Community Care Overview Kameron Matthews, MD, JD, FAAFP ... · • Spina Bifida Health Care...
Transcript of Community Care Overview Kameron Matthews, MD, JD, FAAFP ... · • Spina Bifida Health Care...
Community Care Overview
Kameron Matthews, MD, JD, FAAFPDeputy Under Secretary for Health for Community Care
Community Care Overview
Kameron Matthews, MD, JD, FAAFP
Deputy Under Secretary for Health for Community Care
March 29, 2019
NACHC P&I Forum
Agenda
• Community Care Overview
• Current Roles & Responsibilities
• Community Care Programs
• Community Care Vision
• Community Care Major Initiatives
• Community Care Under VA MISSION Act of 2018
• TriWest Expansion
• Community Care Network
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VA Office of Community Care – Current Roles
Our Goal for Community Care: Deliver a program that is
easy to understand, simple to administer, and meets the
needs of Veterans and their families, community providers,
and VA staff
Key Functions and Activities:
• Operate Veteran and Family Member Community Care
Programs:
Operate Veterans Choice Program and other community care programs to purchase care outside of VA
Operate claims processing and customer service operations for community care programs
Contract with vendors to maintain a network of community providers
• Bring Revenue to VA
Revenue cycle management - billing of private health
insurance and Veteran copayments
• Manage Fraud, Waste & Abuse
Programs for Veterans
• Veterans Choice Program (VCP)
• Veterans Choice Program Provider Agreements
• Traditional Community Care
• State Home Per Diem Program
• Indian Health Service / Tribal Health Program
(IHS/THP) Reimbursement Agreements Program
• Foreign Medical Program
Family Member Programs
• CHAMPVA
• CHAMPVA In-house Treatment Initiative (CITI)
• Children of Women Vietnam Veterans
• Spina Bifida Health Care Benefits
• Camp Lejeune Family Member
• Caregiver Support Program
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“Achieving personalized, integrated, and high-quality care for our Veterans”
Vision
• Consolidated Community Care Program
• Support VA’s vision of a single, high performing network
• Seamless extension of VA’s network of facilities
• Authorities provided in the VA MISSION Act of 2018
• Meet the needs of all stakeholders
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Community Care Major Initiatives
Veterans
Community Providers
Staff
Decision Support Tool
CCN/VCAsPC3 - TriWest
eCAMS/Community Care Reimbursement
System
Enrollment systemHealth Share
Referral Manager
Provider ProfileManagement System
Master database of community providers and facilities
Industry standard claims processing
Established robust community provider network
Helps identify eligible Veterans and schedule care with the Veteran’s preferred provider
Provides information on Veterans enrolled in the VA and whether they meet certain eligibility criteria for community care
Referral and Authorization Management Tool with online services for community partners
• Completed approximately 29.6 million appointments in the community for Veterans in FY 2018, an increase of 56% from FY 2014
• Major transformation initiatives for Community Care underway to keep up with the robust growth
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Community Care under VA Mission Act
• The MISSION Act of 2018 signed into law by the President on June 6, 2018. The Act includes four main pillars:
• Consolidating VA’s community care programs
• Expanding the Program of Comprehensive Assistance for Family Caregivers to eligible Veterans of all eras
• Strengthening VA’s ability to recruit and retain quality healthcare professionals
• Providing VA the necessary flexibility to align its infrastructure footprint with the needs of our Nation’s Veterans
• Authorizes access to urgent care (walk-in) community clinics for enrolled Veterans
• Creates standards for timely payment to community care providers
• Strengthens the process for VA and partnering health care providers who prescribe opioids to Veterans
• Ensures providers removed or suspended from VA practice do not treat veterans in the community
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Eligibility Criteria under MISSION Act
The MISSION Act establishes six different eligibility criteria for community care:
• VA does not offer the care or services the Veteran requires
• VA does not operate a full-service medical facility in the State in which the Veteran resides
• Veteran was eligible to receive care under the Veterans Choice Program and is eligible to receive care under certain grandfathering provisions
• VA is not able to furnish care or services to a Veteran in a manner that complies with VA’s designated access standards
• Veteran and the Veteran’s referring clinician determine it is in the best medical interest of the Veteran to receive care or services from an eligible entity or provider based on consideration of certain criteria that VA would establish; or
• Veteran is seeking care or services from a VA medical service line that VA has determined is not providing care that complies with VA’s standards for quality
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TriWest Expansion
• In early October 2018, the VA reached an agreement with TriWest Health Care Alliance (TriWest) to:
• Extend its current coverage for one year
• Expand its services to all regions across the country, to include former Health Net Regions
• Ensures access to community care where needed until the CCN contracts are fully implemented.
