2017 & 2018 New Member Employers 2017 2018 Almon, Inc. American Metal Technologies Bemis Manufacturing Company Inlanta Mortgage, Inc. Krones, Inc. Nordco, Inc. Oldenburg Group, Inc. Wisconsin Aluminum Foundry Company Associated Banc-Corp. The Bon-Ton Stores, Inc. Goodwill Industries of North Central Wisconsin, Inc. Goodwill Industries of Southeastern Wisconsin, Inc. Kohler Co. Reinhart Partners, Inc. Sendik s Food Markets And significant growth expected throughout 2018 and for 1/1/19
Today s Agenda 2:30-2:35 Welcome 2:35-2:40 Mary Ellen Stanek, Baird Opening Remarks 2:40-3:30 Julie Schuller, M.D., Sixteenth Street Community Health Centers Joy Tapper, Milwaukee Health Care Partnership 3:30-4:10 John Prince, OptumRx 4:10-5:00 Peer-to-Peer Networking
Business Health Care Group March 21, 2018
Mission The Milwaukee Health Care Partnership is a public/private consortium dedicated to improving health care for low-income, underserved populations in Milwaukee County, with the aim of improving - health, reducing disparities, and lowering the total cost of care.
Members 4 Health Systems Ascension WI Aurora Healthcare Children s Hospital & Health System Froedtert Health 5 Federally Qualified Health Centers (FQHCs/Community Health Centers) Gerald Ignace Indian Health Center Milwaukee Health Services, Inc. Outreach Community Health Centers Progressive Community Health Centers Sixteenth Street Community Health Centers Public Health Agencies City of Milwaukee Health Dept. Milwaukee County Dept. Health & Human Services WI Dept. of Health Services and Medicaid Office Academic Medical College of Wisconsin Affiliates: Wisconsin Hospital Association, Wisconsin Primary Health Care Association, Medical Society of Milwaukee County, Wisconsin Statewide Health Information Network (WISHIN), Free Community Clinic Collaborative (FC3), Others
Milwaukee County Population Profile 2017County Health Rankings Milwaukee County s rank among 72 Counties Quality of Life 72 Overall Health 71 Health Behaviors 71 Socioeconomic Factors 71 Length of Life 66 Clinical Care 45 Who is Vulnerable? Milwaukee County Population 957,735 Nearly 20% of residents live at or below the federal poverty level 33% are enrolled in a Medicaid program 46% of children are covered by Medicaid Between ~7% of the population is uninsured at any point in time
Health Disparities Milwaukee County Average Age of Death by Race/Ethnicity 80 White Age in years 75 70 65 Black Hispanic 60 American Indian 55 Asian 50 2012 2013 2014 Secondary Data Report: Wisconsin Interactive Statistics on Health (WISH) dhs.wisconsin.gov/wish/ mortality
Core Functions 1. Assess & build awareness of community health needs 2. Implement a community wide plan and policy agenda* 3. Secure and align public and private funding and invest in high- impact initiatives 4. Monitor and report outcomes 5. Serve as a clearing house for new initiatives *Improve efficiency and effectiveness by reducing duplication, fragmentation of efforts and cost
Goals 1. Secure adequate and affordable health insurance coverage for all 2. Increase the availability and accessibility to health care programs and services 3. Enhance care coordination and navigation within and across health and social care delivery systems 4. Address targeted community health issues via cross-sector collaboration
ACTIVITES & ACCOMPLISHMENTS
Nationally Recognized Enrollment Coalition +75 Organizations Sources of Insurance in Milwaukee County 2017 >160 Enrollment Assisters and Insurance Navigators +20 Outreach and Enrollment Events Crowd Funding for Community Marketing Campaign
Uninsured in Milwaukee County 140,000 120,000 100,000 80,000 60,000 40,000 20,000 Pre- ACA 12.6% 117,311 39,422 22,202 39,442 22,202 55,667 17,769 41,820 Post - ACA 6.8% 63,338 24,913 15,861 33,802 28,058 11,512 23,768 46% Reduction in the Uninsured Rate 2.00 FPL 1.38 to 1.99 FPL < 1.38 FPL 0 Quarterly Coverage Report October 2017 2013 2016 Milwaukee Enrollment Network 13
Primary Care Access Study Highest Poverty Zip Codes accounted for: 45% of total county population 71% of the county s Medicaid and uninsured population 27% of total primary care physicians 60% of primary care treatable ER visits
Primary Care Access FQHC Growth Plan Build the capacity and capabilities of Milwaukee s Community Health Centers Invest in New Access Points Support operational improvements, efficiencies, collaboration and shared services
Access Organized and Supported Other Safety-Net Clinics +25 Free Medical Clinics; 38 other Safety Net Clinics reported 510,472 patient visits in 2016.
