2018 canada – united states community health centres …...– providing comprehensive,...
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2018 Canada – United States COMMUNITY HEALTH CENTRES
SUMMIT
SETTING THE
STAGE
Joseph Gallegos
Bruce Gray
Scott Wolfe
September 27, 2018
Victoria, British Columbia, Canada#CACHC18
The Canadian ContextSETTING THE
STAGE
Scott Wolfe
Executive Director
Canadian Association of
Community Health Centres
Toronto, ON
#CACHC18
CDN CHCs: A Sum of Parts
CHCs have different origins across Canada, very often in isolation from each other (within and across provinces). No linear history (i.e. unlike http://chcchronicles.org/histories in U.S.).
Emerge as responses to the imperfect offering of CDN “Medicare”. Two key drivers at local level:
• Lack of health services (eg, rural communities)• Inadequacy of existing health services (eg, inappropriate to local
needs; too medicalized; no health equity approach, etc)
CDN “Medicare”: An Imperfect Offering
Yay!!!“Universal” single-payer healthcare
But wait…• “Hospital and doctor services” only• 13 provincial healthcare systems• Underplayed/valued federal role• Dominance of FFS, medical model• Gaps: dental, vision, Rx, and others• Disconnected from SDOH• No clear consideration of equity
CHC Landscape
200+ CHCs
1. Provides interprofessional primary care
2. Integrates services & programs in primary care, health promotion and community wellbeing
3. Community-centred
4. Actively addresses social determinants of health
5. Committed to health equity and social justice
CDN Definition: Community Health Centre
Additional Challenge: A Fraught
Social/Political Environment
• Austerity• Populism = isolationism = anti-elitism = racism• Complexity vs soundbites• Broken “first past the post” electoral system
CHCs are currently affected by a highly divisive and polarized social context – a global trend, it seems.
Opportunities
CHCs can and must lead• Control what we can control: document impact, demonstrate value• Civic leadership: engagement/education; community building; acting as
connective tissue between different communities• CHCs = solution to multiple complex challenges faced by governments
Complete the unfinished business of Medicare • National Pharmacare, public dental care, community-centred PHC
Leverage our national and global networks (IFCHC, CACHC/NACHC)
Priority: Strengthening our CHC
Movement Across Canada
• Increase CHC association capacity at federal & provincial levels
• Increase coordination of federal and provincial CHC association
efforts
• Better document our impact, tell the CHC story
• Show how CHCs are solution to multiple complex challenges
Canadian Advocacy Agenda: Priorities
• Investment in Community Health Centres
• Universal, single-payer National Pharmacare
• Investment in public dental care
• Investment in affordable housing + support for homeless
• Improving health and opportunity for refugees
Other: harm reduction / opioid crisis, democratic engagement
The U.S. ContextSETTING THE
STAGE
Joseph Gallegos
Senior VP, Western Operations
US National Association of
Community Health Centers
Albuquerque, NM
#CACHC18
2017 Uniform Data System Report
2017 Uniform Data System Report
Historic Changes in Health Care
Key Health Care Trends in U.S.
• Payment reform amidst spending limitations: shift to global payments | Volume / Encounters => Value / Outcomes
• Therapeutic advances
• Access to health care technologies (telehealth, noninvasive bio-monitors, wellness/disease management apps)
• Moving “Upstream”: Social determinants of health
Historic Changes in Health Care
Key Health Care Trends in U.S.
