January 26-28, 2017 Delray Beach, Florida › wp-content › uploads › 2017 › 02 ›...

1

2017 WINTER STRATEGY MEETING January 26-28, 2017 – Delray Beach, Florida

REPORT TO THE CHAIR J. Ricardo Guzman, MPH, LMSW

February 23, 2017

Mr. Chairman: The 2017 Winter Strategy Meeting (WSM) came at a time when major change and uncertainty had produced high levels of concern and anxiety among attendees and the entire movement. While we did not want to underplay the serious challenges we face, we needed to convey that we had an aggressive plan of action. In addition to informing attendees about that plan, we wanted them to question and test it and to offer enhancements. By the end of this year’s meeting, most attendees had a good understanding of the path forward, including immediate next steps; that in turn produced a degree of certainty in our actions and diminished anxiety. However, we underscored the enormity of the task ahead, and that success would only come from a commitment to a coordinated, sustained plan of action. Our presenters challenged and stimulated the attendees who came prepared to engage in all parts of the meeting. Even though we had fewer external speakers than in past years, those we had delivered messages that continue to resonate with all of us and contributed to reducing some of the concern and anxiety. The internal speakers (staff from health centers, networks, PCAs, and NACHC) shared specific experiences and conveyed information that again helped assure people that we can and will meet the challenges ahead. The seriousness of the situation and the quality of the presentations increased attendee involvement in all parts of the meeting and led to concrete recommendations to improve our plan of action. The current environment dictated allocating the majority of our time to advocacy (“Strengthening the Health Center Message” and “Delivering the Message”); however, we also conveyed the long-range importance of continuing to improve health center operations and being prepared for delivery system and payment reform (“Preparing for Tomorrow’s Challenges Today”).

2

Attached to this report are the major ideas and recommended actions from this year’s meeting. A summary of the principal observations and priority actions are described below. GENERAL OBSERVATIONS Because of the important decisions that will affect the future ability of health centers to be successful, NACHC consultants, staff, and external presenters described in detail the political landscape – both in DC and state capitals – where these decisions will ultimately be made. Different presenters drove home points related to vulnerabilities and assets of which we must be aware: Vulnerabilities

1) Insufficient numbers of health center organizations and people involved in advocacy. 2) Actions that inadvertently weaken our non-partisan image and bi-partisan support. 3) Too few elected officials who understand why preserving Medicaid is so important to

health centers. 4) Lack of knowledge about health centers among key members of the new administration.

Assets

1) People! – patients, providers, board members, and staff can best tell the “health center

story” to elected officials and policy makers. Our strongest voice is from “the people back home”.

2) Economic Impact – employment, purchasing, and a healthy workforce all contribute to local economies.

3) Front-line Responders – backbone of the safety-net in local communities responding to public health issues and problems.

4) Effect on the Cost Curve – proactive, continuous, and coordinated care delivered by health centers saves $24 billion annually.

Acknowledging these vulnerabilities and assets, the breakout groups identified a short list of principles needed for effective advocacy efforts: Recognize that we are engaged in a multi-front battle – retain the essential elements of

existing health center legislation; avoid a funding cliff (health centers and workforce); and preserve Medicaid.

Prepare for a marathon – this is not a sprint and will require the capacity to mount a sustained action plan.

Coordinate national, state, and local advocacy action plans – only some states and very few health centers have 12-month advocacy “calendars”.

Tailor messages to multiple audiences – simple (easy to share); core points (easy to adapt to specific situations); precise (easy to understand).

Engage messengers who are more than “the usual suspects” – physicians, patients, community partners, and other non-traditional community representatives must join in delivering the message.

