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What Community Health Planning Offers to Health Care Reform

What Community Health Planning Offers to Health Care Reform. Fran Weisberg Executive Director July 27, 2009. Presentation Overview . Health Care Reform & the States What is “Community Health Planning”? Elements of Community Health Planning Case Study: Community Health System 2020

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What Community Health Planning Offers to Health Care Reform

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  1. What Community Health Planning Offers to Health Care Reform Fran Weisberg Executive Director July 27, 2009

  2. Presentation Overview • Health Care Reform & the States • What is “Community Health Planning”? • Elements of Community Health Planning • Case Study: Community Health System 2020 • Finger Lakes Health Systems Agency • NYS Backdrop • The 2020 Commission • New York State Response to 2020 Commission • Community Health Planning & Health Care Reform

  3. Health Care Reform & The States • Federal Health Reform: Priorities • Increase health insurance coverage • Contain increasing costs • Increase access to high quality care • States’ Health Reform: Priorities • Increase health insurance coverage • Affordability of health coverage and services • Care that is of higher quality, greater value, and includes more preventive services

  4. Health Care Reform & The States Issues: • How, in a time of weak state revenues, to afford coverage for those who cannot afford coverage? • Massachusetts: Subsidized care at risk for legal immigrants • Maine: Tax for increased subsidies for Dirigo Care repealed by voter initiative, 11/08 • BUT 13 states increase subsidies for children’s health coverage (NY Times, 7/19/09) • How to encourage the “right” mix of health services? • How to ensure health services are distributed to allow access to needed care?

  5. Health Care Reform & the States Additional State Health Reform Approaches • Improved public health initiatives to increase preventive services • Promoting evidence-based approaches • Realigning incentives with reimbursement reform • Constraining growth of health services and facilities Examples from New York State to follow…

  6. What is Community Health Planning? A structured approach to involving a geographically defined community in an open public process designed to improve the availability, accessibility, and quality of healthcare services in their community as a means toward improving its health status. • Identify community needs • Assess capacity to meet those needs • Allocate resources • Resolve conflicts

  7. Elements of Community Health Planning Objective data Structured analytics Capacity analysis Community engagement Multiple stakeholders Focus on community need over individual stakeholders’ priorities Local input to state decision-making

  8. Case Study: Community Health System 2020 • Finger Lakes Health Systems Agency • Birthplace of Community Health Planning • Prototype for NYS CON legislation in 1964-65, Federal legislation in 1966 • Survived even when federal legislation expired in 1986, and when NY state funding ceased in 1995 • Reinvigorated in 2006 with new emphasis on representing the community’s best interests • New model: Health Planning for the 21st Century • Data & Analytics • Capacity Analysis • Community Engagement • Reducing disparities • Strong relationship with NYS Dept. of Health

  9. Backdrop: New York State • Berger Commission: Acknowledgement that market competition did not “right size” the health services system • New administration in Albany with mission to change “business as usual” in health care • Realigning incentives for primary and preventive care • Prevention Agenda: Improving community health and reducing disparities

  10. Backdrop: New York State • Increase coverage for vulnerable populations • Child Health Plus: Children in families up to 400% of Federal Poverty Level • Family Health Plus • Renewed emphasis on community health planning and rethinking approach to Certificate of Need

  11. The 2020 Commission Formed to review community need for new acute hospital beds in response to CON applications from 3 major health systems for 278 beds and facility modernization Blue Ribbon Panel of Stakeholders: hospital trustees but not management, consumer, business, labor, regional representatives The 3 CON applications reviewed as a “batch” rather than individually Commission looked at the health care system regionally, not just from a single county perspective Requested input from community, including providers, business, underserved, consumers

  12. The 2020 Commission Recommendations: • 140 new acute beds (~50% of requested) • All modernization requests • Demand management initiatives to reduce use of inpatient care • Community Investment Initiatives • CON applicant hospitals participate with other community stakeholders • Trigger mechanism to fast track additional acute beds if demand management approaches fail to reduce need for inpatient care

  13. Community Investment Recommendations • Decrease by 25%* preventable admissions for ambulatory sensitive conditions • Decrease by 15%* low acuity Emergency Department use • Decrease by 20%* low acuity admissions to CON applicant hospitals of residents from outlying counties • Establish goals that represent improvements in the metrics that quantify both health status and system effectiveness for the region, emphasizing reduction of health disparities among populations and increased overall system efficiency and quality • FLHSA to convene a new Task Force to provide leadership, guidance, and oversight for these initiatives, including developing the necessary funding mechanisms * Preliminary Goals

  14. New York State Response to 2020 Commission • Slight increase (+12) in the number of new acute beds approved within applicants’ CONs • Approved facilities’ modernization plans • Endorsed Commission’s Community Investment recommendations including linking hospital participation to CON approval • Promotes 2020 Commission as model of “new health planning” • Sees pairing of community investment with CON approval as an approach to ensuring health system meets community needs

  15. 2020 Commission: Next Steps • 2020 Performance Commission convened by FLHSA to implement 2020 Commission’s Community Investment Recommendations • ED Use Work Group • Preventable Hospitalizations Work Group • Regional Community Health System Work Group • “2020 Commission” for the 6 counties in the region, including Monroe, but broader Finger Lakes focus • Other issues to include: • Workforce • Patient migration • Adequacy of primary and preventive care

  16. Community Health Planning & Health Care Reform • Ensures an independent entity that identifies community needs and objectively measures progress in meeting those needs • Ensures that all community stakeholders have a voice in determining need for health system resources • Since “health care is local”, ensures that local perspective will be heard at state and federal levels • Uses CON as a tool to shape the healthcare system to encourage better distribution of health care resources and thus reduce geographic disparities

  17. Community Health Planning & Health Care Reform • Works to constrain unfettered growth of health system resources will aid in containing costs • Links health services capacity to community needs to promote investment in resources that will benefit community health • Bridges health system improvements with enhancing public health

  18. Is Community Health Planning a Realistic Option in Health Reform? • 38 States still have some form of Certificate of Need • Public health assessments are already closely linked with determination of community need • H1N1 Flu demonstrates the link between public health and health system resources • As cost savings are sought, community health planning may offer a credible way to “optimize” healthcare service system growth

  19. Is Community Health Planning a Realistic Option in Health Reform? • Rochester, as the model, offers an example to those shaping federal health care reform: • Because health care is ultimately a local concern, ensures communities participation and input into their own health delivery system • Using CON as a tool in capacity planning • Promotes a delivery system designed to meet the needs of the community, especially the underserved • Emphasize the importance of primary and preventive care • Appropriately constrains health system costs by keeping health system capital costs in check • Saves on operating costs by designing a system without excess capacity to maintain

  20. Finger Lakes Health Systems Agency The triangle represents our agency’s role as a fulcrum—the point on which a lever pivots—boosting the community’s health by leveraging the strengths of all stakeholders. The fulcrum is also a point of equilibrium, reflecting our ability to balance the needs of consumers, providers and payers on complex health matters. The inner triangle also evokes the Greek letter delta—used in medical and mathematical contexts to represent change—with a forward lean as we work with our community to achieve positive changes in health care. Give me a lever long enough and a fulcrum on which to place it, and I shall move the world. —Archimedes 1150 University Avenue • Rochester, New York • 14607-1647 585.461.3520 • www.FLHSA.org

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