Policy Road Map for Health Equity: Outlook and Opportunities - PowerPoint PPT Presentation

Loading...

PPT – Policy Road Map for Health Equity: Outlook and Opportunities PowerPoint presentation | free to download - id: 70306f-Yjc2Y



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Policy Road Map for Health Equity: Outlook and Opportunities

Description:

Policy Road Map for Health Equity: Outlook and Opportunities Minnesota Community Health Worker Alliance Statewide Meeting Michael Scandrett, JD Emily Zylla, MPH – PowerPoint PPT presentation

Number of Views:36
Avg rating:3.0/5.0
Slides: 59
Provided by: Jri99
Learn more at: http://mnchwalliance.org
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Policy Road Map for Health Equity: Outlook and Opportunities


1
Policy Road Map for Health EquityOutlook and
Opportunities
  • Minnesota Community Health Worker Alliance
    Statewide Meeting
  • Michael Scandrett, JD
  • Emily Zylla, MPH
  • Halleland Habicht Consulting
  • June 5, 2014

2
Topics for Today
  • Health care reform health coverage
  • New provider care delivery and payment models
  • Health equity policy developments
  • Opportunities for CHWs

2
3
1. Health Care Reform Expansion of Health
Coverage
4
Background the American Health Care System
  • More expensive than other countries
  • Poorer health of the population
  • Highly variable quality, effectiveness and safety
  • Inadequate prevention
  • Poor management of chronic disease
  • Perverse financial incentives
  • Unsustainable cost increases

5
Background the American Health Care System
6
Consequences
  • Decreased worker productivity
  • Rising costs contribute to government budget
    deficits and divert resources from other
    government priorities
  • Erodes health insurance coverage and benefits
  • More uninsured and underinsured
  • Persistent health disparities

7
Federal Reforms 2010Affordable Care Act (ACA)
  • Medicaid Expansion
  • Health Insurance Exchanges a marketplace to buy
    insurance
  • Regulations of Private Health Insurance
  • Reforms to Provider Payment Methods
  • Increased Prevention and Wellness
  • And more.

7
8
ACA Expands Health Coverage
Universal Coverage
Individual Mandate Health Insurance Market
Reform
Medicaid Coverage (Up to 133 FPL)
Exchanges (Subsidies for 133 400 FPL)
Employer Sponsored Coverage
8
9
Overall, Minnesota rate of Uninsured Ranks
3HOWEVER
Uninsured Rates in Communities of Color
SOURCE KCMU/Urban Institute analysis of 2011 and
2012 ASEC Supplements to the CPS.
Less than 20 (14 states)
30-49 (16 states)
20- 29 (14 states)
More than 50 (7 states, including DC)
10
Disparities in Insurance Coverage
Source MDH, Health Economics Program
11
MN Coverage Options
11
12
  • Minnesotas Health Insurance Marketplace
  • 223,000 Enrollments to Date
  • 126,039 in Medicaid
  • 46,417 in MinnesotaCare
  • 50,733 in Qualified Health Plans
  • Navigators help consumers choose a health plan
    and enroll
  • Many problems with MNsures start-tup

13
Impact of ACA on Uninsured
Estimated Uninsured in MN, With Without ACA
13
Source Gruber/Gorman Analysis, Prepared for
Health Care Reform Task Force, MN, 2012
14
Preview Access to care 5 years after reforms
enacted
15
But, the ACA has not solved the problem of the
uninsured
16
The Remaining Uninsured201,000
16
Source Gruber/Gorman Analysis, Prepared for
Health Care Reform Task Force, MN, 2012
17
Reason for Coverage Gap
18
Compared to the Insured Population, the Uninsured
are
  • Younger almost twice as likely to be under 34
    years of age (54 uninsured vs. 29 insured)
  • Poorer over twice as likely to have income below
    200 of poverty (56 vs. 27)
  • More Diverse almost twice as likely to be from a
    community of color (32 vs. 19)
  • Less educated nearly twice as likely not to
    graduate from high school (8.3 vs. 5.2)
  • Single over twice as likely to be unmarried (44
    vs. 21)
  • Male a third more likely to be male (63 vs.
    47)

