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Creating Opportunities for Health Homes: Effective Advocacy
National Alliance to End HomelessnessKaren Batia, [email protected] 16, 2012
Health care as runaway reactor
Heartland Health Outreach
“The U.S. system’s cost is fueled by a runaway reactor called fee-for-service reimbursement. It has taught us that…when caregivers make more money by providing more care, supply creates its own demand. By some estimates, a staggering 50 percent of health care consumed seems to be driven by physician and hospital supply, not patient need or demand.”
Clayton Christensen, The Innovator’s Prescription
Advocacy lessons learned
Sometimes people do the right things for the wrong reasons
Create a “win win” solution
Make the business case from the perspective of people served not your organization or siloed interest
Provide service-based examples and educate those you are trying to influence
Be a consistent presence and provide “go to” expertise
A perspective of “pragmatic optimism” in combination with “pragmatic realism” demonstrates vision and a means to potentially achieve goals
Heartland Health Outreach
What Heartland Health Outreach is doing to prepare for health reform opportunities
Consultation and guidance in becoming a CCE/Medicaid accountable care organization
Participating in CMS ACO learning collaborative
Participating in Medicare FQHC advanced primary care practice (APCP) demonstration, conducted by CMS in partnership with Health Resources and Services Administration (HRSA) – evaluation of PCMH
Participating in Department of Health and Human Services (DHHS), Assistant Secretary Planning & Evaluation (ASPE), A case study: Medicaid Opportunities and Innovations for people experiencing homelessness; one of six communities across the country; leverage national experts on ACA and Medicaid reform
Heartland Health Outreach
Creating a coordinated care organization for vulnerable individuals who are high users of health care services
In February 2011, Heartland Alliance presented a policy brief to the Illinois Department of Healthcare and Family Services (HFS) in response to health care reform legislation:
Medicaid reform legislation mandates 50 percent of Illinois Medicaid enrollees be assigned to a coordinated care entity (CCE) by January 1, 2015
Federal health reform expands eligibility for Medicaid to everyone at or under 133 percent of the Federal Poverty Level on January 1, 2014; eligibility is no longer dependent on disability
700,000 new individuals eligible for Medicaid in Illinois by 2014 ~ Illinois Medicaid enrollment close to 3,000,000 (30 percent increase)
Illinois mandated to provide alternative care and community housing options for individuals currently residing in nursing homes/IMDs who are able to live in less restrictive environments
Heartland Health Outreach
Health homes & care coordination ~ Highlights of the Heartland Way
Reasonable and meaningful health outcomes for vulnerable populations; utilize population specific data driven strategies
Policy must incentivize outcomes that are pragmatic, increase quality and reduce costs
Electronic health records and health information exchange among partners
Ensure financial sustainability
Health homes include a medical home – Medical providers, social service providers, wraparound and care
coordination services– Participant-identified needs shape services offered – How and where services are provided matter
Heartland Health Outreach
Health homes & care coordination ~ Highlights of the Heartland Way
Continuous quality and process improvement
Siloed systems of care barriers must be tackled through systems and service integration
Entitlement process must be streamlined and simplified; provider incentives for outreach and enrollment
Administrative infrastructure must incorporate innovative strategies including:
– Braid funding streams– Partnership development– Care coordination– Funding strategies that align with care goals
Heartland Health Outreach
The role of permanent supportive housing in implementing the ACA and Medicaid reform in Illinois
Published August 2011 https://webmail.heartlandalliance.org/whatwedo/our-programs/health- care/medicaid-and-permanent-supportive-housing-policy-paper.pdf
Partnership between Corporation for Supportive Housing (CSH), Health and Disability Advocates (HDA), and Heartland Alliance, in collaboration with AIDS Foundation of Chicago (AFC), Supportive Housing Providers Association (SHPA) and Chicago Alliance to End Homelessness (CAEH)
Analysis of current Illinois Medicaid reimbursement and funding in PSH; policy recommendations to maximize reimbursement opportunities and Medicaid crosswalk
Heartland Health Outreach
Recommendations to the State
Leverage current Medicaid taxonomy to reimburse for PSH services that meet Medicaid expectations; expand with ACA opportunities ~ allowing federal housing dollars to be used for housing & rental subsidies not services
PSH providers without infrastructure to bill Medicaid serve Medicaid eligible and vulnerable people, assistance needed to partner with health networks, FQHCs & CMHCs
Heartland Health Outreach
Recommendations to the State
Investing in PSH capacity enhances community continuity of care, and reduces utilization of high cost urgent and long-term care