3

In addition to their work related to advocacy, the breakout groups produced a set of principles associated with health centers succeeding in the transformation of health care delivery: Concrete operational improvement action plans are still crucial – we cannot put these

efforts “on hold” while dealing with advocacy issues. Be prepared for MCOs and other payers to push for increased managed care, cost control,

and revised payment arrangements. Meet Leavitt’s challenge to be in marketplace-driven networks by responding to his “Seven

Challenging Questions”: a) Can you change patient behavior? b) Do you have a strong brand? c) Do you have access to adequate capital? d) Can you assume and manage risk? e) Do you have a big enough clinical footprint? f) Does your clinical footprint enable you to be the primary care provider for a critical

mass of patients? g) Can you be a strategic integrator with high “collaborative IQ” that brings hospitals,

specialty providers, social service providers, and others into integrated networks? PRIORITY ACTION AREAS The challenge from all WSMs is to sort through the many good ideas and suggestions and identify priority actions requiring immediate attention. This year’s meeting produced a resounding “Call to Action” that we have already begun to rally around. Our joint email (2/7/2017) sent this “Call to Action” to all attendees and many of their counterparts who were not at the WSM. Beyond the “Call to Action” and activities associated with making it happen, there are several other actions requiring immediate attention: While we have more information than most groups, we need more and sharper detail.

Actions to consider are expanding economic impact analysis to local health center service areas and refining impact analysis to focus on congressional districts.

Most health centers are still unable to access and analyze relevant claims data from MCOs and other payers/ purchasers. We must enhance our data analytics / business intelligence capacity, enabling the integrating of patient data from EHRs with claims data from payers/ purchasers.

An adequate health center workforce – primary care providers and other essential staff – continues to challenge most health centers. Workforce concerns will continue to require a multi-faceted approach – advocacy (NHSC, THC), retention (competitive salaries, team practice models), supply (“grow our own”), and recruitment.

In response to the requests to examine the value of a national health center branding campaign, we should consider if the benefits outweigh the costs.

Recognizing the challenges we face and the magnitude of the effort required to meet them, continue to explore ways to assure there are sufficient resources to support the efforts.

4

CONCLUSION This year’s WSM certainly confirmed the notion that we live in interesting times. While we acknowledged real and serious challenges, we also affirmed the tremendous assets we have when we operate as a coordinated primary care network. These assets can continue to create opportunities if used wisely. To that end, the broad NACHC (members, boards, PCAs, networks, and staff) must all expand their leadership activities. People are hungry for information and guidance about how to respond to this changing environment. For the sake of the more than 25 million people health centers serve today and the many more health centers could serve, all of us at NACHC will need to step-up to the challenges and redouble our efforts to preserve and strengthen the largest primary care network in the country.

Sincerely,

Tom Van Coverden President and CEO

1

NACHC WINTER STRATEGY MEETINGJanuary 26-28, 2017

Delray Beach Marriott – Delray Beach, FL

SUMMARY ANDRECOMMENDATIONS

Attachment 1

SETTING THE STAGE

Threats are real!

Challenges are real!

But opportunities

are still there!

2

SETTING THE STAGE

PERIOD OF CHANGE WHICH BRINGS UNCERTAINTY

• Still more questions than answers

• In our world, the only constant is change

• How are we going to respond to change?–Fight it

–Accept it

–Lead it

SETTING THE STAGE

STAGES OF LEGISLATIVE CHANGE – IMPLICATIONS FOR OUR ADVOCACY EFFORTS

• Budget Resolution Phase (completed)

• Presidential “Magic” Phase – executive orders and actions

• Repeal Phase 1.0 – completed by Congress’ spring recess

• Repeal Phase 2.0

• Replacement Phase(Leavitt)

3

SETTING THE STAGE

HEALTH CENTERS MUST BE IN MARKETPLACE-DRIVEN NETWORKS – IMPLICATIONS FOR OUR

DELIVERY SYSTEM TRANSFORMATION EFFORTS

• Can you change patient behavior?• Do you have a strong brand?• Do you have access to adequate capital?• Can you assume and manage risk?• Do you have a big enough clinical footprint?• Can you aggregate a critical mass of patients?• Can you be strategic aggregators with high

“collaborative IQ”? (Leavitt)

PRIORITY FOCUS AREAS

FOCUS AREA 1:

Advocacy Capacity – Strengthening the Health Center Message

FOCUS AREA 2:

Advocacy Capacity – Delivering

the Message

FOCUS AREA 3:

Preparing for Tomorrow’s Challenges Today

4

CHARGE: Focus Area #1: ADVOCACY CAPACITY –Strengthening the Health Center Message

Must make the case:

1) that Health Centers are an essential asset in health care delivery, aka “value”

2) that the asset needs to be preserved, aka “impact”

3) with multiple and key audiences – elected officials, policy makers, payers, patients, providers, and partners

EXPECTED OUTCOME: Identify ways to strengthen and adjust the message to work with the various audiences.

