February 2014 Understanding Diverse Investments and Moving Forward Under Health Care Reform
Meeting Report: Sexual and Reproductive Health in the South Understanding Diverse Investments and Moving Forward Under Health Care Reform I. Meeting Impetus and Purpose The ongoing health inequities in the South are a product of both history and neglect. Limited access to sexual and reproductive health (SRH) services is a part of this dynamic, and is an important factor in the region s poor SRH outcomes, including high rates of unintended pregnancies and alarming rates of STDs, including HIV. Now is a pivotal time in American history to address this situation, given ongoing health care reform and the opportunities offered by full implementation of the Affordable Care Act (ACA) in 2014. In a proactive response to these challenges and opportunities, SRH-focused donors, advocates, and other partners from both the private and public sectors have sought solutions, implemented new initiatives, and made other investments to improve health outcomes. These investments have affected individual sectors such as family planning, STDs, and HIV -- silos in a larger SRH provider and advocacy network but mapping and understanding the intersections and potential gaps in these diverse investments has not been done across the larger frame. In order to better understand these intersections and gaps, the National Coalition of STD Directors (NCSD), the National Family Planning & Reproductive Health Association (NFPRHA), and the New Morning Foundation (NMF) came together to host a pilot meeting with partners that had made investments and have a stake in improving SRH outcomes in the South. The organizers hoped to create an opportunity for these five states to gain a greater understanding of what was being done within SRH in their own states and across the group of states; as well as document some of their successes and resources in the hopes of helping other states with their strategic efforts. The meeting took place in September, 2013, in Charleston, South Carolina, and included more than 40 representatives from Alabama, Georgia, Mississippi, North Carolina, and South Carolina, as well as representatives from the U.S. Department of Health and Human Services, including the Centers for Disease Control and Prevention and the Office of Population Affairs. The purpose of the meeting was threefold: 1) Share information about which entities are doing what and where in this set of Southern states both programmatically and from a resource investment perspective to support SRH, defined by the hosts to include family planning and STDs (including HIV); 2) Identify gaps in investments and programs; and 3) Explore challenges and opportunities related to the ACA and other health care reforms, and how each state and STD, HIV, and family planning sectors within each state are addressing them. In an effort to balance inclusiveness with the goal of facilitating discussion, the meeting sponsors kept the number of s from Page 1
each state to 5 or less. Invitees were drawn from the following categories: state public sector partners such as STD Directors, HIV Directors, and Title X Directors; private sector partners such as state or regional SRH-focused advocacy or service delivery groups; national organizational partners working in SRH; and national public sector partners working in SRH such as agencies of the Department of Health and Human Services. Page 2
II. Meeting Results The meeting began with a presentation about the impact of the ACA on opportunities to improve SRH outcomes, followed by a series of facilitated roundtable discussions over two days. Roundtable discussions were broken out by state and sectors (e.g. family planning, STD, HIV) as well as cross-sector. The roundtable discussions during the meeting centered around four concepts: opportunities, challenges, critical needs, and potential next steps. Participants were given time to meet within their respective states to discuss their ideas on the four conceptual areas. These breakout sessions were followed by a reconvening of the entire group to report on the roundtable discussions. Upon reviewing the results across sectors and states, important commonalities appeared within each concept. Common themes among the five participating states are outlined below. Common Theme: Opportunities to Enhance SRH Work Collaboration across SRH sectors Utilization of academic resources that are available in the community Partnerships with primary care providers, specifically federally qualified health centers (FQHCs) Ability to harness data already collected from STD/HIV/family planning to enhance care Existing capability and experience of SRH stakeholders to serve vulnerable populations Common Theme: Challenges that Limit SRH Work A political climate that is hostile to SRH providers and services A workforce shortage and limited workforce training Federal funding budget cuts Pharmaceutical cost increases Lack of Medicaid expansion by the states Organizational financial insecurity Common Theme: Critical Needs and Priorities to Continue SRH Work Need for increased access to education and SRH health services for youth Need for effective messaging across the SRH sectors that reflects status as health care experts Need for greater utilization of publicprivate partnerships Need to gain leverage with third-party payers, including Medicaid and commercial insurance Need to continue mapping of resources and strategies across the SRH sectors, including: o Care integration and coordination o Efficiencies among services o Process for care delivery/how patients can access care all along the SRH spectrum Need for training on revenue cycle improvements Need to reduce barriers to care that come from stigmas, stereotypes, and discrimination Need for public-private partnerships Page 3