• Community Health Centers can sign up directly with TriWest: https://joinournetwork.triwest.com
From VA Secretary Wilkie:
“TriWest has worked collaboratively
with VA from the start of the Veterans
Choice Program to address
implementation challenges and to
improve the program to better serve
Veterans. Extending the time and
reach of our partnership with TriWest
will ensure Veterans get the care they
need while the department transitions
to delivering care under the MISSION
Act next year.”
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Community Care Network (CCN)
Benefits of the CCN:
• Gives VA control of Veteran care and experience
• VA is taking back scheduling, care coordination, and customer service functions
• Gives VA convenient access to a network of qualified, credentialed providers
• by having a provider network accredited by a nationally recognized accrediting body
• Gives VA a streamlined community care processes
• by including more services under CCN
• by no longer adjudicating claims
The Community Care Network (CCN) is a new set of region-based contracts to provide health care services in the community through a
contractor who builds and credentials the associated network and processes claims.
Community Health Centers (Region 1) looking to join the CCN
network can contact Optum at:
Achieved in Partnership
VACO ContractorVAMCRegion/
VISN
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Questions
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Health Centers and VeteransNACHC Policy and Issues Forum
March 29, 2019
Jennifer Joseph, PhD, MSEdDirector, Office of Policy and Program Development
Bureau of Primary Health Care (BPHC)
Health Resources and Services Administration (HRSA)
HRSA – VHA Partnership
• Support quality of care at health centers partnering with the VA
• Promote coordination of care between health centers and VHA medical facilities
• Support the use of EHR and data sharing
• Provide technical assistance and training for providers serving veterans
• Support data exchange on HRSA grantees and VHA sites
• Assignment of NHSC participants at VA medical facilities or other sites
• Collaborate on VA MISSION Act
• Explore opportunities to pilot new activities
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Veterans Served at Health Centers, 2008-2017
100
150
200
250
300
350
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Tho
usa
nd
s
2008 2011 2014 2017Growth from 2008-2017
(% Increase)
Veterans 213,841 249,548 289,391 355,648 66.3%
Source: Uniform Data System, 2008-2017
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Health Centers Serving VeteransOther 2017 UDS Highlights
95% of health centers served
veteran patients
54% of veterans receive services from rural health
centers
Public housing grantees served 9%
of all veteran patients served
Healthcare for the Homeless grantees served 26% of all veteran patients
served
The top veteran-serving states are
ME, AK, MT, VT, and ID
Source: Uniform Data System, 2017
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Thank You!
Jennifer Joseph, PhD, MSEd
Director, Office of Policy and Program Development
Bureau of Primary Health Care (BPHC)
Health Resources and Services Administration (HRSA)
(301) 594-4300
bphc.hrsa.gov
Sign up for the Primary Health Care Digest
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Connect with HRSA
To learn more about our agency, visit
www.HRSA.gov
Sign up for the HRSA eNews
FOLLOW US:
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FEDERAL VETERANS POLICY UPDATE
POLICY AND ISSUES FORUM
3/29/19
Oliver Spurgeon IIIDeputy Director of Federal Affairs
National Association of Community Health Centers
New Year,
New Congress,
Same Issues
June 2018
Veterans Community Care Program
March 2019
• Vets meet 1/6 conditions exist for outside care
• Some CHOICE Program regs. will remain after June 2019 (payment rates, etc.)
• New flexibility for vets w/ no full-service VA/low density states
• Focus on distance from home to care, not VA site
• VA MISSION Act signed
• VA coordinate care/scheduling
• Replace 30-day/40 mile standard*
• June 2019 deadline for VCCP regs. & strat. plans
Already completed:
VCCP proposed rule released on 2/22/19
Congressional Activity
Congressional Oversight Focused on VCCP Rollout:
55 MoCs express concern over access standards on 3/25• “trigger a massive shift of care to private
sector.”• “arbitrary and one-size-fits-all approach...”
We urge the VA to:
• Re-evaluate number/type of access standards• Review estimate of budgetary impact of change
“The Department should remain the primary coordinator of
care for all veterans, instead of setting up a system where
it’s possible a subset of vets will never see a VA doctor.”
What’s Next?