Focus Area #1: ADVOCACY CAPACITY –Strengthening the Health Center Message

CURRENT CHC MESSAGE

• HCs are the largest primary care network in the country• HCs are the health care home for more than 24 million Americans,

operating as locally-owned businesses, providing local solutions for local (& national) problems, and boosting local economies

• HCs are on the front lines of the most challenging health care crises: Zika, opioid addiction, Veterans’ access, etc.

• HCs bring together medical, dental, mental health & addiction care in locally integrated settings, partnering w/other local service providers

• HCs’ focus on prevention, early care & care integration saves more than $24 Billion annually, for governments & private payers

• HCs are bending the “cost curve” by reducing: ER use, diagnostics & hospital admissions

5


CURRENT CHC MESSAGE

• To continue to do their job well, HCs need Congress to address the twin pillars of their success:

• Stable, continuous grant funding to support care for un/underinsured & services not covered by most insurance (e.g., outreach, transportation, health/nutrition education, care management)

• A strong Medicaid program that works for low-income communities & their care providers, like HCs


CURRENT CHC MESSAGE

• Inaction (or contrary action) on the twin pillars would cause:• Loss of care for 9 Million people, loss of 50,000 jobs, closure of

2800+ sites• Flexibility is already built into PPS payment system

• Turning either program (CHCs or Medicaid) into a Block Grant would bring deep & irreparable harm

• For HCs, fixed funding obviates growth when needs spike• Similarly, in Medicaid, a Block Grant or Per Capita Cap will

leave states facing either financial ruin or serious health crises when public health threats emerge (opioid epidemic, Zika virus, Vets unmet care needs)

6


CURRENT CHC MESSAGE

Most of all:

Don’t repeal the ACA unless & until you have a viable

replacement plan

We need to lead in the work to develop the solution


Overarching Observations:

• Different Lens - Revisit our message so that it is relevant to both Rs and Ds

• What “they” want to hear – when they want to hear it

• Personal relationships are essential – messaging without the relationship does not go very far – get folks into health centers

• Capacity to mount a sustained, coordinated campaign

• “Do No Harm”• People (covered and served)• Investments (past R and D Administrations)

7


RECOMMENDATIONS

• Brand recognition strategy, including advertising campaign

• What we are (local, businesses, integrated care, high quality, bend cost curve)

• Enhanced impact analyses capacity (Local, Congressional District, State, National)

• Economic impact• Employment impact• Cost avoidance impact• Total cost of care impact


RECOMMENDATIONS

• Principles to guide our messaging• Simple – easy to share• Core points – easy to adapt to specific situations• Precise – easy to understand• Condensed – option to get details• Alignment – avoid fragmentation

• Enhanced Social Media Capacity• Tweeting “101” at P&I• Toolkits• Other training

8


RECOMMENDATIONS

• Finding additional people to deliver our message

• Clinicians

• Partners

• Patients

• Community Representatives (who have not traditionally been involved)


OTHER NOTEWORTHY SUGGESTIONS

• Suggested Tagline – “I work for my patients…”: “Healthy people work”

• Medicaid Primer – one legislative authority, but many specific State names

• Better sharing of information already available – new cooperative agreement may help

• Use the “50 Year Anniversary” video

• Get P&I “read aheads” out earlier

• Waianae Coast PPS example (graph)

9

CHARGE: Focus Area #2: ADVOCACY CAPACITY –

Delivering the Health Center Message

Successful delivery of the message requires multiple people delivering it consistently, while tailoring it to a variety of audiences. Ultimately, this will require state

specific strategies and solid, actionable plans that reflect the unique character of each state.

EXPECTED OUTCOME: Development of specific state plans for enhanced advocacy.