19
The Remaining Uninsured Undocumented Immigrants
  • The largest category of the remaining low-income,
    uninsured Minnesotans is people who are not
    eligible for MA or the MNsure Exchange due to
    their immigration status
  • Most uninsured immigrants seek care from safety
    net providers Community Health Centers,
    community dental and mental health providers, and
    public hospitals and clinics
  • The only State of Minnesota program for these
    Minnesotans is Emergency Medical Assistance,
    which covers emergency care and hospitalization

20
Uninsured Immigrants Future Policy
Opportunities
  • Emergency Medical Assistance (EMA)
  • A DHS Report on EMA called for expanding the
    coverage and benefits for undocumented immigrants
  • 2014 Legislation requires a report to the 2015
    Legislature on possible improvements to the EMA
    program
  • Funding for Safety Net Providers
  • 2014 Legislature provided additional grants to
    safety net providers to serve uninsured patients
  • 2015 is a State Budget Session where funding for
    the uninsured will be decided

21
Health Coverage Opportunities for CHWs
  • MNsure outreach to communities
  • MN enrollment navigation and assistance
  • Advocacy on behalf of communities of color
  • MNsure advisory committees and Board
  • State agencies
  • MN state legislature
  • Political campaigns

22
QUESTIONS
23
2. New Provider Care Deliveryand Payment Models
24
Triple Aim of Health Reform
  • Improve the health of the patient population
  • Improve the patient/consumer experience
  • Improve the affordability of health care

24
25
Minnesota Ahead of the Curve
2008 2010 Minnesota Reforms
  • New Care Models Health Care Homes Care
    Coordination
  • Quality Measurement for payment, consumer
    information, and accountability
  • Payment Reform Evolving to pay for VALUE rather
    than VOLUME

25
26
New Care Models
Health Care Homes
  • A primary care provider or team
  • Certified by MDH
  • Paid a monthly per-person care coordination fee
  • Partner with and engage the patient/family to
    improve health and manage chronic conditions
  • Coordinate all needed services, with EHR IT
  • Address non-clinical factors affecting health

26
27
Accountable Care Organization
  • A network of clinics and health care providers
    who take responsibility for managing the health,
    quality and total cost of care (TCOC) for their
    patients
  • In Minnesota, ACOs serving patients enrolled in
    Medicaid and MinnesotaCare are called Integrated
    Health Partnerships (IHPs) and were formerly
    known as Health Care Delivery Systems (HCDS).

27
28
MN ACOsIntegrated Health Partnerships (IHPs)
  • Medical Assistance/MinnesotaCare ACOs in MN
  • DHS contracts directly with IHPs in a new way to
    serve a specified patient population
  • IHPs provide needed services for the patients
    attributed to their clinics
  • Gain sharing payments made if the IHP reduces
    the total cost of care for attributed patients
    while maintaining quality of care and patient
    satisfaction
  • Nine IHP projects are underway more are coming

28
29
Who is Establishing ACOs?
  • Large integrated hospital-clinic organizations
  • Alliances of independent clinics and hospitals
  • Safety Net Providers serving low-income and
    underserved populations
  • County health care, social service and public
    health agencies

29
30
ACOs and Safety Net Populations
  • Early models were developed by large
    hospital-clinic companies working with large
    employers serving a mainstream, middle-class
    population.
  • Will ACOs work in Safety Net Settings?
  • Cultural competence and socio-economic factors
  • Co-occurring MI and chemical dependency
  • Non-medical services needed (housing,
    transportation, etc.)
  • Risk-adjustment for higher costs, poorer outcomes

30
31
IHP Shared Savings
Shared Savings
32
FUHN (FQHC Urban Health Network)
  • FUHN is a Virtual IHP (made up of independent
    clinics)
  • Ten FQHCs working in partnership
  • AXIS Medical Center, Cedar-Riverside Peoples
    Center, Community University Health Care Center,
    Indian Health Board of Minneapolis, Native
    American Community Clinic, Neighborhood
    HealthSource, Open Cities Health Center,
    Southside Community Health Services, United
    Family Medicine, West Side Community Health
    Services
  • OPTUM provides data analysis and other expertise

