Presented by Michaela Hoffman Mission Neighborhood Health Center Courtney Mulhern -Pearson

1. Healthcare Reform and the HIV Community: A model of a local level, collaborative approach to navigate coverage changes Presented by Michaela Hoffman Mission Neighborhood Health Center Courtney Mulhern-Pearson San Francisco AIDS Foundation Anne Donnelly Project Inform

2. 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

3. Getting to know you

4. Which best describes where you work? • Clinic • Community-based organization • Health department • University • Hospital • Other

5. Which best describes what you do? • Clinician (MD, PA, NP, nurse, dentist, etc) • Case manager/benefits counselor • Health education (peer educator, promotora) • Administrator • Researcher • Consumer representative • Other

6. I feel I can explain ACA to a friend • Yes---100% • Yes---75% • Yes---50/50 • A little bit • No

7. Health care reform in the local context: San Francisco

8. 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

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

10. 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

11. 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

12. 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

13. Overview of SF HIV Health Care reform task force

14. 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

15. 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

16. 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

17. Resources developed by the Task Force

18. “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

19. “Client FAQ”(for staff too!) Short and clear (2 pages) Reduce anxiety Promote knowledge and participation Promote communication with medical provider General and EDITABLE for organizations Samples here today and for download on our webpage

20. 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

21. 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.

22. Successes and challenges

23. 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

24. 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

25. Overview of Recommendations for a successful local transition

26. Goals The 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.

27. Goals are informed by the Continuum of Care

28. Recommendation #1 Ensure that resources are in place to preserve the continuum of HIV services including outreach, primary prevention, and status awareness.

29. Recommendation #2 Reduce barriers to care and enhance client engagement and retention through coordinated and streamlined benefit eligibility screening/enrollment processes.

30. Recommendation #3 Ensure 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.

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

32. Recommendation #5 Ensure 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.

33. Recommendation #6 Ensure 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.

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

35. Recommendation #8 Continue 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.

36. Recommendation #9 Ensure 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

37. Considerations for other local planning efforts

38. 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

39. 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

40. 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

41. 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

42. PLANNING FOR YOUR LOCAL AREA

43. QUESTIONS?

44. MORE INFORMATION

45. 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

46. 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

47. Please Visit www.HIVHealthReform.orgto access slides from today’s presentation

48. 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

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

50. Contact Information • Contact: • info@sfhivhealthreform.com • michaelahoffman@mnhc.org • cpearson@sfaf.org • adonnelly@projectinform.org