• House hearing on MISSION Act IT
implementation on 4/2
• House hearing on FY20 VA budget
request on 4/3:
• $220.2 billion (+9.6% over FY19)
• $8.9 billion for MISSION Act rollout
• $1.6 billion for EHR modernization
“We need to do more to ensure our veterans get the care they earned and
deserve...this proposed budget puts that care and support at risk.” – Chairman Takano
Questions?
Oliver Spurgeon IIIDeputy Director of Federal Affairs
www.nachc.org
Promising Practice Spotlight: Identifying Veterans in the FQHC and Linking
them to VA via the Iowa VHA-FQHC Pilot Program
Ted Boesen -Iowa Primary Care Association (PCA)
Dr. M. Bryant Howren - Department of Veterans Affairs Office of Rural Health
Ron Kemp - Community Health Centers of Southeastern Iowa (CHC/SEIA)
NACHC Policy & Issues Forum, March 29, 2019
VHA-FQHC Pilot Program Background
• Partners & Background
• Project goals
• Screen all patients presenting for care at CHC/SEIA for veteran status using a standardized methodology;
• Screen all adult patients to identify behavioral health issues, including depression, anxiety, substance use disorder and Post Traumatic Stress Disorder (PTSD);
• Identify and assist interested, eligible veteran patients with assessing VA care enrollment and services; and
• Ensure veteran patients screening positive for behavioral health issues receive timely behavioral health care at a VA facility or the CHC/SEIA.
Project timeline (to-date)
• 2014-2015: Discussions between Veterans Rural Health Resource Center and the Iowa Primary Care Association
• 2016: Funding secured for project management and a part time RN Care Coordinator, partnerships formalized
• 2016: Screening for veteran status established at CHC/SEIA
• 2016 - 2018: Pilot project underway
• 2018-Present: Expansion of screening for veteran status to additional Iowa FQHCs underway, part time RN Care Coordinator goes full time, new site started with additional RH Care Coordinator
Pilot Program Phase 1:Screening for veteran status at CHC/SEIA
• The screening question was revised and added to the EMR as a required field
• Staff were informed, trained, and rollout occurred at all sites
• Reliable data was then available and the number of identified veteran patients at CHC/SEIA increased dramatically
Have you served in the military or armed forces?
This includes: Air Force, Army, Coast Guard, Marines, Navy, National Guard, or Reserves?
Yes_____ No_____
Pilot Project Phase 2: Implementation of behavioral health screening and establishing referral processes
• Single site implementation for veterans only
• VA Program Care Coordinator
• Establishing new VA behavioral health screening and treatment workflows
• Establishing and starting the referral processes
• Expansion of implementation for veterans only to additional sites
Health Center Marketing Flyers
Upcoming Program Implementation Phases
• Adding a provider on site that can perform VA eligible services
• Eventual expansion of behavioral health screening to all adult patients (single site to all sites)
• Introducing telehealth services to the pilot program
• Expansion to additional FQHCs
• Studying processes and procedures for project duplications efforts, capturing best practices, and internal/external reform recommendations
Overcoming Barriers
• VHA-FQHC Pilot Program toolkit
• Without Compensation (WOC) process
• Project tracking
• Conflicting priorities and time dedication
• Internal marketing
• Start a conversation
Discussion and Thank You
• Speaker Contact Info
• M. Bryant Howren, PhD, [email protected]
• Ted Boesen, [email protected]
• Ron Kemp, [email protected]
Serving the Veteran Population in Health Centers
NACHC Training and Technical Assistance Resources
March 2019
Providing Care for Veterans in CHCs Fact Sheet
You Can Access
This Resource on the
Health Center
Resource Clearinghouse:
https://www.healthcenteri
nfo.org/details/?id=1887
Or use the Search
function at
www.healthcenterinfo.org
Fact Sheet –Updated January 2019
www.healthcenterinfo.org
Veterans Choice/Mission Act Toolkit
You Can Access
This Resource on the
Health Center
Resource Clearinghouse:
https://www.healthcenteri
nfo.org/details/?id=1888
Or use the Search
function at
www.healthcenterinfo.org
Veterans Services Toolkit – Updated March 2019
www.healthcenterinfo.org
Other Resources
• Join the NACHC Veterans Interest Group – open to all health center stakeholders as a forum for information exchange and updates via mail group
• Contact NACHC’s lead staff for Veterans Programs - Gina Capra or Dick Bohrer [email protected]
• Check our website Veterans Page regularly for updates
www.nachc.org Health Center Operations Special and Vulnerable Populations
• See NACHC’s Formal Comment Submission (March 18, 2019) in response to VA’s Proposed Rule on the Community Care Network Program Access Standards