Specialty Access for Uninsured Program
ACCESS Behavioral Health Advancing MKE County BHD Redesign Investments and Expansion in Outpatient Care Expansion to Psychiatric Teleconsultation Services Expansion Oral Health Embed Hygienists in Primary Care Settings Expand Seal-A-Smile program in high risk schools Improve access for Special-Needs Dentistry
Care Coordination Emergency Department Care Coordination Goal: Decrease avoidable ED visits and connect to Primary Care and other health resources. ED to Health Home Program +55,000 referrals since 2009; ~500 patients per month 45% show rate; 55% stick rate 44% decrease in ED visits once connected
Collaborative Community Health Improvement Priorities
Leveraging Investments Shared Community Investment Fund (SCIF) Health Systems Strategic Funding Pool Total Investments: $26.6 million MHCP/ United Way Health Improvement Fund (HIF) Challenge Grant Total Investments: $2 million Other Extramural Funding Total Raised: $5.9 million More than $32 million in aligned funding to improve access, reduce disparities and slow the rate of increase in the cost of care in Milwaukee.
Greater Milwaukee Business Foundation on Health Medication Access $185,832 in GMBFH grant funding over 7 yrs. to support prescription assistance program: Served 5,717 unique patients Filled 30,943 prescriptions Provided medications at an average wholesale value of $37,285,106 ROI = $201 in Rx cost savings for every $1 contributed Health Information Exchange $164,000 grant enabling the connection of 8 largest safety-net clinics to WISHIN Coverage $300,000 commitment from 2018 2020 to strengthen and sustain insurance enrollment assistance
Impact on Payers and Employers Supporting enrollment, ensuring timely access to the right care and improving overall population health benefits payers and employers Securing Coverage and Access to Care for Working Poor Estimate > 50% uninsured are employed 78% of Medicaid beneficiaries live in a family with at least one working family member; 60% of adult Medicaid enrollees are employed full or part time Reducing Cost-Shifting Reducing charity pass- through Reducing Medicaid uncompensated care Hidden Tax Medicaid Tax-Payer Value Building a Safer, More Productive, and Prosperous Community Preventing and addressing illness, chronic disease and disabilities Supporting the development of a healthier workforce
Sixteenth Street Community Health Centers Over 45 years of quality, patient-centered, family- based healthcare and supportive services
What is a Community Health Center (CHC)? For over 50 years, HRSA-supported community health centers have provided comprehensive primary and preventative health care services which means Medical Dental Behavioral health Substance use care Connections to social services
Community Health Center Requirements Have a 51% patient-majority board of directors Be located in/serve a medically underserved area or population Apply for and receive competitive HRSA grants for continuation Comply with HRSA 19 program requirements Demonstrate compliance through routine HRSA operational site visits
Our Mission To improve the health and wellbeing of Milwaukee and surrounding communities by providing quality, family-based health care, health education and social services, free from linguistic, cultural and economic barriers.
