Implementation of Collaborative TB/HIV Activities by ICAP: Success and Challenges
Healthcare Reform and the HIV Community: A model of a local level, collaborative approach to...
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Transcript of 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
San Francisco HIV Health Care Reform Task Force
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
San Francisco HIV Health Care Reform Task Force
GETTING TO KNOW YOU
San Francisco HIV Health Care Reform Task Force
Which best describes where you work?
a. Clinicb. Community-based organizationc. Health departmentd. Universitye. Hospitalf. Other
San Francisco HIV Health Care Reform Task Force
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
San Francisco HIV Health Care Reform Task Force
I feel I can explain ACA to a friend
a. Yes---100% b. Yes---75%c. Yes---50/50d. A little bite. No
San Francisco HIV Health Care Reform Task Force
HEALTH CARE REFORM IN THE LOCAL CONTEXT: SAN FRANCISCO
San Francisco HIV Health Care Reform Task Force
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
San Francisco HIV Health Care Reform Task Force
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
San Francisco HIV Health Care Reform Task Force
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
San Francisco HIV Health Care Reform Task Force
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
San Francisco HIV Health Care Reform Task Force
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
San Francisco HIV Health Care Reform Task Force
OVERVIEW OF SF HIV HEALTH CARE REFORM TASK FORCE
San Francisco 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
San Francisco HIV Health Care Reform Task Force
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
San Francisco HIV Health Care Reform Task Force
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
San Francisco HIV Health Care Reform Task Force
RESOURCES DEVELOPED BY THE TASK FORCE
San Francisco HIV Health Care Reform 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
San Francisco HIV Health Care Reform Task Force
“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
San Francisco HIV Health Care Reform Task Force
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
San Francisco HIV Health Care Reform Task Force
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.
San Francisco HIV Health Care Reform Task Force
SUCCESSES AND CHALLENGES
San Francisco HIV Health Care Reform Task Force
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
San Francisco HIV Health Care Reform Task Force
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
San Francisco HIV Health Care Reform Task Force
OVERVIEW OF RECOMMENDATIONS FOR A SUCCESSFUL LOCAL TRANSITION
San Francisco HIV Health Care Reform Task Force
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.
San Francisco HIV Health Care Reform Task Force
Goals are informed by the Continuum of Care
San Francisco HIV Health Care Reform Task Force
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
San Francisco HIV Health Care Reform Task Force
Recommendation #2Reduce barriers to care and enhance client
engagement and retention through coordinated and streamlined benefit eligibility screening/enrollment processes.
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
San Francisco HIV Health Care Reform Task Force
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.
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
San Francisco HIV Health Care Reform Task Force
Recommendation #4Ensure affordability of insurance coverage, including Medi-Cal managed care and qualified health plans offered in Covered California.
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
San Francisco HIV Health Care Reform Task Force
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.
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
San Francisco HIV Health Care Reform Task Force
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.
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
San Francisco HIV Health Care Reform Task Force
Recommendation #7Engage both SF Medi-Cal managed plans (San Francisco Health Plan and Anthem Blue Cross Partnership Plan) as key partners in ACA.
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
San Francisco HIV Health Care Reform Task Force
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.
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
San Francisco HIV Health Care Reform Task Force
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
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
San Francisco HIV Health Care Reform Task Force
CONSIDERATIONS FOR OTHER LOCAL PLANNING EFFORTS
San Francisco HIV Health Care Reform Task Force
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
San Francisco HIV Health Care Reform Task Force
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
San Francisco HIV Health Care Reform Task Force
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
San Francisco HIV Health Care Reform Task Force
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
San Francisco HIV Health Care Reform Task Force
PLANNING FOR YOUR LOCAL AREA
San Francisco HIV Health Care Reform Task Force
QUESTIONS?
San Francisco HIV Health Care Reform Task Force
MORE INFORMATION
San Francisco HIV Health Care Reform Task Force
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
San Francisco HIV Health Care Reform Task Force
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
San Francisco HIV Health Care Reform Task Force
Please Visit www.HIVHealthReform.org
to access slides from today’s presentation
San Francisco HIV Health Care Reform Task Force
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
San Francisco HIV Health Care Reform Task Force
Evaluation Session ID: 141 SHORT URL LINK: http://goo.gl/Nx3NYP QR Code:
San Francisco HIV Health Care Reform Task Force
Contact Information Contact:
[email protected] [email protected] [email protected] [email protected]