Challenges: A Closer Look The hosts chose two of the common challenges listed above and invited s to break into groups to further discuss the problem, as well as potential solutions. Participants discussed workforce shortage and fiscal insecurity. The suggested solutions for both challenges are given in detail below. SOLUTIONS ACROSS STATES: Workforce Shortages Improve culture/pride for those in public health Work with universities/training programs on pipeline and leadership training Increase and/or develop advocacy efforts with medical/nursing board Work on licensing requirements with medical/nursing boards Encourage clinicians in working to the top of your license Reduce indirect costs in order to boost salaries Raise profile of CDC-funded Disease Intervention Specialists (DIS) to attract co-funding (for example, from emergency services grants) Train clinicians particularly for working in rural areas Increase telemedicine capabilities Utilize existing CDC resources especially STD Increase utilization of the National Health Service Corps (Title X-specific) Seek money from private funders to fund innovative ways to subsidize salaries to increase competitiveness Hire one coordinator for volunteers use existing university resources SOLUTIONS ACROSS STATES: Fiscal Insecurity For NGOs Obtain 340B pricing Maximize support from drug and patient assistance programs Increase insurance coverage of preventative services Market services to private insurance Seek support/partnership with a foundation For Public Providers Maximize support from drug and patient assistance programs Increase insurance coverage of preventative services Develop billing systems Develop relationship with administrators/providers with other safety-net programs Start acting like private sector, i.e. develop billing systems Seek expert advice on billing and marketing for private insurance For All Providers Ensure sustainability of service: link with primary care, especially for non-complex cases Partner with those providing other types of services (i.e. pediatricians) Need for both integration of STDs into primary care and differentiation of services Investigate new models of payment: charge-per-life/per capita fee model (fee for service will not keep doors open) Determine if there is a distinction between health care patient and public health care patient Page 4
III. Next Steps for States Although the collaborative opportunities and specific next steps were different for each of the five states, there were common threads among the action steps that each state identified as a result of the discussions. Representatives from all five states committed to continue the conversations that began in Charleston once they returned home. Next steps for states fell into the following categories: Collaboration: Begin or continue collaborating across sectors o Utilize public-private partnerships o Delineate challenges with third-party payers and address them collectively Communication: Continue the conversation o Identify and invite stakeholders to participate in ongoing discussions who can fill the knowledge gap identified at the initial meeting Innovation: Look for ways to diversify funding o Leverage statewide funds o Pool resources o Cross-sector grant applications o Expand scope of foundation support Sharing: Resource sharing to collectively increase professional knowledge o Create online resource directory o Host forums led by subject matter experts Page 5
IV. Feedback from Participants Comments from the s were overwhelmingly positive. According to a survey of s in the weeks following the meeting: 85% of s agreed that the meeting gave them the opportunity to identify resources available to build capacity to increase the quality, quantity, and effectiveness of their SRH services. 96% of s said that participating in the meeting would enhance their state s efforts to improve SRH outcomes. Examples of feedback included the following statements. Not only did I learn about initiatives in Georgia, but the relationships developed will literally change the prevention outcomes with our new pursuits and collective impact. STD/HIV and Family Planning sector The conversations were intense and it took until the second day for me to fully realize the networking potential. However, the foundation has now been laid for productive follow-up, capacity building, and a significant impact on outcomes. STD/HIV and Family Planning sector [Discussion about t]he state s pace and budget process was both fascinating and educational. I expect we will be able to help each other behind the scenes to further each other s goals. STD/HIV and Family Planning sector It was good to have discussions with other players from my state and learn what types of activities they are involved in. It was also beneficial hearing from other states and getting ideas for collaboration from them. If we are able to capitalize on the momentum of the meeting together in Charleston, we should be able to work more closely together to improve outcomes in our state. Family Planning/ Reproductive Health sector Extremely well-organized and well-planned to promote conversations. This was a first for me and the efficacy of a conversation as opposed to a conference has been a frequent discussion within our community and organization since I ve returned. STD/HIV and Family Planning sector One of the best meetings I ve been to, because the organizers were so energetic and proactive about having open discussion. It allowed the s to be engaged. Most meetings are mandates and have [an] uncomfortable atmosphere. The organizers energy and commitment to SRH is key! STD/HIV sector The connections we were able to make among colleagues in South Carolina and in other states are invaluable. We are continuing our conversations. Family Planning/ Reproductive Health sector Page 6