+ Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and...

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+ Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro, Ph.D. Policy Director

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Page 1: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

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Health Care & Housing Are Human Rights

The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do

July 13, 2012

Barbara DiPietro, Ph.D.Policy Director

Page 2: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+National Goals of Health Reform

Increase access to care

Improve health outcomes

Lower costs to individuals

Reduce total spending

Improve quality of care

Health Care & Housing Are Human Rights

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+The Affordable Care Act (ACA) P.L. 111-148 as amended by P.L. 111-152

8 Major Components: Private insurance reforms (includes Exchanges)

Medicaid reforms Quality improvements Prevention of chronic disease/public health Strengthening health care workforce Improve transparency and accountability Improve access to medical technologies Revenue provisions

Health Care & Housing Are Human Rights

Page 4: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+Current Status Over 2 years since legislation signed into

law; major provisions not active until 2014, but there’s so much to do!

Mixed public awareness of ACA content & impact; myriad of philosophical viewpoints

Administration: Full speed ahead

Congress: Attempts to repeal, hinder, de-fund

Judicial: Supreme Court upholds law, makes Medicaid expansion optional

Health Care & Housing Are Human Rights

Page 5: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+Priorities for HCH Grantees

Health Care & Housing Are Human Rights

Parameters of Law; Opportunities & Challenges

Page 6: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+Medicaid Expansion: The Bus Pass

Health Care & Housing Are Human Rights

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Health Care & Housing Are Human Rights

Medicaid Expansion: Who Is Eligible?

Currently eligible: children, pregnant women, disabled people, and some parents of children

Newly eligible (starting January 1, 2014): Law expands Medicaid to those at or below 138% FPL. About $15,000/year for singles About $25,500/year for family of 3

Must be a U.S. citizen or legal resident here for at least 5 years

Some states have started expanding Medicaid already

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Health Care & Housing Are Human Rights

Medicaid Expansion Financing Expansion group only: Enhanced federal match

to states 100%: 2014 through 2016 95%: 2017 94%: 2018 93%: 2019 90%: 2020 and thereafter

Current eligible groups: current federal match

Maintenance of effort: Prohibited from reducing Medicaid or CHIP eligibility, increasing premiums or enrollment fees, or otherwise cutting enrollment for mandatory groups/services* (pending further guidance as a result of the Supreme Court decisision)

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Health Care & Housing Are Human Rights

Enrolling Many More People Now: Medicaid has 60 million enrollees (1 in 5

people)

2014: Expansion adds 13-15 million new people (depending on outreach and enrollment)

“Woodwork”: Could add 4-5 million currently eligible-unenrolled

Total: about 80 million people will have Medicaid (about 1 in 4 people)

Washington State: 308,000 newly eligible, 66,000 currently eligible-but-

unenrolled

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Health Care & Housing Are Human Rights

Easier Enrollment

Law requires fast, simple process using technology

Must coordinate Medicaid, state “Exchanges” and CHIP

Paper documentation will not be needed

Do not need: paper copy of paycheck/utility bill, birth certificate, ID or social security card (unless there’s a problem)

Will need to know: full legal name, social security number, your birth date, and income

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+Facilitated by Technology

Eligibility will be based on income Not whether you have children or a disability Not whether you have a bank account, or the

value of your car, or other “assets” you might have (no asset tests)

The Medicaid system will automatically verify your income with the Internal Revenue Service (IRS).

The Medicaid system will automatically verify your identity and your citizenship/residency status with Social Security.

Health Care & Housing Are Human Rights

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Health Care & Housing Are Human Rights

Applying for the New Medicaid

Online applications (but can also do by phone and mail)

Do not need a permanent address and do not need to prove residency in your state.

“No fixed address” will be an option

Alternative points of contact available

No in-person interviews

Simple renewal process, only need to renew once every 12 months

Automatic renewal unless there’s a change

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Sources: 2010 UDS Data, HRSA2010 Census data State Health Facts (* Note: 101-139%)

Page 15: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+Those Remaining Uninsured Law does not provide a “right to health care”

Estimate over 26 million left uninsured in 2016

Medicaid eligible (but not enrolled): 30-50%

Undocumented persons: ~30%

Individual Mandate: requires most people to get health insurance or face a penalty.

