Community Health Partnership and Health Care Reform An Overview of Working Together May 25, 2011 Presentation Overview • Health Care Reform- Getting Familiar with Landmark Legislation • Role of Community Health Centers (CHCs) • Carrying out the Promise of Health Care Reform in Santa Clara County • Our Call to Action! Circle of Health Care Reform Henry J. Kaiser Family Foundation Pop Quiz on Health Care Reform What’s in the health care reform legislation? Patient Protection and Affordable Care Act, 2009 Health Care Reform Hits Main Street by the Kaiser Family Foundation Pop Quiz Self-Scoring! How did the public do? Grading the Public • • • • • 1/4 got 7-10 answers correct 1/3 got 0-4 answers correct 2/3 got 5 or more answers correct Most people got 4-6 questions correct Less than 1% responded to all 10 questions correctly What does the health care reform law do? • The health care reform law: – Expands, promotes, and improves health care insurance coverage – Requires delivery system changes – Promotes primary and preventative care – Improves health care quality How does health care reform impact medically underserved communities? • Health care reform makes an $11 Billion investment in Community Health Centers • Expands Medicaid/Medi-Cal • Improves quality and coordination of care • Funds prevention and wellness initiatives • Funds workforce development initiatives Community Health Centers • The idea for health centers was inspired by a model of community care in South Africa. • Created in 1965 as part of the Office of Economic Opportunity to provide health and social service access points in poor and medically underserved communities. • Incorporated the community empowerment philosophy. Community Health Centers • Community Health Centers (CHCs) play a vital role as the safety net for our country’s health delivery system. • Do not turn anyone away for lack of insurance or ability to pay. • CHCs are community driven; at least 51% of the health center board must be patients. Community Health Centers • Improve access to primary and preventative care • Facilitate access to specialty care • Provide quality care and produce cost savings Administration of CHCs U.S. Department of Health and Human Services HRSA-Health Resources and Services Administration BPHCBureau of Primary Health Care What does this mean locally? 1115 Waiver Bridge to HealthCare Reform Medi-Cal Waiver • The Medi-Cal 1115 Waiver • 1115 Waiver Relationship to Health Care Reform • 1115 Waiver Components The 1115 Waiver • Agreement: Federal Government & State of California • Allows the State to “waive” national Medicaid regulations • Savings from the program will go back into the “waiver” program created • A mechanism for funding to public hospitals for Medi-Cal services and indigent care • Previous waiver programs in Santa Clara County: A lowincome health initiative called Valley Care and funding for hospital to care for indigent patients. Health Care Reform 1115 Waiver Components • Medi-Cal Coverage Expansion • Seniors & People with Disabilities • DSRIP-Delivery System Reform Incentive Pool – Improve infrastructure – Innovation – System Redesign – Population-Focused Improvement – Urgent improvement in Care (access,quality, etc.) • 20,000-30,000 New Patients in Santa Clara County Health Care Reform Promising New Coverage MediCaid <133% of FPL 1 Person < $14,404 4 People <$29,327 Exchange 133-400% FPL 1Person $14,404-$43,320 4 People $29,327-$88,200 Personal >400% FPL 1Person >$43,320 4 People >$88,200 The Role of Community Health Partnership Community Health Center Advocacy NACHC-National Association of Community Health Centers CPCA-California Primary Care Association Consortia (are) state-wide Regional Associations of Safety-net Clinics or Community Health Centers Community Health Partnership (is) a Consortium of safety-net, community health centers in Santa Clara and San Mateo County Asian Americans for Community Involvement, Foothill Health Centers, Gardner Family Health Network, Indian Health Center of Santa Clara Valley, Planned Parenthood Mar Monte, Mar Monte Community Clinic, MayView Community Health Center, North East Medical Services, Ravenswood Family Health Center, RotaCare Bay Area, School Health Clinics of Santa Clara Valley OUR ROLE Policy and Advocacy • To ADVOCATE on behalf of CHCs • To ensure that the CHCs role as a VITAL component of the countywide System of Care • To represent CHCs at local, state, and federal government levels (in concert with CPCAs strategic plan) OUR ROLE Preparing CHCs for Health Reform • Assessing CHC capacity for expansion • Testing and implementing payment reform initiatives • Helping build systems that will quantify QI and DSRIP measures • Supporting and increasing enrollment & retention in qualifying health plans OUR ROLE Providing technical assistance to CHCs in these areas: – Patient Centered Medical Home – Achieving Meaningful Use of Electronic Health Record Systems – Building operational infrastructure that improves: • • • • • Cost management Resource management Data collection and reporting Patient care coordination Quality management Call to Action! • Be part of an Historic Era in Healthcare! • Be part of a TEAM with a strategic direction! • Be part of a something BIGGER than the sum! • Witness the transformation of CHCs into Medical Homes! Be part of a MOVEMENT in health care by: • Participating in legislative events and advocacy activities • Educating yourself about the Santa Clara Health and Hospital System • Determining linkages and opportunities between your program and health care reform (enrollment, medical home, etc.) Questions/ Discussion References • • • • • Jorge De Luna, MPH California Primary Care Association (CPCA) Families USA Kaiser Family Foundation National Association of Community Health Centers (NACHC) Thank You!