healthcare reform and the hiv community: a model of a local level, collaborative approach to...

San Francisco HIV Health Care Reform Task Force

Healthcare Reform and the HIV Community: A model of a

local level, collaborative approach to navigate

coverage changesPresented by Michaela Hoffman

Mission Neighborhood Health Center

Courtney Mulhern-PearsonSan Francisco AIDS Foundation

Anne DonnellyProject Inform


Objectives Provide an example of one local response to health care

reform implementation Receive specific examples of tools that can help prepare

HIV Service Providers, patients/clients and decision makers for the transition to ACA implementation

Identify next steps for your local setting that could contribute to a smooth transition


GETTING TO KNOW YOU


Which best describes where you work?

a. Clinicb. Community-based organizationc. Health departmentd. Universitye. Hospitalf. Other


Which best describes what you do?

a. Clinician (MD, PA, NP, nurse, dentist, etc)b. Case manager/benefits counselorc. Health education (peer educator, promotora)d. Administratore. Researcherf. Consumer representativeg. Other


I feel I can explain ACA to a friend

a. Yes---100% b. Yes---75%c. Yes---50/50d. A little bite. No


HEALTH CARE REFORM IN THE LOCAL CONTEXT: SAN FRANCISCO


Health Care Reform in San Francisco Medicaid expansion Access to qualified health plans (QHPs)

through Covered California (Marketplace) Upcoming transitions:

RW to Medicaid and Covered California (CC) Low income health program to Medicaid

expansion & CC Pre-Existing Condition Insurance Program to

Medicaid expansion or CC


PLWH in SF – who will be most impacted by HCR?

Medi-Cal; 44%

Uninsured; 24%

Medicare; 15%Private Insurance;

5%Other Public

Insurance; 5%

Percent of SF RW Consumers by In-surance type

Data were obtained from the SFDPH HIV Health Services ARIES database. The reporting period for the data presented is from October 1, 2011 through September 30, 2012.

~15,000 PLWH in SF~7,000 received Ryan White funded services of some type


Challenges for PLWH and their Providers

Ryan White program (RW) – patient centered comprehensive HIV care

Payer of last resort : RW can’t pay for services that can be provided under other coverage

HCR expanded coverage means transitions and integration of services Transitions to new plans, providers, pharmacies Service integration: once in new coverage, may need

continued access to RW services: Those not offered by other coverage: specific types of case

management, adherence, linkage to housing Help with costs: out of pocket and premium costs for care and

medications


Experience with Transitions in Care

Medi-Cal: seniors and people with disabilities into managed care plans – mandatory for all except dual eligibles - 2011

Partial and temporary Medi-Cal expansion (Low Income Health Programs – LIHPs ): RW clients to LIHPs – mandatory, if eligible – 2011 - 2013


Upcoming Transitions

RW clients to: Medi-Cal – if eligible, mandatory; QHPs through CC – voluntary but encouraged

LIHP beneficiaries to: Medi-Cal expansion – mandatory; QHPs through CC – voluntary but encouraged

Pre-existing Condition Insurance Program (PCIP) clients to: Medi-Cal expansion – mandatory; QHPs in CC – voluntary


OVERVIEW OF SF HIV HEALTH CARE REFORM TASK FORCE


Mission Develop recommendations and transition

readiness plans with the goal of:

Minimizing disruption in client care and ensures access Preparing community-based HIV providers for changes in

funding Preparing the broader health care system


Members

The Task Force is comprised of members from the HIV prevention and planning councils, consumers, SFDPH, the HIV/AIDS providers network, advocates and other key stakeholders


Key Deliverables

Research Best Practices for integration of HIV services, models that ensure access and quality

Create recommendations for a re-envisioned local system of care that builds on our historical success

Develop and share tools to inform and prepare HIV Service Organizations and consumers for a smooth transition

Share recommendations with key stakeholders, decision makers, HSOs and consumers


RESOURCES DEVELOPED BY THE TASK FORCE


“Provider Considerations”

Providers often the last to know;

This was the first deliverable released

Developed while collecting data/interviews for recommendations

Re-released as information became available; Now on the third version

Samples and a more generalized checklist are available for you today


“Client FAQ”(for staff too!)