Changing US demographics & dynamics• Age - impact on Medicare and health providers
• 60% more 65+ in 2025 than 2010
• Ethnicity (e.g. growing Latino population). Need for cultural competency and culturally-relevant providers
Attitude toward health, wellness & well-being
Increased emphasis on partnerships & collaboration: Accountable Care
• fully integrated vertical/horizontal levels of care
• avoid “lone wolf” approach to delivering care
Our 2018 Legislative Agenda:
5 Key AreasFederal Grant Funding
FY19 Appropriations; Long term stability for cliff
MedicaidState-federal connection; Protections for overall program and CHC PPS
Behavioral Health/SUD Treatment
Targeted grant funding; Adding billable providers; opioids
340B Drug Pricing Program
Maintaining health center access
Telehealth
Reimbursing CHCs as distant and originating sites
**Workforce issues included throughout agenda**
Policy Priorities
Workforce – Supports CHC Model of “patient-centered care” through team-based approach; Ability
to Recruit & Retain; Provider of Choice/Employer of Choice (National Health Service Corps,
Teaching Health Centers, CEO/CFO, Boot Camp)
Financial Sustainability – Protect CHC grant funding; Protect Medicaid and Children Health
Insurance Programs (CHIP) and other public funding sources, Payment model for CHCs – Medicaid
Prospective Payment System)
340B Pharmacy Benefits – Provide low-cost pharmaceutical supplies for uninsured patients)
Leveraging Tele-Health especially in rural areas – Reimbursement by 3-party payers; Malpractice
coverage; initiating/receiving site; broad band in rural areas
Civic Engagement and Advocacy at local/state/federal level
Behavioral Health & Substance Use Disorder Treatment – Targeted Funding to CHCs; Adding
Billable Providers
Opportunities
CHCs have broad support from policy makers – CHCs viewed by Congress as “front-line”
providers and leaders in community health. Continue to educate members of Congress, state
legislators, federal/state agency officials; city/county officials on value proposition of CHCs
From Triple Aim to Quadruple Aim – CHCs have a long history to impact the following:• Improving the patient experience of care (including quality and satisfaction);
• Improving the health of populations; and
• Reducing the per capita cost of health care
• Focus on Provider/Staff Engagement, Recruitment and Retention – Employer of Choice
CHCs increase access, improve quality of care and reduce overall cost of care
CHC Model – Expertise in addressing Social Determinants of Health (SDOH) – Health Plans are
taking note of the value of CHCs in addressing SDOH
Collaborate with other sectors on SDH – housing; transportation; food safety; employment/training
Challenges
Lack of National Immigration Policy - Increased fear and anxiety for immigrant families, especially children. Fear of deportation due to increased immigration enforcement. Patients not accessing care except for acute/emergency treatment. Dis-enrolling from any form of public assistance
30% Rate of Uninsured – Even after Affordable Care Act (ACA). Threat of Repeal of ACA
Workforce Shortage - Across the Spectrum: Physicians, Physician Assistants, Nurse Practitioners, Behavioral Health Therapists, Dentists, Hygienists, Pharmacists
“CHC model” being challenged to play broader role in public/community health
(i.e., spread of communicable disease-Zika virus in Puerto Rico, Dade County, FL, TX; water contamination in community water systems – Flint, MI; Expand Mental Health Services – lack of gun control; Opioid Use Disorder treatment)
Financing of Health Care – Moving from “Volume” to “Value”
Pressure on CHCs to balance “Mission” with “Margin” – Long Term Financial Sustainability at risk
Challenges, cont.
• Uncertainty continues
• Tax bill zeroed out the individual mandate penalty starting in 2019
• Congressional attempts to address marketplace instability, but no agreement on best path forward; likely no action before elections
• Action has moved to the states – waivers to allow for reinsurance programs to stabilize and reduce premiums
Advocacy & Civic Engagement:
Key to Our Success
Army of 200,000 Health Center Advocates
facebook.com/HCAdvocacyTwitter: @HCAdvocacy
Sign up for text alerts!Text HCADVOCATE to 52886
Sign up for the weekly Washington Update, calls to action, and other
important advocacy communications at
www.hcadvocacy.org/join
The Case for CollaborationSETTING THE
STAGE
Bruce Gray
Chief Executive Officer
Northwest Regional
Primary Care Association
Seattle, WA
#CACHC18
Can-Am CHC Collaboration:
The RIGHT Thing to Do
The “big picture”: ecologies that transcend borders– Similar physical environment
– Common industries and regionalized economies
– Cross-border travel and population movement
– Public health risk factors in common (e.g. increasing chronic disease, Substance Use Disorders)
The shared vision – Providing comprehensive, integrated, holistic, patient-centered & community-based primary
health care Addressing the Social Determinants of Health (SDOH) through “enabling” services
– Offering innovative, team-based workforce models
The value proposition – Sharing promising practices & strategies (knowledge-exchange)
– Building mutually beneficial peer-to-peer networks
– Engaging in collaborative action based on shared vision
Can-Am CHC Collaboration:
The SMART Thing to Do
Evolving Regional Political Frameworks:
The Pacific Coast Collaborative (PCC) example
• Formed in 2008. Forum for cooperative action, leadership and information
sharing by Govts of British Columbia, California, Oregon and Washington.
• Cities of Vancouver, Seattle, Portland, San Francisco, Oakland, and Los
Angeles have since officially joined, with AK in official observer status.
• Pacific Coast of North America => the world’s fifth-largest economy, 55
million people, combined GDP of $3 trillion.
• Primary shared goal: reducing greenhouse gas emissions at least 80 percent
by 2050 through regional action to transform power grids, transportation
systems, buildings, and economies.
