1115 waiver. mid-1990s Grassroots advocacy by Texas CHW organizations, community leaders and health professionals brings CHW training and certification to the attention of a group of state legislators. 2001 The PPDC completes its work and submits its final report, Feasibility of Voluntary Training and Certification of Promotores(as) or Community Health Workers. In response to the PPDC s report, the legislature passes SB 1051, directing TDH to establish a training and certification process, and SB 751, amending requiring that state health agencies use certified CHWs to the extent possible. 2011 In response to advocacy efforts, HB 2610 is passed. DSHS (previously TDH) and HHSC are directed to study the feasibility of employing CHWs both privately and publicly; research funding methods; and develop recommendations to increase funding for and employment of CHW employment. Texas applies for a 1115 waiver. CMS approves their proposal. The waiver moves most Texas Medicaid patients into managed care (MCO) organization, and allows MCOs to bill certain CHW services as service costs, rather than administrative costs.
Minnesota CHW Timeline 2003 The BCBSM Foundation funds a set of CHW focus groups on training and professional development needs, through the Wilder Research Center. The BCBSM Foundation invites a representative from Minnesota State Colleges and Universities (MnSCU) to visit the CHW Certificate Program at San Francisco State University. 2005 The Robert Wood Johnson Foundation funds HEIP s Minnesota Community Health Worker Project, and its statewide policy council. The BCBSM Foundation commissions at the UC-SF Center for the Health Professions, to identify possible CHW payment models. Minnesota implements a standardized CHW curriculum through MnSCU 2008-09 Further legislation in 2008 (HF 3222) and 2009 (SF 1504) expands the range of approved supervisors. With planning grants from the Foundation and other sources, the CHW Policy Council creates the MN CHW Alliance to advance the profession and its impact, through education, policy, research, workforce development, and a CHW association. 2002 The Blue Cross Blue Shield Foundation of Minnesota (BCBSM) commissions a survey on the use of CHWs across the state of MN. Major findings: demand for CHWs is rising, and increasing the size of a qualified workforce will require standardized training. The BCBSM Foundation hosts a forum for policy makers, health care representatives, and educators, to discuss the survey results and means of promoting the use of CHWs. 2004 The BCBSM Foundation provides a grant to the Minnesota International Health Volunteers to build a CHW Peer Network. The BCBSM Foundation provides funding to the Healthcare Education-Industry Partnership (HEIP.) HEIP develops Minnesota s CHW curriculum and major workforce development efforts. 2007 HEIP s MN CHW Project successfully advocates for legislation (HF 1078) permitting Medicaid reimbursement for specific services provided by certified CHWs under supervision by qualified healthcare professionals. The Federal government approves MN s State Plan Amendment, allowing the legislation to go into effect. 2010 HEIP completes an expanded 14-credit version of the CHW curriculum.
Massachusetts CHW Timeline 2002 Massachusetts Public Health Association becomes a key ally and fiscal sponsor to MACHW. 2003 The Blue Cross Blue Shield of Massachusetts Foundation begins funding MACHW. 2005 MACHW engages constituents and organizations across the state in an advocacy campaign, educating CHWs on the legislation and leading strategies including letter writing, calling and meeting with legislators, Securing endorsements from other organizations, and participating in hearings. 2000 Collaboration between CHW leaders and MDPH leads to the formation of the MA Association of CHWs (MACHW). MDPH receives federal funding to support CHW network activities; develop Department definitions and policies for contracting and supervision, and undertake a a statewide survey of the CHW workforce. 2003 MDPH continues its relationship with MACHW, providing TA, as MACHW serves as the voice of the profession. MPHA also provides TA. 2004 Working with MDPH and MPHA, MACHW embarks on a legislative strategy. They introduce a bill to be taken up by the legislature in the 2005-06 session. The bill would require MDPH to study of the CHW workforce, including their activities, effectiveness, and their employment market, as well as develop recommendations on making the workforce sustainable. 2005 MDPH publishes a report: Community Health Workers: Essential to Improving Health in Massachusetts MDPH convenes the CHW Advisory Council to conduct a literature review on CHW effectiveness, undertake a workforce study and employer survey, identify possible means of financing, and develop recommendations on training and certification. MDPH creates an Office of Community Health Workers.
Massachusetts CHW Timeline, continued 2008 MACHW holds regional meetings to obtain CHW perspectives on training and certification. MACHW drafts legislation to establish a MA Board of Certification, and submits it for the 2009-10 legislative session. 2008-10? The Boston Foundation funds research and advocacy efforts as part of the CHW Initiative of Boston, which is led by Action of Boston Community Development (ABCD). ABCD contracts MACHW and MPHA staff to lead its Policy Committee, which collaborates with the MA League of Community Health Centers and other community health and advocacy groups. 2010 The Certification Board bill, H4130 (previously H 247) is passed by the legislature and signed into law. 2012 MA passes another state health reform law, known as Chapter 224, which creates the Prevention and Wellness Trust Fund (PWTF). The legislature commits $60 million over 4 years. 2016 MDPH continues to provide TA and funding to MACHW 2008 MACHW collaborates closely with MDPH when drafting the legislation. The proposed Board is to be located in the MDPH Division of Health Professions Licensure and supported by a costneutral financing mechanism. 2009 MDPH moves the Office of CHWs into its Division of Prevention and Wellness to strengthen the connection between chronic disease work and CHW work. MDPH contracts with MACHW to conduct CHW focus groups to gather further input on the definition of core competencies in the legislation. 2010 MDPH CHW Advisory Council releases its report, CHWS in MA: Improving Health Care and Public Health to the legislature. The report offers a synthesis of current cost-benefit research, effectiveness research, and 34 recommendations on strengthening training, funding, and state infrastructure including certification. 2012 MDPH is given responsibility for designing managing PWTF initiatives. 2014 MDPH incorporates significant use of CHWS in all 9 PWTF public/private community partnerships
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