Medicaid billing and reimbursement methods should be streamlined to more easily braid funding streams and leverage needed resources
Heartland Health Outreach
The Illinois Innovations Project
State of Illinois goal: A redesigned health care delivery system that is more patient-centered, with a focus on improved health outcomes, enhanced patient access, and patient safety
To achieve this goal, the state must:– Engage community partners in promoting coordinated quality
care across all provider and community settings– Offer new funding incentives and flexibility– Measure delivery system effectiveness and efficiency– Promote risk-based funding arrangements – Break down silos in programs and funding– Think outside the box on prevention and health education
Julie Hamos, HFS, October 2011
Heartland Health Outreach
State of Illinois context
Implementation of Medicaid reform– Requires 50 percent of Medicaid recipients be enrolled in “risk-
based Care Coordination” by 2015
IL interest in Affordable Care Act incentives– Health home option– Financial incentives to integrate duals (Medicare + Medicaid)
The Innovations Project is designed to achieve the state’s goal by:
– Testing community interest and capacity to provide alternative models of delivering care (i.e., not through traditional HMOs)
– Aligning with Accountable Care Act CMS initiatives– Building on interagency collaborations
Heartland Health Outreach
Care coordination as defined by Illinois
Integrated delivery systems in which participants receive care from providers responsible for providing or arranging the majority of care, to include primary care, diagnostic and treatment services, behavioral health services, inpatient and outpatient hospital services, dental services, and rehabilitation and long-term care services
Must include risk-based payment based on health outcomes, use of evidence-based practices, and use of electronic medical records
Heartland Health Outreach
Priority Population: Adults
Seniors and adults with disabilities (including those in long-term care, those with serious mental illness)
Children in the families of enrolled adults
Section 2703 of Health Home Demonstration Option targets populations for certain care coordination:
– Individuals with at least two chronic conditions, or one chronic condition and at-risk for another; or
– One serious or persistent mental health condition– Chronic conditions include a mental health condition,
substance use disorder, asthma, diabetes, heart disease, and being overweight; other chronic conditions such as HIV/AIDS will be considered
State is particularly interested in proposals that include individuals with mental illness and/or substance use disorders
Participation in a CCE is voluntary; handled by client enrollment broker
Together4Health – Our mission
To be a regional community health home safety network that supports vulnerable people, including those living with chronic and multiple medical and mental health conditions, people living in poverty, people experiencing homelessness, the unemployed and underemployed, and those with limited access to services due to cultural or language barriers.
Together4Health providers go outside our own walls, linking the people we serve to a full range of services that improve and support the health of our community.
Together4Health – Our values guide care
Services we provide are person- and family-centered and address both individual and community needs
Incorporate a continuum of housing and other social services that strengthen participants’ ability to engage in, and benefit from, health care
Employ evidence-based, evidence-informed, innovative, and promising practices that are regularly evaluated and vetted by consumers of care as part of our commitment to continuous quality improvement
Create a sustainable and healthy business model that responds to economic realities, policy shifts, and emerging health demands, as well as to the needs of our partners and the people we serve
Together4Health – Our goals
Ensure that our participants experience the highest quality care
Improve the health of vulnerable populations
Reduce the per capita cost of health care
Reduce health disparities
Share accountability for the outcomes of patient care across the partnership
Address social determinants (lack of housing, employment, food security, and social supports) that have a negative impact on health
Continue to revise and improve the model, according to input from research partners who evaluate and report on network services, outcomes and disseminate findings
Heartland Health Outreach
Together4Health – Our partners
Hospitals – ranging from safety net to an academic medical center
Community health centers (FQHCs)
Community mental health centers (CMHCs)
Substance use providers
Medical respite care
Supportive housing providers
Alliance of Chicago Community Health Centers (HIT)
Organizations that support providers, i.e. AIDS Foundation of Chicago (AFC), Corporation for Supportive Housing (CSH)
Advocacy organizations and trade associations
Specialty care – HIV/AIDS; people experiencing homelessness; refugees; people with language or cultural barriers
Together4Health – Health home model