Transcript 1115 Waiver Components - Community Health Center Association

Community Health
Partnership and
Health Care Reform
An Overview of Working Together
May 25, 2011
Presentation Overview
• Health Care Reform- Getting Familiar with
Landmark Legislation
• Role of Community Health Centers (CHCs)
• Carrying out the Promise of Health Care
Reform in Santa Clara County
• Our Call to Action!
Circle of
Health Care
Reform
Henry J. Kaiser Family
Foundation
Pop Quiz on Health Care Reform
What’s in the health care
reform legislation?
Patient Protection and Affordable
Care Act, 2009
Health Care Reform Hits Main Street
by the Kaiser Family Foundation
Pop Quiz
Self-Scoring!
How did the public do?
Grading the Public
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1/4 got 7-10 answers correct
1/3 got 0-4 answers correct
2/3 got 5 or more answers correct
Most people got 4-6 questions correct
Less than 1% responded to all 10 questions
correctly
What does the health care reform
law do?
• The health care reform law:
– Expands, promotes, and improves health care
insurance coverage
– Requires delivery system changes
– Promotes primary and preventative care
– Improves health care quality
How does health care reform impact
medically underserved communities?
• Health care reform makes an $11 Billion
investment in Community Health Centers
• Expands Medicaid/Medi-Cal
• Improves quality and coordination of care
• Funds prevention and wellness initiatives
• Funds workforce development initiatives
Community Health Centers
• The idea for health centers was inspired by a model
of community care in South Africa.
• Created in 1965 as part of the Office of Economic
Opportunity to provide health and social service
access points in poor and medically underserved
communities.
• Incorporated the community empowerment
philosophy.
Community Health Centers
• Community Health Centers (CHCs) play a
vital role as the safety net for our country’s
health delivery system.
• Do not turn anyone away for lack of
insurance or ability to pay.
• CHCs are community driven; at least 51% of
the health center board must be patients.
Community Health Centers
• Improve access to primary and preventative
care
• Facilitate access to specialty care
• Provide quality care and produce cost
savings
Administration of CHCs
U.S. Department of Health and Human Services
HRSA-Health Resources and
Services Administration
BPHCBureau of
Primary
Health Care
What does this mean
locally?
1115 Waiver
Bridge to HealthCare Reform
Medi-Cal Waiver
• The Medi-Cal 1115 Waiver
• 1115 Waiver Relationship to Health Care
Reform
• 1115 Waiver Components
The 1115 Waiver
• Agreement: Federal Government & State of California
• Allows the State to “waive” national Medicaid regulations
• Savings from the program will go back into the “waiver”
program created
• A mechanism for funding to public hospitals for Medi-Cal
services and indigent care
• Previous waiver programs in Santa Clara County: A lowincome health initiative called Valley Care and funding for
hospital to care for indigent patients.
Health Care Reform
1115 Waiver Components
• Medi-Cal Coverage Expansion
• Seniors & People with Disabilities
• DSRIP-Delivery System Reform Incentive Pool
– Improve infrastructure
– Innovation
– System Redesign
– Population-Focused Improvement
– Urgent improvement in Care (access,quality, etc.)
• 20,000-30,000 New Patients in Santa Clara County
Health Care Reform
Promising New Coverage
MediCaid
<133% of FPL
1 Person
< $14,404
4 People
<$29,327
Exchange
133-400% FPL
1Person
$14,404-$43,320
4 People
$29,327-$88,200
Personal
>400% FPL
1Person
>$43,320
4 People
>$88,200
The Role of
Community Health
Partnership
Community Health Center Advocacy
NACHC-National Association of Community Health Centers
CPCA-California Primary Care Association
Consortia (are) state-wide Regional Associations of Safety-net Clinics or Community
Health Centers
Community Health Partnership (is) a Consortium of safety-net, community health
centers in Santa Clara and San Mateo County
Asian Americans for Community Involvement, Foothill Health Centers, Gardner Family Health Network, Indian Health Center of Santa
Clara Valley, Planned Parenthood Mar Monte, Mar Monte Community Clinic, MayView Community Health Center, North East Medical
Services, Ravenswood Family Health Center, RotaCare Bay Area, School Health Clinics of Santa Clara Valley
OUR ROLE
Policy and Advocacy
• To ADVOCATE on behalf of CHCs
• To ensure that the CHCs role as a VITAL
component of the countywide System of Care
• To represent CHCs at local, state, and federal
government levels (in concert with CPCAs strategic
plan)
OUR ROLE
Preparing CHCs for Health Reform
• Assessing CHC capacity for expansion
• Testing and implementing payment reform
initiatives
• Helping build systems that will quantify QI
and DSRIP measures
• Supporting and increasing enrollment &
retention in qualifying health plans
OUR ROLE
Providing technical assistance to CHCs in
these areas:
– Patient Centered Medical Home
– Achieving Meaningful Use of Electronic Health
Record Systems
– Building operational infrastructure that improves:
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Cost management
Resource management
Data collection and reporting
Patient care coordination
Quality management
Call to Action!
• Be part of an Historic Era in Healthcare!
• Be part of a TEAM with a strategic direction!
• Be part of a something BIGGER than the
sum!
• Witness the transformation of CHCs into
Medical Homes!
Be part of a MOVEMENT in
health care by:
• Participating in legislative events and
advocacy activities
• Educating yourself about the Santa Clara
Health and Hospital System
• Determining linkages and opportunities
between your program and health care
reform (enrollment, medical home, etc.)
Questions/
Discussion
References
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Jorge De Luna, MPH
California Primary Care Association (CPCA)
Families USA
Kaiser Family Foundation
National Association of Community Health
Centers (NACHC)
Thank You!