Short and clear (2 pages)

Reduce anxiety

Promote knowledge andparticipation

Promote communicationwith medical provider

General and EDITABLE fororganizations

Samples here today and for download on our webpage


Transition Recommendations

Targeting policy makers and leadership at both the local and state levels.

Identifies key action steps to ensure a safe transition

Proposes a post-ACA model of care that builds on the successes of Ryan White AND the benefits of ACA


Community Forums

Outreach to PLWH

Three forums, different dates/times/locations in Oct/Nov/Dec

Provide participants with the information they need to make important decisions about their healthcare coverage

For those with new coverage options, give them enough info to take the next steps towards enrollment

Feature information tables/representatives from Medi-Cal, Covered California, benefits counselors, etc.


SUCCESSES AND CHALLENGES


Successes Commitment from all key sectors was essential to success All bodies represented at every meeting and among Task

Force leadership

Open communication and data sharing

Advanced and frequent information sharing with HIV Organizations

Identified their needs, answered their questions, engaged them and their clients in learning about ACA impact

Prompt identification of potential challenges


Challenges Open communication and data sharing

Difficult to break out of silos, but essential for success in this transition

Delays in decision making by Federal/State bodies

Time/funding: need a few dedicated people who will keep the process moving Relied on a small group of volunteers for the majority of

content


OVERVIEW OF RECOMMENDATIONS FOR A SUCCESSFUL LOCAL TRANSITION


GoalsThe Recommendations support the following goals: Goal 1: Promote successful community-based interventions

aimed at outreach, testing, and linkage to care.

Goal 2: Reduce barriers to timely engagement in quality, affordable, patient-centered care.

Goal 3: Ensure culturally appropriate patient-centered care.

Goal 4: Promote continuity of coordinated care.

Goal 5: Improve individual and community health outcomes.


Goals are informed by the Continuum of Care


Recommendation #1

Ensure that resources are in place to preserve the continuum of HIV services including outreach, primary prevention, and status awareness.

GOAL 1: Promote successful community-based interventions aimed at outreach, testing, and linkage to careGOAL 2: Reduce barriers to timely engagement in quality, affordable, and patient-centered careGOAL 3: Ensure culturally appropriate patient-centered careGOAL 4: Promote continuity of coordinated careGOAL 5: Improve individual and community health outcomes


Recommendation #2Reduce barriers to care and enhance client

engagement and retention through coordinated and streamlined benefit eligibility screening/enrollment processes.



Recommendation #3Ensure a sufficient number of culturally and linguistically competent benefits counselors/advocacy workers are trained and available throughout the community to support the education, screening, and enrollment and retention needs of PLWH who require multi-program enrollment/re-certification, including ADAP/RW, Medi-Cal and/or access to an insurance product through the Health Benefits Exchange.



Recommendation #4Ensure affordability of insurance coverage, including Medi-Cal managed care and qualified health plans offered in Covered California.



Recommendation #5Ensure that HIV service organizations (HSO) and PLWH have accurate and useful information in advance of ACA implementation and as systematic changes are implemented in the future.



Recommendation #6Ensure that HIV safety-net medical providers, private physicians, and community based pharmacies have the opportunity and technical assistance required to engage with the multiple insurance products offered through Covered California and Medi-Cal.



Recommendation #7Engage both SF Medi-Cal managed plans (San Francisco Health Plan and Anthem Blue Cross Partnership Plan) as key partners in ACA.



Recommendation #8Continue to support and enhance the role of the public health community in coordinating with primary care to ensure continuous quality improvement, optimum health outcomes for PLWH, and decreased risk of HIV transmission.



Recommendation #9Ensure that Ryan White funds continue to be utilized to address gaps in service and improve health outcomes for PLWH.

There will still be a substantial, ongoing need for funds for core medical services



CONSIDERATIONS FOR OTHER LOCAL PLANNING EFFORTS


Why does HCR require community planning?