Medicaid counts toward the mandate

Penalty: $95 in 2014, $695 in 2016 — BUT…

Those not filing taxes are exempt from the penalty

Less than ~$10,000/year in 2012Health Care & Housing Are Human

Rights

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Health Care & Housing Are Human Rights

Outreach & Enrollment Law requires states “establish procedures for

outreach and enrollment activities to vulnerable & underserved populations” Children Unaccompanied homeless youth Children and youth with special health care needs Pregnant women Racial and ethnic minorities Rural populations Victims of abuse or trauma Individuals with mental health or substance-related

disorders Individuals with HIV/AIDS

Concern: No resources allocated for these activities

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+A Word on the State Exchanges “Shopping center” for health insurance for

individuals and small employers Must be implemented by January 1, 2014 Subsidies and credits, based on income 100%-400%

FPL Focused on individual and small group markets Must contain insurance with “Essential Health

Benefits” States will need to determine what additional benefits

they cover (at state expense)

Anticipate covering 8 million in 2014 20 million in 2016

Health Care & Housing Are Human Rights

Page 18: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+Eligibility Between Two Systems

(0-138% FPL)(100%+)

Subsidies/credits: 100-400% FPL

100-138%

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Health Care & Housing Are Human Rights

Medicaid Expansion: Our Challenges Meeting increase in demand for services

Expanding services and workforce Balancing productivity & quality Ensuring Medicaid & Exchange plans are

coordinated Identifying funding for service gaps and remaining

uninsured Maximizing billing, coding & IT system functioning Participating in state-level decisions Ensuring staff training across all teams, at all levels Ensuring states choose to expand Medicaid

Page 20: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+4 Clinical Questions

1. Patients: How will volume and acuity change? What additional services are needed beyond your walls?

2. Access: How quickly can patients be seen?

3. Teams: How do clinical/non-clinical staff communicate & collaborate? Outreach team?

4. Needs: How are the health needs of homeless populations being communicated to policymakers?

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+5 Administrative Questions

1. Billing: Is it maximized, do systems need to be upgraded, do staff need to be (re)trained?

2. Filling gaps: What other services/resources are needed, and how are these needs being communicated to state decisionmakers?

3. Managed care: How will a transition from block grants impact service delivery/staffing?

4. Additional personnel: How can you increase clinical & support staff (e.g., case managers, outreach workers, billing specialists, etc.)?

5. Technical Assistance: Are you reaching out to your PCA and/or the National HCH Council if needed?

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+Health Centers: The Bus

Health Care & Housing Are Human Rights

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+Health Center Expansion $11 billion in new funding (in addition to

annual funding) + creation of Trust Fund

Funding for New Services and Locations: $9.5 billion total FY2011: $1 billion (final: no increase) FY2012: $1.2 billion (final: +$200M) FY2013: $1.5 billion (final: TBD)

FY2014: $2.2 billion (final: TBD)

FY2015: $3.6 billion (final: TBD)

Funding for New Buildings: $1.5 billion totalHealth Care & Housing Are Human

Rights

Completely depends on related Congressional decisions

Page 24: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+What To Do With $11 Billion?

National goal: Double the number of people served by CHCs

20 million 40 million by 2015

New access points

Expanded services

Capital projects

Health Care & Housing Are Human Rights

Page 25: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+Health Care Reform: Readiness

Have a clear organization-wide plan Vision Goals and objectives Outcome measures Data collection and quality

improvement Definition of success

Health Care & Housing Are Human Rights

Page 26: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+NEEDS ASSESSMENT

Who will you serve and what do they need?

Who is homeless in your local area?

What are the most prevalent health care and social service needs?

Who is un-served or underserved?

Health Care & Housing Are Human Rights

Page 27: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+Target Population: Needs

Presenting Needs Primary care Oral health Behavioral health Specialty care Housing Medical respite care Employment Transportation

Health Care & Housing Are Human Rights

Page 28: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+Key Relationships

Examine your current partnerships Local hospital Discharge planning sources Referral sources Emergency responders – police & fire Political leaders Business community Continuum of Care

Don’t be afraid to “step out of the box”!

You Need Them and They Need You

Health Care & Housing Are Human Rights

Page 29: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+ Resources to Meet Needs

Who provides the services in each area of identified need?

How will Health Care Reform, including Medicaid expansion, impact any of these service providers?

How will the state of the current economy impact any of these service providers?

Health Care & Housing Are Human Rights

Page 30: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+Resources to Meet Needs (cont’d)

What are the greatest gaps between Needs and Resources?

Are you in a position to address any of these gaps?

Could Health Care Reform help you to address any of these gaps either directly or in partnership with others?

Health Care & Housing Are Human Rights

Page 31: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+Readiness: Finances

Financial ManagementPolicies and procedures

Billing and collection systems

Systems for collecting, organizing and tracking key financial performance data

Health Care & Housing Are Human Rights

Page 32: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+Readiness: Consumer Input

Do you have a consumer as a member of your board of directors?