33
FUHN Project Goals
  • Improved Access to High Quality Primary Care
  • Improved Clinical Quality
  • Improved Consumer Engagement and Satisfaction
  • Reduced Total Cost of Care

34
Challenges What will it takefor an IHP to
succeed?
  • Effective Team-based Primary Care services
  • Robust Care Coordination
  • Patients actively engaged in their care and
    health
  • Communities actively engaged in improving
    population health
  • Health Information Technology (HIT) systems to
    support care coordination and quality and cost
    management
  • Health Information Exchange (HIE) systems to help
    provider networks coordinate care

35
DHS Projects The Next Wave
  • More HCDS projects will coming online in 2014
  • States goal cover 50 of the Medicaid
    population in ACO/IHPs (excluding elderly and
    people with disabilities)
  • ACOs are expanding in the private sector, too
  • Expanding to additional service intensive mental
    health, long-term care, and home and
    community-based services for complex populations
  • SIM Grant - Accountable Communities for Health

35
36
State Innovation Model (SIM) Grant
  • 45 million grant from CMS
  • Expansion of ACO/IHP models
  • Especially small and rural providers, safety-net
    providers, and providers who are not part of
    large integrated health systems
  • Project Goals
  • Transform care delivery
  • Accelerate adoption of ACO models in Medicaid
  • Ensure providers are able to securely exchange
    data
  • Create Accountable Communities for Health

36
37
SIM Budget Allocations
  • 23M for health information technology, secure
    exchange of health information and data analytics
  • 6.3M for practices to improve care coordination
  • 2.5M for quality and performance measurement
  • 10M to support up to 15 Accountable Communities
    for Health

37
38
Accountable Communitiesfor Health
  • Expand IHP Accountable Care model beyond
  • traditional acute care services to include
  • Non-clinical services affecting patients health,
    including social services, public health, housing
  • Community-wide prevention efforts to improve
    overall health and reduce chronic disease
  • Behavioral Health, Long Term Care, and Home and
    Community-based Services
  • Measurable community-wide goals for improved
    population health, health care and cost
    management
  • Roles for citizens, employers, providers, health
    plans, government and communities.

38
39
Measuring Quality
  • Under the new care models and payment reforms,
    reducing future costs is necessary but not
    sufficient
  • Providers must meet also meet standards of
    quality and patient satisfaction
  • Standardized quality measures are measured and
    reported through Minnesota Community Measurement
    and the Minnesota Department of Health

40
SQRMS
  • All providers measured using standardized
    statewide quality measures under Minnesotas
    Statewide Quality Reporting and Measurement
    System (SQRMS)
  • Currently SQRMS does not collect or report data
    by race, ethnicity, language (REL), or
    socio-economic status (SES) such as income,
    homelessness, and gender identity and sexual
    preference

41
Healthcare Education Workforce
  • Health professional education is lagging behind
    emerging workforce trends
  • Increased reliance on primary care providers
  • Multidisciplinary, team-based care
  • Use of allied, mid-level and paraprofessional
    practitioners
  • Skilled in using EHR, HIE and data to drive care
    delivery
  • Skilled at patient and community engagement
  • Cultural competency and relevance

42
Recap of Trends
  1. Care coordination of all health care services
    needed by a patient
  2. Services delivered through multi-disciplinary
    primary care teams.
  3. Provider accountability for quality, health
    outcomes and costs using standardized measures.
  4. Improved patient satisfaction and engagement in
    their own health and health care.
  5. New payment methods and financial incentives for
    providers to reduce the total cost of care
    through prevention, early management of disease,
    and efficient, effective care.
  6. Use of health information technology to improve
    care and reduce costs.
  7. New Coordination of health care with non-health
    care services to address social determinants
    (poverty, race/ethnicity, literacy, homelessness,
    etc.) and reduce health disparities.

42
43
New Models Opportunities for CHWs
  • Member of Primary Care Team
  • Improve Patient Engagement
  • Improve Community Engagement
  • Improve Population Health
  • Address Social Determinants of Health (REL/SES)
  • Advocate for Change
  • Within health care organizations
  • In communities
  • With government agencies
  • With policymakers (MN Legislature, county boards,
    etc.)

