Maximize Access and Coverage

1. Kristen West CHOICE Regional Health Network October 2003 Maximize Access and Coverage A portfolio of best practices to provide better health for more people at less cost

2. Washington State Mason Grays Harbor Mason Co. Department of Health Services Grays Harbor Co. Health and Social Services Department Mason General Hospital Thurston Co. Health & Social Services Department Grays Harbor Community Hospital Peninsula Community Health Center Mark Reed Hospital Sea Mar Community Health Center (Clinica de la Comunidad) Thurston Providence Centralia Hospital Pacific Co. Public Health & Social Services Department Willapa Harbor Hospital Lewis Providence Health and Education Center (RHC) Pacific Morton General Hospital Lewis Co. Health Department Our Regional Members Providence St. Peter Hospital Lewis Co. Department of Health & Social Services Morton General Hospital

3. 16,000 low-income people show us how broken the system is 2003 2002 2001 Sad stories without happy endings Happy Endings

4. What can geographic regions really do? Focus on care delivered within region. Be an experiment for fundamental restructuring of finance and delivery. Assume existing limits. Assume no limits. Who do you target? Every resident. Low-income under age 65 below 250% of FPL. Uninsured. Where do you start? How much money do we have to spend? What service does everyone have a right to regardless of their ability to pay? What improves health status? How do you make insurance work better? How bold and how soon? Relieve immediate suffering. Allow the system to collapse as quickly as possible and prepare to implement something brand new. Sequential steps, growing in magnitude over a long planning horizon. Play Medical Deity

5. By 2008, we will achieve 100% access to services we agree everyone has a right to • 85,000 low-income people • 35% currently uninsured • 65% are in an unstable mix of public programs • 75% live in a home where one adult works • Access to prioritized services • Use health outcome evidence • Fully fund enhanced primary care and prevention from a community pot • Purchase catastrophic insurance • Will cost $187 million a year • Organize what’s currently spent: 80% • Reduce costs: 10% • New revenue: 10%

6. With Project by mid-2006 Medical Home, Full Access Phased In Over Time Medical Home, Full Access Medical Home, Not Full Access Medical Home, Not Full Access No Medical Home No Medical Home Without Project 100% Access 2008

7. Stabilize the safety-net. Get small employers participating. Deliver evidence-based and patient-focused care through health teams. Enroll people with limited incomes in a medical home. Reduce costs and redirect savings to cover more people. Purchase services of greater value to the community. Six Interdependent Principles for Achieving 100% Access

8. What principles does your community need to be in action on to achieve 100%/0?

9. Found Best Practices Achieving Impacts We Desired

10. The Power of the Portfolio Intersect, align and reinforce contributions (like a Lego set)

11. Buncombe/Spokane Project Access Muskegon 3-Share Galveston Jesse Tree CHOICE RAP Arizona PCAP Seattle Kids Get Care Portfolio of Best Practices Kentucky SKYCap Utah Access Health

12. Buncombe/ Spokane Project Access Galveston Jesse Tree Muskegon 3-Share CHOICE RAP Arizona PCAP Organize care, acknowledge practitioners contribution and enhance well-being and access as a negotiable community asset Creates a local infrastructure for 100% access Human service providers use a common web-based, highly leveraged community resource referral system Incent small employers to financially contribute for low-wage workers Facilitate enrollment in programs and access to medical home, specialists and interpreting services

13. A system emerges Project Access Care coordination, billing and accounting, provider contracting Quantify and use value of donated resources as a negotiable asset Assess-ment Client enrollment and coordinated referrals along the continuum Jesse Tree/ 211 Disease mgmt Rx assist ER case mgmt 3-Share Universal application, complex casework, referral directory Outreach Employer/ employee coverage advice CHOICE Regional PCAP

14. Health Policy What services does everyone have a right to? How will we pay for this? Integrate funding and programs then move decisions to the community level Develop and recognize local capacity Community resource referral system integrated Patients easily connected to programs and services Small employers financially contribute voluntarily Practitioners each treat their fair share of low-income Health outcomes improved Cost of direct care reduced Parallel and interdependent processes What mix of best practices exist or need to be implemented to strengthen your local capacity?

15. You can pay for 100% Access if you… • Combine and use what’s already being spent: • Directly, through public programs • Indirectly, through uncompensated care • Reduce the cost of care and capture savings: • Less fragmentation • Less administration • Augment with new revenue: • Additional Medicaid reimbursement • Employers • Consumers

16. Get started today! • Be in action campaign mode: • Create abundance through offers and requests • Be clear about the what and let go of the how • Don’t let criticism veto action • Guide resources to local activity. • Protect the vision. • Boost local champions.

17. Group Discussion Questions What portfolio of best practices could you put together? Are you willing to declare yourself the portfolio manager? What do you need from whom to get started?