Focus Area #2: ADVOCACY CAPACITY –Delivering the Health Center Message

BOTTOM LINE: NEED TO PUT IN PLACE LOCAL, STATE, AND NATIONAL ADVOCACY PLANS

Rationale: Lack of local, state, and national advocacy plans increase likelihood of “worst case” scenario

• Block grants (HC Program//Medicaid Program)

• Inadequate Medicaid coverage and payment

• Major reduction of grant support

• Loss of primary care provider resources (NHSC, THC, etc.)

• What’s it look like – lives lost, decrease in health status, lost

jobs, increased costs, etc.

10


CRITICAL ELEMENTS OF LOCAL, STATE & NATIONAL ADVOCACY PLANS

• Advocate! And in doing so, keep the messaging simple, brief, and concise. Perfect the art of making your case in 1 minute.

• Demonstrate the old axiom that Politics make strange bedfellows. In other words partner with others that you haven’t partnered with before.

• Be consistent and repetitious. Delivering a message once or twice during a state legislative session is not enough; prepare for a marathon.

• If you don’t ask, you shall not receive.



• Understand your audience. If you’re in a red state, talk about tenets of health centers that align with Republican thinking i.e. local control, “access” to care, patients paying on a sliding fee, patients paying full rate over 200%, patients taking ownership of their health care.

• Become acquainted on a first name basis with both the elected official and his or her staff.

• Be prepared. Do your research. Be able to anticipate questions.

11



• LEAD, don’t just be at the table, otherwise you might end up on the menu. Bring solutions. Policy makers want solutions. They don’t want to just hear about problems. Bring them ideas about health care innovation, how to control cost, and improve quality.

• Keep it local, invite them to your health center. Don’t underestimate the power of this simple act.

• Utilize our most important assets and make them the face of our action plans: Our providers and Our patients!


CALL TO ACTION

• PCAs develop annually a 12-month advocacy action plan.

• CHCs develop annually their own 12-month advocacy action plan.

• Then execute the PCA and HC plans!

12


MAJOR CHALLENGES TO

IMPLEMENTING PLANS• Complacency – prior successes cause some to defer

action

• Business as usual will be sufficient – NOT!

• HC Board member commitment and involvement

• Engaging the “folks back home”

• Finding the “sweet spot,” e.g., “reason for every elected official to support health centers, challenge is finding that reason.”

• Reluctance to enable and empower HC staff to participate in advocacy


ADVOCACY ASSETS

1. People – patients, board members, providers, staff

2. Footprint/market share (local and state)

3. Economic impact – including stabilize neighborhoods and communities

4. Established integrated care model –access/quality/cost – bend the cost curve

5. Front-line responders to public health issues

6. Data capacity – turn data into impactful information

7. Others too numerous to list!!

13


PRIMARY STAKEHOLDERS

• State and local elected officials, especially those with the “majority party” & those who are newly elected

• Employers and businesses, including Chambers and service organizations

• Hospitals

• State Associations (Hospitals, Rural Health, Nursing Homes, etc.)

• MCOs/Health Plans

• Institutions of higher education


PRIMARY STAKEHOLDERS

• Medicaid Directors

• Major HC vendors

• Again, others too numerous to list!! Including having a clinician group that meets with physicians who are in senior leadership positions, e.g., Dr. Price and Dr. Shulkin.

14


IMPORTANT THINGS TO REMEMBER WHEN PUTTING A STRATEGY IN PLACE

• Must reinforce the bi-partisan support for health centers and the non-partisan nature of HCs

• Always leave your personal political ideology at the door. Always wear CHC and our patients on your sleeve.

• Achieve the notion of “help me, help you”

• Be able to talk the business side of HCs, as well as we talk the mission and value of HCs

• Build the coalitions even before they may be needed


IMPORTANT THINGS TO REMEMBER WHEN PUTTING A STRATEGY IN PLACE

• Be on “other groups” policy priorities list

• Need congressional district and state-specific data to support the “value proposition”

• Acknowledge that this is a marathon

• “Accept chaos, offer calm, bring back hope”

15

CHARGE: Focus Area #3: PREPARING FOR TOMORROW’S CHALLENGES TODAY

States will continue to move toward more autonomy in their Medicaid programs, with quality care and

lower costs being the ultimate objectives.