44
QUESTIONS
45
3. Health Equity Policy Developments
46
Health Equity
  • Increased attention to health disparities
  • MDH Report February 2014
  • Health in All Sectors
  • Statewide Leadership Structural Racism
  • Strengthen Community Relationships
  • Redesign Grant Programs
  • Strengthen Data on Disparities

47
Health Care Reforms Impact on Health Disparities
  • MA expansion improves health coverage benefits
  • Patient relationship and engagement is key to
    provider care delivery and payment model reforms
  • Payment reforms will allow resources to be
    shifted from hospital/specialty to primary
    care/outpatient and to services to address social
    determinants of health
  • Coordination with social services other county
    services will help address social determinants of
    health
  • Quality Measurement to track and report quality
    for communities of color and other populations
    with health disparities.

47
48
2014 Legislative Session Highlights Health
Equity
  • Health Equity grants
  • Funding for Interpreters
  • Grants for Health Care for Uninsured Patients
  • Emergency Medical Assistance Program
  • Statewide Quality Reporting and Measurement
    System (SQRMS) Changes

49
Data SQRMS, REL SES
  • Data on Health Disparities
  • Statewide quality measures cant be broken down
    by race, ethnicity and language (REL) or
    socio-economic status (SES)
  • Lack of data on quality of care for communities
    of color and REL/SES groups is a barrier to
    identifying and eliminating health disparities
  • Risk Adjustment
  • Providers are accountable for quality of care
  • Current measures do not adjust for REL/SES,
    causing harm to providers who serve REL/SES
    patients

50
Data SQRMS, REL SES
  • 2014 Legislation
  • SQRMS plan to measure quality of care based on
    REL/SES and adjust provider quality scores based
    on these factors
  • MDH
  • Develop an implementation plan and budget to
    present to the 2015 Legislature
  • Consult with stakeholders in developing the plan,
    including communities of color and other groups
    with health disparities
  • Use culturally appropriate methods of engaging
    communities in the process of developing the plan

51
Health Equity Issues to Watch
  • SIM Accountable Communities for Health
  • Statewide community engagement Summer 2014
  • RFP expected Sept. 1, 2014
  • 2015 Legislative Session
  • State budget year
  • Legislative proposals from the Health Equity
    Report
  • Implementation plan for REL/SES quality
    measurement and risk adjustment
  • Emergency Medical Assistance program changes
  • Coverage and access to care for the remaining
    uninsured

52
Whats the Role of CHWs in Reducing Health
Disparities?
  • CHWs come from the communities they serve,
    building trusting and vital relationships.  These
    crucial relationships significantly lower health
    disparities because CHWs
  • Facilitate access to services and coordination of
    care
  • Improve the quality and cultural agility of care
  • Improve chronic disease management and
  • Increase the health knowledge and self
    sufficiency of underserved populations
  • Increase patient and community
  • engagement

53
QUESTIONS
54
4. Opportunities for Community Health Workers
under Reform Trends
55
The Value of CHWs in Health Care
  • Educating and engaging patients in managing their
    health and coordinating the services they need
  • Bringing cultural knowledge and skills to primary
    care teams
  • Bringing cultural knowledge and skills to health
    care organizations, public health agencies and
    other public and private organizations
  • Strengthening engagement of communities of color
    with health care organizations and the health
    care system
  • Identifying and addressing health disparities

56
Opportunities for CHWs Individually
  • MNsure (navigation, etc.)
  • Care delivery and payment models (PC, HCH,
    ACO/IHP, ACH)
  • Public health and population health improvement
  • Patient and community engagement
  • Health equity/eliminating disparities
  • Community leadership
  • Public policy advocacy

57
Opportunities for CHWs Working Together
  • Business Case for CHWs. Make the case that CHWs
    provide a financial return-on-investment and add
    value in other areas
  • CHW Workforce Models. Promote roles of CHWs with
    health systems, clinics, public health agencies,
    and IHPs
  • Community Engagement. Assist communities served
    by CHWs in being engaged in policy advocacy and
    holding health care organizations and the health
    system accountable
  • Policy Advocacy Advocate together on public
    policies, reforms, programs, and funding on
    behalf of populations served by CHWs

58
QUESTIONS
About PowerShow.com