Providers and clients need up to date reliable and local information from multiple agencies – federal, state & local Information is rapidly changing & complex

Requires much more knowledge than just enrolling in insurance Ongoing changes in requirements, & specific procedures Systems are at different levels of readiness

Need to understand interim procedures

Providers need consistent and detailed training to be able to counsel clients about HIV issues Clients who will not be making changes Clients who will be transitioned because of payer of last resort Clients who will have choices about new coverage


Why does HCR require community planning?

Providers need to share sustainability strategies in new coverage environment For clinic operations For reimbursement

Need to build networks to successfully screen and enroll clients Medicaid expansion clients Clients who have options in the Marketplace

Need to build networks to ensure that clients get help with access problems and that problems get reported to decision makers Monitoring is up to us!

Advocates and program providers need to work closely together to ensure that they are sharing information Need to understand what is working and what is not to build

sustainable systems


Some Key Components that Can Emerge From Collaborative Planning

Leadership and/or point people to gather, digest, and disseminate important information Information changing quickly, especially in the first year Allows organizations to share a “health care reform guru” position Can also represent your group with key decision makers at the state

and local level Medicaid, your Marketplace, your Health departments

An effective HIV-specific communications network

New formal and informal partnerships and better sharing of resources

Better understanding of the impact of changes on clients and providers


Some Key Components that Can Emerge From Collaborative Planning

Local and specific education and training and training materials for providers and clients Clear that HIV specific information will be necessary in most places

to supplement formal ACA information

Shared and coordinated advocacy efforts

Appropriate local systems development HCR brings new systems and differs regionally – local input is

critical Can allow the mapping and creation of networks to enroll, engage

and assist clients with new coverage

Develop of a comprehensive community plan to navigate changes


PLANNING FOR YOUR LOCAL AREA


QUESTIONS?


MORE INFORMATION


Resources State HCR Information -

www.statereforum.org Enroll America www.enrollamerica.org Center for Budget and Policy

Priorities - www.cbpp.org Treatment Access Expansion

Project – www.taepusa.org Kaiser Family Foundation –

www.kff.org Families USA –

www.familiesusa.org National Health Law Program

– www.nhelp.org NASTAD – www.nastad.org Health Resources and

Services Administration –www.habhrsa.gov

http://www.statereforum.org/

http://www.enrollamerica.org/

http://www.cbpp.org/

http://www.taepusa.org/

http://www.kff.org/

http://www.familiesusa.org/

http://www.nhelp.org/

http://www.nastad.org/

http://www.hrsa.gov/


Resources SF HIV Health Reform Task Force -

http://www.sfhiv.org/resources/health-care-reform-transition-2/

Covered California – www.coveredca.com Health Access - www.health-access.org Western Center on Law and Poverty – www.wclp.org National Senior Citizens Law Center – www.nsclc.org Health Consumer Alliance – www.healthconsumer.org



http://www.coveredca.com/

http://www.health-access.org/

http://www.wclp.org/

http://www.nsclc.org/

http://www.healthconsumer.org/


Please Visit www.HIVHealthReform.org

to access slides from today’s presentation

http://www.hivhealthreform.org/


Evening Town Hall: Health Care Reform Open Forum

Presented by the HIV Health Care Access Working Group, Ryan White Working Group, Federal AIDS Policy Partnership and HIVHealthReform.org

Join national and state policy experts and your peers for a relaxed, open forum where you can ask burning questions about health care reform implementation, share your concerns, and learn more about implementation efforts.

Monday, September 9 6:15 – 8:00 p.m. Strand 12A, Level 2 Hyatt Regency New Orleans


Evaluation Session ID: 141 SHORT URL LINK: http://goo.gl/Nx3NYP QR Code:

http://goo.gl/Nx3NYP

http://goo.gl/Nx3NYP


Contact Information Contact:

[email protected] [email protected] [email protected] [email protected]

mailto:[email protected]




healthcare reform and the hiv community: a model of a local level, collaborative approach to...

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