We will need to recognize this reality and take deliberate steps to define our futures.

EXPECTED OUTCOME: Development of specific state plans for enhanced health center operations and preparation for payment reform.

Focus Area #3: PREPARING FOR TOMORROW’S CHALLENGES TODAY

OVERVIEW

In addition to a state advocacy action plan, each

state needs an integrated organizational model

that ensures health centers are operating

effectively and responding to changes in local and

state environments.

16


OVERVIEW

While there will be different organizational models, the critical competencies that need to be in place in each state are:

• Advocacy and member services

• Quality, practice improvement

• Converting data to information

• Information aggregator and negotiator

• Back office and administrative service provider


OVERVIEW

This capacity is needed to provide services that:

• Enable all ships, aka health centers, to rise

• Enable all HCs to be recognized as quality providers

• Show that all HCs are prepared to respond to change

• Enable all HCs to move from volume to value

17


HEALTHY INDIANA 2.0

What people want to know:

• What has worked/what has not?

• What features to support/what to challenge?

• How does it fit with Medicaid plans in DC – Capitol Hill

and/or Administration?

• What other plans have been enacted that extend

Medicaid?


HEALTHY INDIANA 2.0

RECOMMENDED ACTION

• NACHC prepare a white paper based on HIP 2.0 and other Medicaid extension options that addresses the above questions

• Establish capacity at the state level to replicate what the North Carolina “example” accomplishes

18


WHAT’S KEEPING YOU UP AT NIGHT?

National Policies/Issues

• Workforce Development• Supply

• Changing policies, e.g., HPSA scoring

• Data Infrastructure – too much data, not enough information!

• Integration and Differentiation – how to bring more organizations under the tent while staying who we are

• Policies that have implications or potential collateral damage for HCs, e.g., Immigration/Refugees

19


WHAT’S KEEPING YOU UP AT NIGHT?

State Policies/Issues

• Changes to 340(b)

• Waivers (1332, 1115, etc.)

• State Budget “deficits” – what will get cut

• National Association of Medicaid Directors “wish list”


WHERE ARE HEALTH CENTERS VULNERABLE?

Health Center Operations

• Ability to assume risk

• Care management & care transition capacity

• Accurate and appropriate documentation of patient visits – it is more than just coding!!

• Primary care provider capacity

• Necessary services that may be outside scope of project

• Inadequate capacity to provide needed information in a useable fashion

• Patient attribution methodologies

• Aging HC leadership

20


WHERE ARE HEALTH CENTERS VULNERABLE?

Marketplace

• Hospital movement into primary care

• Retail urgent care operations

Delivery System

• Inadequate specialty care referral capacity


WHAT DO WE NEED TO DO?

• Improve ability to identify and share best practices –leverage new technologies

• Identify the “trusted experts”• Re-brand – more than clinics who only serve limited

types of people• Respond to changing patient expectations, e.g.,

Millennials• Develop closer relations with Academic Medical Centers

and Public Health Departments• Make succession planning a priority• Create and implement a clear plan in support of

pursuing the “Quadruple Aim”

21

Never forget that to be successful, we must:

• View things from a different context

• Establish critical partnerships

• Remain nimble and flexible

• Stay united!

WRAP UP

Manny LopesTess KuenningLindsay FarrellEva TurbinerLolita LopezCheri RinehartKim SchwartzPhil HarewoodLarry McCulleyBerneice Mills-Thomas

Lucy Ramirez-TorresSeferino MontanoTeresita BatayolaDennis KruseTom TrompeterRoss BrooksJohn SantistevanAvein Saaty-TafoyaBen Flores

Thank you, Group Leaders!

January 26-28, 2017 Delray Beach, Florida › wp-content › uploads › 2017 › 02 ›...

Documents

Transcript of January 26-28, 2017 Delray Beach, Florida › wp-content › uploads › 2017 › 02 ›...