Health Services Integration A Vision For 2015: Strategic Direction and Action Plan

Presentation to the Fairfax County Board of Supervisors

October 9, 2012

Agenda

• Background and Approach

• Reminder of Key Issues

• View of Current Safety Net

• Attaining the Goals - Action Priorities to Reach 2015

• Summary

• Next Steps

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Background and Approach

• Fairfax County Health Care Reform Implementation Task Force

• Established December 2010

• George Mason University: Task Force Consultant

• Purpose and Approach

• Study the provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010

• Analyze the operational impact of the various requirements

• Develop policy recommendations and action plan, including community engagement and participation, on health care integration strategies for the Fairfax community

• Recommend strategies for implementation

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Approach: Action Plan

• Action Plan includes:

• Policy decisions related to future structuring of safety net services

• Analysis of existing, revised and future health insurance coverage opportunities

• Review and incorporation of best practices from peer jurisdictions

• Development and identification of performance measures

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Reminder of Key Issues Potential Impact of Health Care Reform on Existing Public Health Care Services

• Between 130,000 and 140,000 Fairfax County residents are uninsured or underinsured – approximately 12% of total population

• Expansion of Medicaid eligibility, if enacted in Virginia, would cover approximately 25,000–30,000 additional individuals • Virginia’s Medicaid program currently covers individuals with

incomes ranging between 80% and 133% of Federal Poverty Level (FPL), depending upon need category, with some services offered to very low income individuals at or below 30% of FPL; and 250% FPL for nursing home residents

• An additional 30,000 - 40,000 individuals could receive subsidies under a Virginia Health Insurance Exchange (HIE)

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Reminder of Key Issues

Even with full implementation of these options, or repeal of the Affordable Care Act, the county’s current service array is still needed to support primary, behavioral, public health, oral, and support services because gaps still remain for newly covered individuals and others not covered.

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Our Health Safety Net Defined

• Safety net customers are uninsured and underinsured individuals

• Safety net providers include the constellation of county and community sponsored health services that provide health care to the safety net customer

• County-Based Services: Community Health Care Network; behavioral health services offered by the Fairfax-Falls Church Community Services Board; Health Department Dental Clinics; and contracted services for oral health, specialty care, and support services.

• Community-Based Services and Partners - examples: Inova Health System, HCA/Reston Hospital, Kaiser Permanente, Federally Qualified Health Centers, free clinics, private practices and other health care professionals.

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Key Service and Capacity Gaps in the Current Health Safety Net • Many uninsured are “over income” for existing programs.

• Some services are not offered – or are not consistently available and accessible - to all who need them.

• Shortages exist for Medicaid providers and reduced/no fee care in several specialties (e.g., cardiology, neurology, podiatry, gastroenterology, dermatology). Patients must obtain out-of-region care, forcing local care coordinators to use resources to find providers willing to treat these patients.

• Gaps remain in Medicaid coverage in areas such as services to persons with disabilities, oral care, supportive services, and community-based services.

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Key Service and Capacity Gaps in the Current Health Safety Net

• Waiting lists exist for a number of services, including CHCN clinics.

• A lack of standardized community health data hinders system planning and monitoring efforts.

• Limited overhead and administrative coordination creates inefficiencies (e.g., access, referrals, enrollment, volunteer

recruitment, technology development)

• A lack of system-wide planning and policy oversight makes integration difficult.

• The financial viability of core safety net services is a concern; there is a need for diversified and coordinated funding strategies for county programs.

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Development of the Action Plan

• Extensive dialogue among HCRTF members.

• Reviewed data and recommendations cited in GMU report.

• Research data, interviews, best practices

• Held briefing and feedback sessions with over 10 BACs and interested community groups.

• Investigated and interviewed administrators of safety net systems in other local governments.

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Attaining Our 2015 Goals

An integrated, effective health care delivery system that provides appropriate and affordable health care for everyone in the Fairfax community.

Support Individual Responsibility

Seek System

Integration/Optimization

Pursue Sustainable System Financing

Ensure Accountability,

Transparency, and Improvement

Pursue Advocacy and

Stewardship Consistent with County’s Mission

Guiding Principles

Public/Community Safety Net Service Integration

Revenue Strategies and Policies

Information Management and Data Sharing

Leadership & Stewardship

Evaluation and Planning

Core Goal Areas Vision Critical Work

1. Develop options on system integration. 2. Creation of a broader health safety net “Health Integration Council” to

establish agreed-upon performance targets. 3. Develop strategies to address community-wide disparities .

1. Implement a continuous process improvement system incorporating customer care quality and outcomes.

2. Establish benchmarks for performance and standards-driven service delivery based on national standards .

1. Develop and maintain long-term financial plans and sustained funding in relation to: • Health Insurance Exchange • Medicaid expansion • Navigation of individuals to right plans

2. Advise the Board of Supervisors on appropriate policies and investment strategies.

1. Expedite utilization of the new cross-program integrated eligibility system.

2. Develop tools for online collaboration and information dissemination by staff and service providers.

3. Develop common data exchange of information protocols.

4. Establish integrated business practices and infrastructure tools for screening, eligibility and enrollment systems.

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1. Expand working relationships with Northern Virginia Federally Qualified Health Centers, and other safety net providers, to create access and service delivery processes to support full service integration.