Can-Am CHC Collaboration:
The SMART Thing to Do, cont.
PCC & Public Health
• 10th anniversary meeting of PCC March 2018 - Statement of
Cooperation (SOC) on responding to the overdose crisis:
– “The jurisdictions are committed to ending the stigma and discrimination
associated with addiction and substance use disorders, and, to that end, to
identifying and defining areas of future cooperation that will enable an
effective and compassionate response to the overdose crisis.”
Local political frameworks (e.g. Rotary International)
• District 5060 (central BC & WA) and District 7010 (ON & MI)
• Joint meetings and membership on both sides of border
Can-Am CHC Collaboration:
The NECESSARY Thing to Do
Strategy: Leverage pricing
and licensure protections to
ensure a key part in service
delivery.
Strategy: Integrate data and
information in new ways to
better link supply and demand.
Combined net worth: $14.6B.
Current state vs future state for CHCs – analogy of taxis vs ride sharing
• Massive geographic reach and a background in logistics
• Deep experience serving Medicaid patients
• Relationships with State government
• Ability to lever profitability in additional service lines (PBM)
• Unlimited capital to invest
• Deepest experience applying technology to logistical challenges
• Massive existing user base and a highly sticky engagement model
• A focus on innovation
• Incubated through Alphabet’s Sidewalk Labs, w $20 mil in vc
• Political connections through a high profile Board of Directors
• Offering primary care, behavioral health, social services
• Technology to integrate within underserved communities
• Intend to serve underserved communities. From CEO: “CHCs are
facing really significant challenges and aren’t moving as fast as they
need to be toward value-based payments.”
Can-Am CHC Collaboration:
The NECESSARY Thing to Do, cont
Can-Am CHC Collaboration:
The NECESSARY Thing to Do, cont.
A shot across the bow at CHCs and our mandate
Sidewalk Labs & Waterfront Toronto
• Waterfront established in 2001 by Govt of Canada, Province of Ontario and City of Toronto to lead renewal of city’s waterfront.
• Sidewalk Labs won Waterfront Toronto’s RFP.
• Sidewalk Toronto joint effort by the two entities to create new kind of mixed-use, complete community on Toronto’s Eastern Waterfront (325 hectares/800 acres).
• Alphabet plans to move Google’s Canadian headquarters to the Eastern Waterfront.
“The future’s already here. It’s just not very evenly
distributed.”
- William Gibson
Canada – U.S. Survey SETTING THE
STAGE
Scott Wolfe
Executive Director
Canadian Association of
Community Health Centres
#CACHC18
Overview
• Survey report online at: https://infogram.com/2018-canada-us-community-health-centres-survey-1h7j4dn7djed6nr?live
• Survey conducted from Aug – Sept 2018 with CHCs in 5 Canadianprovinces and 14 U.S. states
• 153 responses (Canada = 73, U.S. = 80)
• Goals: identify trends related to services and populations served by CHCs in both countries, with some special attention to opioid crisis; identify areas for collaboration between CHCs and their associations (national, state/provincial, and regional) across borders.
What’s Included in the Report
Sections:• CHC Service Sites, Geographies and Catchments• Populations Served by Canadian and U.S. CHCs• CHC Services and Programs - Clinical• CHC Services and Programs - Clinical comprehensiveness
➢ 15+ Club: CHCs providing services/programs in 15 or more of 22 clinical areas listed in survey
• CHC Services and Programs - Social/Community• CHC Services and Programs - Social comprehensiveness
➢ 8+ Club: CHCs providing services/programs in 8 or more of 13 social/community service areas listed in survey
• The Opioid Crisis - CHC Observations• The Opioid Crisis - CHC Responses• The Opioid Crisis - Comprehensiveness of CHC Responses
➢ 8+ Club: CHCs providing services/programs in 8 or more of 10 service and organizational dev’t areas listed in survey
• The Opioid Crisis - CHC Comments• Participating Community Health Centres
Urban Rural Suburban
Canada 74% 32% 15%
United States 40% 58% 34%
74%
32%
15%
40%
58%
34%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Chart Title
Canada United States
Locations of Communities Served by CHCs
Relative Strengths of CHCs
CANADA: Comprehensiveness of social/community programs
UNITED STATES: Comprehensiveness of clinical services
See Full Survey Findings
https://infogram.com/2018-canada-us-community-health-centres-survey-1h7j4dn7djed6nr?live
2018 Canada – United States COMMUNITY HEALTH CENTRES
SUMMITThank You!www.ifchc.org/victoriasummit2018
September 27, 2018
Victoria, British Columbia, Canada#CACHC18