community health work: financing & sustainability
TRANSCRIPT
Charlie Alfero, Executive DirectorSouthwest Center for Health InnovationNM Primary Care Training ConsortiumNational Center for Frontier [email protected]
Community Health Workers
Address Health and Social System Failures, Cost(Financing and Sustainability)
Arthur Kaufman, MDVice Chancellor for Community HealthUniversity of New [email protected]
San Leucio, Benevento, Campania, IT
Santa Paolina, Avellino, Campania, It
US Spends much less on Social Services than other Western Countries
“Saving Money” in the US
Means Testing In or Out Qualified or Out of Luck Engraining Discrimination and Divisiveness Age, Sex, Race, Economic Condition Based Criteria Disproportionate / Targeted Responses and
Exacerbation of the Problem (Divide and Conquer)
Social JusticeIs Systemic
If Everyone is IN – No one is OUT!
The Language of Failed Policy
Racism
Minority
Social Determinants of Health
Disparities /
Inequities
RuralDisproportions(Older, Sicker,
Poorer, Life Expectancy)
ACES
Categorical and Soft Money
Discretionary /
Entitlement
A Diagram of the Medical Model – Patient View
Complex Health Systems
Strategies for Tomorrow –Brown
Where are Social Services,EmploymentAndEducation?
We Get What We Pay For!
0 5 10 15 20 250
1
2
3
4
5
6
7
8
9
Diminishing Returns of Complexity
Complex SystemsAnd Cost
ROI – Health / Well-Being
US – Spend More / Get Less
Clinical Involvement in Social Issues
Social Determinants Referral to Community Health Worker for:
Food Assistance Housing Assistance Utilities Assistance Transportation
Assistance Daycare Assistance Legal Assistance
Employment Assistance
Education Assistance
Substance Abuse Assistance
Safety Assistance Domestic Violence
Assistance Other
Each Social Determinant of Health has an ICD-10 code ex.Lack of Food – Z59.4Inadequate Housing – Z59.1Lack of Education – Z55.9Lack of Transportation – Z59.8Problems Employment - Z56.89Insufficient Income – Z.56Also Abuse Codes – T74
Excellent Health
Average Health Very Poor Health
% Population
Population Health
Strategies
Comprehensive Patient Support
Intensive Care
Coordination
% of Cost
Primary Care Linked
Strategies
Specific Strategies are Necessary to Address the Underlying Causes of Ill Health
Medicaid: Comprehensive Intervention Strategy
Comprehensive Patient Support with Community Health Workers (CHWs) Social Assessments Support Clinical
Strategies Non-Clinical Interventions and Education Facilitated Access to a Wide Range of
Services as Indicated Supportive Services to Achieve Primary Care
Goals
Medicaid: Comprehensive Intervention Strategy
Intensive Care Coordination Lead by CHWs High Risk / Cost Patients with Favorable Patient
Ratios Patient-Specific Plans 100% Case Review by MCO Cost Evaluation
Medicaid: Comprehensive Intervention Strategy
Population Health StrategiesSocial Assessments Inform Internal Policy and
Systems ChangesClinical Priorities Inform Community Health
ImprovementCommunity Engagement
Stakeholders / Partners Other Vehicles
We Call it…………
16
CHISPASMeansSPARKS
CHISPAS: Links Clinics and Communities
CHW links within Clinic Providers Front Desk Medical Assistants EHR, Referral System, Warm Handoffs, Team Huddles
CHW links in Community Community-Engaged CHWs Social Services Referrals and Development Other Sectors (ex. Transportation, Food, Utilities)
Anticipated Cost Savings by Program
Maurice Moffett, PhDHealth Economist, Office for Community Health
Year 1 Year 2 Year 30.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
Comprehensive CHW Patient Centered Medical Home
CHISPAS Contract Features
Contracts with Medicaid and MCOs to Develop Pilot Program – Still There – Will do One more Year
Contract / Service Standards and Guidelines Targeted Curriculum Training and Technical Assistance
Tele-Education and Program Support
Roll Out Plan – Adding Four More Sites Evaluation, Research, Publication
Standards and Guidelines – (Excerpt/Draft) COMPREHENSIVE PATIENT SUPPORT
Standard Requirement Framework/ModelElement A – Assess and stratify members’ individual needs
1. Document the number of Medicaid members that access the clinic annually for preventive services and / or care.
Policy showing how the information is consistently collected.
Monthly report
CMS Accountable Health Communities (CMS-AHC)
1. Verify Medicaid eligibility, contact and demographic information.
Log of contact or record review
Proof of Medicaid eligibility documented in patient record.
CHISPAS – protocol
1. 100% of CE patients who access the clinic are surveyed to identify social determinants of health [using the Well Rx and / or CMS Z-Codes in patient health records]
Policy Completed WellRx in
patient record Annual report with
analysis of Well Rx results
Analysis of Z Coding in EHR
CMS-AHCPI-CCHHPCMHCHISPAS ProtocolSIM
What Incentives to Different Payment Systems Have?
Model Volume Cost Quality
Fee-For-Service High / Low High / Low High / Low
Capitation High / Low High / Low High / Low
Global Budgets High / Low High / Low High / Low
Value-Based, Shared Savings
High / Low High / Low High / Low
We Chose PMPM Service Contracting
Budget-able Scalable Service Contracts Report-Based Payments Specific Separate from Medical Payments Moves Health Equity from a Soft Money
Concept to an Administrative Unit
PAYMENT MODEL
Comprehensive Patent Support and Community Health $5.75 PMPM
Intensive Care Coordination$321 PMPMLimited Numbers
Primary Care Providers
• Medical• Dental• Behavioral• Patient /
Family / Community Health
Range of Care• Prevention• Diagnosis• Treatment• Management
4 Core Primary Care Service Payment Equity Model
PAYMENTSYSTEM