Do you have a Consumer Advisory Board?

Do you utilize focus groups to gain consumer input?

Do you conduct consumer satisfaction surveys?

Health Care & Housing Are Human Rights

Page 33: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+Readiness: Governance

Does your Board understand the impacts of Health Care Reform?

Has your board adopted a Strategic Plan incorporating the elements of HCR?

Health Care & Housing Are Human Rights

Page 34: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+Workforce: The Bus Driver

Health Care & Housing Are Human Rights

Page 35: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+Workforce Development

Health Care & Housing Are Human Rights

$1.5 billion for National Health Service Corps

Health Center-based residency programs

Scholarships, loan repayments (primary care physicians, family nurse practitioners, certified nurse midwives, physician assistants, dentists, dental hygienists, and certain mental health clinicians

School-based health centers

Increases to Medicaid provider payments

Page 36: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+Challenges to Capacity

Health Care & Housing Are Human Rights

Too many new patients on top of already large number of patients at health centers

Unemployment, housing costs and other factors increasing number of people using assistance programs

How do we prepare for meeting patient needs?

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+Workforce Provisions and Planning

Health Care & Housing Are Human Rights

Where are the gaps in your existing staffing pattern?

What staff will you need for service expansion?

What is your staff retention rate?

What strategies do you use to retain existing staff?

What’s the “health” of your team?

Page 38: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+Workforce Provisions and Planning

Health Care & Housing Are Human Rights

Are you a learning environment?

How do you train for Evidence Based Practices?

How can self-care training and integration be a key part of recruitment and retention strategies?

Page 39: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+Workforce Provisions and Planning

Health Care & Housing Are Human Rights

Do you have an opportunity to partner with a school of medicine or other training venue?

Are you maximizing opportunities with the National Health Service Corps?

How can volunteer clinicians be recruited to help fill gaps and further make connections in the community?

Page 40: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+Care Delivery Models: Bus Maintenance

Health Care & Housing Are Human Rights

Page 41: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+Care Delivery Models Ultimate goals:

Improve access Increase quality Decrease cost

Emphasis on collecting data, eliminating disparities, improving systems, creating efficiencies

Focus on TEAM: includes both clinical and non-clinical members

Data sharing, electronic health records are key

Models will influence finance and staffingHealth Care & Housing Are Human

Rights

Page 42: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+Care Delivery Models Renewed focus on coordination and

integration of services

Integrated care Access Services Funding Evidence-based practices Data

Patient-Centered Health Homes

Accountable Care OrganizationsHealth Care & Housing Are Human

Rights

Page 43: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+Action Steps: What to do NOW

Hold site visit/meeting with: Your state’s Medicaid director & health reform lead Your PCO/PCA Your state and local health officer & local DSS

director Legislative leadership for health issues

Conduct site tours Attend health reform stakeholder meetings Ensure strong strategic plan/needs assessment is

in place Form PCMH workgroup internally Partner with your fellow service providers

(shelters, behavioral health care, others)

Health Care & Housing Are Human Rights

Page 44: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+Keeping an Eye on the Ultimate Goals Greater access to Medicaid hopefully translates into better health

Growth of health center services/locations = increased number of places to serve patients

Increased number of providers = easier access to care

Greater use of EHR and team models hopefully translates into better services

Better health + more resources = preventing and ending homelessness

Health Care & Housing Are Human Rights

Page 45: + Health Care & Housing Are Human Rights The Nuts and Bolts of Health Reform: What’s Important and What You Need to Do July 13, 2012 Barbara DiPietro,

+More Information

The National Health Care for the Homeless Council is a membership organization for those who work to improve the health of homeless people and who seek housing, health care, and adequate incomes for everyone. www.nhchc.org

Additional health reform materials at: http://www.nhchc.org/healthcarereform.html

NHCHC offers free individual memberships at: http://www.nhchc.org/council.html#membership

Technical assistance available

Health Care & Housing Are Human Rights


NUTS & BOLTS OF CONTRACTING · NUTS & BOLTS OF CONTRACTING San Francisco Department of Public Health Contract Development & Technical Assistance (CDTA) Utilizing sound business practices,

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1 Epidemic Data Survivability in UWSNs {dipietro,nverde}@mat.uniroma3.it.

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BIFOLD FUTON FRAME Assembly Instructions WINSTON …pdf.lowes.com/howtoguides/4389193_how.pdfWINSTON TRAY ARM 0309. 30mm Bolts 30mm Bolts 16mm Bolt 16mm Bolt 16mm Bolts 16mm Bolts

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