2. Evaluate and enhance processes to maximize access to oral, prescription and pharmacy , specialty, public health, behavioral and primary health care.

3. Establish front door access process.

4. Assure cultural competency in all aspects of service delivery.

Attaining Our 2015 Goals

• Vision: An integrated, effective health care delivery system that provides appropriate and affordable health care for everyone in the Fairfax community. • Integration among private, public, and community-based

providers; stakeholders; and other critical system participants to maximize service access, capacity, and effectiveness

• Guiding Principles:

• Support Individual Responsibility

• Seek System Integration/Optimization

• Pursue Sustainable System Financing

• Ensure Accountability, Transparency, and Improvement

• Pursue Advocacy and Stewardship Consistent with County’s Mission 12

Attaining Our 2015 Goals

Core Goal Areas:

• Public/Community Safety Net Service Integration

• Revenue Strategies and Policies

• Information Management and Data Sharing

• Leadership and Stewardship

• Evaluation and Planning

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Public/Community Safety Net Service Integration Critical Work

1.Expand working relationships with Northern Virginia Federally Qualified Health Centers, and other safety net providers, to create access and service delivery processes to support full service integration.

2.Evaluate and enhance processes to maximize access to oral, prescription and pharmacy, specialty, public health, behavioral and primary health care.

3.Establish front door access process.

4.Assure cultural competency in all aspects of service delivery.

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Revenue Strategies and Policies Critical Work

1.Develop and maintain long-term financial plans and sustained funding in relation to:

• Health Insurance Exchange

• Medicaid expansion

• Navigation of individuals to right plans

2.Advise the Board of Supervisors on appropriate policies and investment strategies.

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Information Management and Data Sharing Critical Work

1.Expedite utilization of the new cross-program integrated eligibility system.

2.Develop tools for online collaboration and information dissemination by staff and service providers.

3.Develop common data exchange of information protocols.

4.Establish integrated business practices and infrastructure tools for screening, eligibility and enrollment systems.

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Leadership and Stewardship

Critical Work

1.Develop options on system integration.

2.Create a broader health safety net “Health Integration Council” to establish agreed-upon performance targets.

3.Develop strategies to address community-wide disparities.

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Evaluation and Planning

Critical Work

1.Implement a continuous process improvement system incorporating customer care quality and outcomes.

2.Establish benchmarks for performance and standards-driven service delivery based on national standards.

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Fairfax County Health Safety Net Our vision for the future…….

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Further integrate our “front door” services

to improve access

Build on strengths and expertise of

individual network provider models and

best practices to align resources and

create a coordinated system approach

Plan for the future and define success

Leverage all available funding

opportunities

Engage and strengthen community

infrastructure with service providers

…Individuals are at the center of a coordinated continuum of care.

Summary • Current county investment in the health safety net is still

critical and necessary.

• Creating a comprehensive and effective network is a significant community effort.

• All community health providers – primary, behavioral, oral health care and support service providers (e.g., prescription/pharmacy assistance, access and referral, transportation) – must be engaged to achieve the vision for the system.

• The county must leverage its health safety net investments to provide incentives to bring the safety net providers together. • e.g., tax strategies, shared lease arrangements, use of public

space, realignment of funding for publicly provided/supported services

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Summary • The county will need to continually assess multiple aspects of

health care reform implementation.

• State and Federal actions: policies, financing, grant opportunities, initiatives, and legislation

• System results: eligibility and participation, payment reimbursement, essential health benefits

• Economic impact on health care network: national, state, local

• Market conditions: payor sources, insurance and provider capacity (e.g., Inova’s recent purchase of Amerigroup’s Virginia Medicaid operations, Medicaid expansion)

• Public policy recommendations to the Board of Supervisors will include options for leveraging county’s current investment to achieve a comprehensive and effective system of care.

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Next Steps • Create work groups to support critical work activities

• Involve key community providers and health funders, including Federally Qualified Health Centers, community health providers, hospitals, business community, foundations, and others.

• Create a Board-sanctioned Health Integration Council to: 1) develop and monitor a coordinated annual plan for addressing the health safety net needs, 2) develop strategies for integrating service delivery, and 3) create system performance measures and evaluate performance regularly.

• Integrate the Inova Community Health Needs Assessment within the annual safety net plan. 22

Next Steps

• Continue development of the action plan • Dynamic process but ready to begin implementation on critical

work areas.

• Link the action plan to cross-system human services efforts –Partnership for Healthier Fairfax/Community Transformation Grant, prevention efforts, and others.

• Develop regular communication strategies to obtain community input into planning and advocacy activities.

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