Our History Since 1969, Sixteenth Street Community Since 1969, Sixteenth Health Street Centers Community has been Health a Centers has been a community leader in community primary health leader services in for primary our city s health most services vulnerable for residents our city s most vulnerable residents Our reputation for compassion, innovation and quality is both locally and nationally recognized Our reputation for compassion, innovation and quality is both locally An independent non-profit agency, Sixteenth and Street nationally now operates recognized at six locations, including three full-service medical clinics and a Women, An Infants independent & Children (WIC) non-profit nutrition agency, program Sixteenth Street now operates at six locations, including three full-service medical clinics and a Women, Infants & Children (WIC) nutrition program
Our Board of Directors Rick Walters Board Chairman Sixteenth Street Patient Rick Walters Board Chairman Wells Fargo Advisors LLC Laura Arnow, CPA Treasurer Arnow & Associates José Avila, MSN, FNP Thomas M. Gazzana Vice President Wayne F. Heidenreich, MD Northwestern Mutual Kathryn Hein Les Aspin Center for Government Steven K. Kulick, MD ProHealth Care, Inc. Lauren Lopez Milwaukee Public Schools Teresa C. Mercado Mexican Fiesta/WHSF Ellen K. Murphy, J.D. UWM School of Nursing Juan Ruiz Secretary United Community Center Suzanne Sanicola, CPA Ascension Wisconsin Levi Sosa 8 of our 13 members are patients
Our Practice Sites Milwaukee Chavez (full service clinic) Parkway (full service clinic) Layton (full service clinic focus on behavioral health and AODA) United Community Center Senior Center (geriatric care) St. Anthony in-school clinics St. Augustine Prep in-school clinic Greenfield Building (WIC location among other services) Waukesha Sixteenth Street Waukesha (full service clinic)
Our Patients Our patient population is extremely diverse, representing many cultures, ethnicities and economic backgrounds.
Our Patients 3% 5% 4% 8% 12% 65% 13 % 29% 24% 71% 85 %
Our Impact In 2016 Sixteenth Street served nearly 38,000 people, in more than 160,000 individual visits.
Our Impact
Our Quality Story Sixteenth Street has been accredited by the Joint Commission since 2010, and passed our last two unannounced Joint Commission audits in 2012 and 2015 In 2013 we received recognition as a Level 3 Patient Centered Medical Home (PCMH) by the National Committee on Quality Assurance In 2016 we were accredited as a Joint Commission Primary Care Medical Home We are part of the Wisconsin Collaborative for Healthcare Quality, an organization that aggregates and publishes health care quality information
Key Quality of Care Indicators Trimester of Entry into Prenatal Care 74% of patients entered prenatal care in the first trimester Childhood Immunizations 92% of children under age two were up-to-date with immunizations Cervical Cancer Screening 71% of women were screened for cervical cancer Hypertension under Control 74% of patients had their hypertension under control Diabetes under Control 74% of patients with diabetes had A1c levels under 9 Low Birth Weight 93% of babies delivered by Sixteenth Street providers were at or above normal birth weight
Operations Coordinated Care for the Whole Person We operate within a fully integrated model of primary care, behavioral healthcare, social services and supplemental services all on-site. Every added service requires an in depth discussion about cost and sustainability. We have to be very disciplined about what is and isn t within our cost model.
Primary Care Team-Based Care On site collaboration between providers, case managers, outreach workers, social workers, support staff, within and across medical and behavioral health departments. Staff of all levels work to the top of their license creating cost efficiencies.
Primary Care Medical and Behavioral Health Services Medical Services Pediatrics Family Medicine Internal Medicine Midwifery Women s Wellness (Prenatal and Pediatric Nurse Case Management) Chronic Care Education Outpatient Behavioral Health Services Psychology Psychiatry Psychotherapy Marriage & Family Therapy AODA (Waukesha and Layton only) MAT (Waukesha and Layton only) Child and Adolescent Day Treatment (Layton Only) ADHD Testing (Waukesha only)
Primary Care Pediatrics We offer the highest quality care and treatment of infants, children, and adolescents. With 49% of our patients being under the age of 18, we care for over 18,000 pediatric patients per year.
Primary Care Internal Medicine We provide long-term, comprehensive care managing both common and complex diseases.
Primary Care Family Practice We offer continuing and comprehensive health care for individuals and families of all ages.
Primary Care Midwifery & Women s Wellness We provide a personalized focus on women s health issues including disease prevention, reproductive health, birth and delivery services, support groups, case management, parenting classes and child enrichment activities.
