Creating Opportunities for Health Homes: Effective Advocacy

National Alliance to End HomelessnessKaren Batia, Ph.D.kbatia@heartlandalliance.orgJuly 16, 2012

Health care as runaway reactor

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“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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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