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School-Based Health Care May 2, 2014 History SBHC Initiative In 2009, TCHF Board approved, 4-year investment in school-based health care to fund new or expanded • School-based health centers • School-based mental/behavioral health services • School-based oral/dental health Goals of the SBHC Initiative • Support the planning and implementation of at least 20 new or expanded school-based health centers (SBHC) • Identify and address policy barriers • Improve the quality of care delivered by SBHCs • Improve the effectiveness of SBHCs at reaching underserved populations • Ensure the financial sustainability of SBHCs SBHC Application Process • Step 1: Complete Readiness Assessment – Submit with grant application – Awarded up to $20,000 for planning • Step 2: Develop 4-year Business Plan – Includes financial pro forma (best and worse case) – Submit with grant application – Awarded up to $400,000 for implementation • Step 3: Implementation – Participation in evaluation Outcomes of Our Investment School-Based Health Centers 50 October 15th 2014 • 2 implementation proposals 40 36 30 20 --------------------------------------------------- New 20 10 10 0 Goal Expanded Achieved Planning Only Planning & Implementation Current Planning Policy Wins • Two provisions in the Patient Protection and Affordable Care Act – Authorization of a federal SBHC grant program – Creation of an emergency appropriation that has provided Colorado SBHCs $2.9 million in capital funding • Passage of HB11-1019, which exempts SBHCs from deductible and co-payment requirement from privately insured patients • Increase in state general line-item for the SBHC grant program by approximately $4.3 million Quality • Partnership with CDPHE and key stakeholders in development of Quality Standards for Colorado Schoolbased Health Centers – Staff participation on advisory group in creating Quality Standards – Advisory member on federally funded Colorado School-Based Health Center Improvement Project Evaluation of Initiative • Selected Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco to conduct evaluation • Timeline: January 2010 – January 2014 • Purpose: Determine if TCHF’s Initiative process was effective in driving Colorado SBHCs toward increased self-sustainability Initiative Process Most Helpful/Challenging 5 4 4.0 3.8 4.2 4.2 3.8 3.2 3 Helpfulness Difficulty 2 1 DevelopDevelop Readiness Assessment Develop Business Financial Readiness Develop BusinessPlan Financial Template Template Assessment Plan Sustainability Indicators Facility School Integration Staffing Services Management Funding Strategies Community Partnerships Marketing & Outreach Sustainability Not in 1 Place In Planning 2 Process Partially 3 Implemented Fully 4 Implemented Facility 4.0 3.9 Staffing Services 3.9 Community Partnerships 3.9 3.8 Funding Strategies 3.5 Management 3.4 School Integration Marketing and Outreach 2.9 Successes: • Policy wins – Facility expansions and renovations – Increased operational support • Increase in billing infrastructure – Medicaid revenue higher than projections – Slight increase in private insurance • Integration of primary and behavioral health care • SBHC reach within Colorado • Medical home designations Challenges: • Lead agency and community partner collaboration – Changes among leads over course of grant – New medical sponsors • School integration • Reimbursement for integrated service delivery • Oral health services • Parent and student engagement – Supportive but difficult to engage • Implementation of marketing and outreach activities What’s Ahead • Closed initiative in December 2013 – Two grants grandfathered in for implementation • Bridge grants to SBHCs in 2014 – Time for new CDPHE monies to be distributed – Insurance expansions • Policy support – CASBHC grant – Address network adequacy via Policy team – Support policies that promote integrated care Strategy Refresh • TCHF has made changes to our long-term goals, strategies, grantmaking approach and evaluation model- www.coloradohealth.org • Future connections to SBHCs – Healthy Schools Collective Impact – Health care focus on prevention within community – Health care continued focus on integrated care Questions?