Behavioral Health Psychiatrists, psychologists and family therapists provide individual and group therapy sessions and medical management for adults and children. They also help clients better manage stress, chronic illness and pain, abuse, neglect issues and depression.
Integration of Medical and BH Services Collocation of behavioral health providers on the same floor Behavioral Health providers able to immediately address mental health concerns during primary care visit Short sessions focus on intervention and relief Reach patients early Collaboration and immediate care is key for preventing behavioral health issues and giving our patients the coordinated care needed to put them in control of their health.
Primary Care Supplemental Services WIC (Women, Infants & Children Program) Social Services Parenting Resource Center Environmental Health Department HIV Services Healthy Choices (obesity prevention program) Women s Wellness (prenatal and pediatric case management, Obstetric Medical Home Initiative)
Support Services WIC (Women, Infant & Children) Nutrition Program We ensure the health and wellbeing of children and families by providing nutrition education, health screenings, breast feeding counseling, food vouchers and other support services.
Support Services Healthy Choices Through family education and community advocacy, Healthy Choices strives to improve the home and neighborhood environment for adults and children in Milwaukee s Southside, so they can enjoy a healthier life.
Support Services HIV Sixteenth Street s HIV program provides a comprehensive approach, including medical care and treatment, supportive case management and prevention education for Milwaukee s Latino population.
Support Services Parenting Resource Center We offer proper car seat usage classes, parenting classes, the child enrichment program and the Stork s Nest (Wisconsin Chapter of the March of Dimes) to our Sixteenth Street parents.
Support Services Social Services Our Social Services department provides crisis intervention, counseling, advocacy, education, health insurance enrollment assistance, referral to community resources and case management services to our patients, their families and the community at large.
Support Services Environmental Health The Department of Environmental Health promotes education, community activities and advocacy for neighborhood development and sustainability, in addition to comprehensive lead outreach and testing. It helps families live safe from lead poisoning, contaminated waters and other hazards.
Support Services Chronic Condition Health Education We provide prevention, intervention and support for patients managing asthma, diabetes and hypertension. Offering individual and group education, support groups and outcomebased care management.
Outreach Many departments within Sixteenth Street are actively out in the community to connect with and educate residents around prevention and maintenance to care. HIV outreach, education and prevention efforts Chronic Conditions (Diabetes and Asthma) outreach, education and prevention efforts Healthy Choices outreach, community advocacy, obesity education and prevention efforts and maintenance Prenatal and pediatric case management HIV case management
Enrollment Eligibility and Enrollment Into Coverage Every patient is evaluated for eligibility Specialists help determine if a client may be eligible and assist with enrollment into Badger Care Plus including coverage for children, families, childless adults and express enrollment for qualifying pregnant and child cases Sixteenth Street submits applications to the state and the state makes determinations on the case
CHCs Community Value Large financial contribution to the health care system as a whole Cost effective care saving the health care system millions Stimulate local economy
CHCs Financial Contribution In 2016, the five CHCs in Milwaukee received $13.3 million in federal grants to care for un- or under-insured patients and wraparound services Source: Wisconsin Primary Health Association
CHCs ED and Cost Effective Care ED and UC Visits Keep people out of ED and UC for non-acute issues Nationally, 69% of ED visits among the general population are primary care sensitive in nature and therefore preventable Average expense for an ED visit= $978 Average expense for a health center visit = $150 Average TOTAL ANNUAL EXPENSE for a health center patient = $687 Cost effective care Health centers average cost runs a dollar less per patient per day compared to all physician settings (while typically serving more complex patients that are more likely to have chronic conditions) Health centers save over $24 billion for the healthcare system annually
CHCs Stimulate Local Economy Community health centers are economic engines. Create jobs Increase business for surrounding companies Take an active part in improving their surrounding environment 707 $75 MILLION FTEs at health centers in Milwaukee Operating expenditures directly into local economies * 2015 UDS
Sixteenth Street Community Health Centers Over 45 years of quality, patient-centered, family- based healthcare and supportive services