Developing a School-Based Community Health Care System

1. Developing a School-Based Community Health Care System June, 2013

2. Presentation Purpose • To provide an overview of a community healthcare system using schools as a platform for services and financing • To identify and describe key community partnerships and their roles • To identify opportunities for improving healthcare services and the supporting business model in a school district

3. School District Healthcare: Context • Has a history defined by school nurses • Increased complexity with children in special education with OT, PT, mental health, and speech services. • Has funding streams of local, federal, and third party revenue. • However, it is not organized or managed as a healthcare system within a community healthcare strategy

4. Why School Health? Source: Bergren, 2012

5. The Need • More medically fragile children and children with chronic illnesses • 15-18% of children/adolescents have a chronic health condition • One in 6 children have a developmental disability • Nearly half can be considered disabled • Significantly more children in special education • 62% increase (1977 to 2008) Source: Bergren, 2012

6. Increasing Needs 306% Between 2000 and 2010: • Developmental delays increased 72% • Other Health Impairments increased 127% • Autism increased 306% 127% 72% Develop Delays OHI Autism Source: Bergren, 2012

7. Why? • With improved neonatal care, more fragile children reach school age. • Toddlers and infants may show no or mild disability, but significant numbers may have moderate to severe disabilities at school age. Source: Bergren, 2012

8. Care/Cost Shift • Acute Care • Medically fragile children in school require ventilators, tube feedings, medication, and other complex nursing care • Ambulatory Care • Chronically ill children are case-managed and receive provider prescribed treatments • Public Health • State mandated screenings, reporting, and surveillance

9. Access to Care an Issue for Louisiana • 60-70% of the 660,000 students statewide are enrolled in Medicaid • Only 336 nurses for 1,450 public schools; 62 School based Health Centers • Only 18 of 891 pediatricians enrolled in Medicaid (2%) are accepting new patients

10. Pieces of the current puzzle: Local School Districts Federal Affordable Care Act State Coordinated Care Networks* How can these be linked for shared benefit? * Louisiana Medicaid Managed Care

11. The Healthcare Model

12. The Model • Relevant insurers: Coordinated Care Networks (Medicaid), 3rd party insurers (Blue Cross, etc.), • Community providers (hospitals, FQHCs, clinics), • Electronic student health record (eSHR) developers • Medicaid, foundations • 3rd party insurers • Healthcare corporations • FQHCs • Registered nurses (RNs) • Nurse practitioners (NPs) • Licensed clinical social workers (LCSWs) • Clerks

13. Expected Healthcare Benefits • 80% reduction in emergency and non-emergency department use • A significant decrease in in-patient Medicaid expenses • An increase in mental health and dental services • Disabled students will receive more healthcare • An increase in Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services (prevention) • Lower prescription use • More children with chronic diseases identified, referred to Coordinated Care Networks (CCNs), and treated

14. Sustainability: Financial • Generates in excess of $70 million new Federal dollars for districts at no cost to Louisiana • Builds infrastructure to leverage local funding to generate more federal dollars • Increases and makes more predictable school nurse revenue • Optimizes revenues for community healthcare providers

15. Expected Benefits to Education • Reduced absenteeism • Improved health and behavior • Lower dropout rates/higher graduation rates • Improves job satisfaction of faculty/staff • Attracts more student enrollment

16. Sustainability: Infrastructure • Creates partnerships between healthcare networks, school districts, and communities • Statewide, can generate approximately • 1,000 new well-paying RN and LCSW jobs • 300 nurse practitioners jobs • 300 clerk jobs • Integrates community health care (schools, hospitals, clinics, public health, etc.)

17. An Application of the Healthcare Model Lafayette Health Initiative

18. An Application of the Model Lafayette Health Initiative • 43 schools • 30,451 children K-12 • 70% eligible for Medicaid Source: Student Information System, LDE, 2011

19. An Application of the Model Lafayette Health Initiative • Medicaid • District • Other 3rd Party health contracts • Lafayette Parish School System • Picard Center • SWLA (FQHC) • State Medicaid Agency • CCNs • Foundations • Area Hospitals • 3rd Party Insurers • 67 RNs, • 67 LCSWs • 16 NPs • 16 clerks

20. The Partnership Roles and Benefits

21. The Partnership: Roles and Benefits School Districts Role • Provides cost-effective platform for child and family health • Optimally organizes services and funding • Provides physical facilities

22. The Partnership: Roles and Benefits Community Hospitals Role • Provide nursing support, upstream clinics, hospital and ancillary services

23. The Partnership: Roles and Benefits Federally Qualified Health Center (FQHC) Role • Provide school-based supports/services with nurse practitioners, Licensed Clinical Social Workers (LCSWs), and clinical services

24. The Partnership: Roles and Benefits Coordinated Care Networks Role • Data sharing and support of care coordination. • Linkage to PCPs. • Potential funding for electronic Student Health Record (eSHR) &outcome measurement

25. The Partnership: Roles and Benefits Medicaid Role • Revenue to pay for healthcare services • Development and implementation of public policies to support the model

26. The Partnership: Roles and Benefits Blue Cross, Foundations, Other Health Providers Role • Data access to students • Fund eSHR, evaluations, technical assistance (TA)

27. The Partnership: Roles and Benefits Picard Center Role • Provide TA to partners, including disease management training, project management, evaluation, eSHR development and support

28. The Partnership: Roles and Benefits Office of Public Health Role • Align policies to better integrate school-based health centers • Provide relevant planning and outcome data

29. Sources of Funding

30. Sources of Funding

31. LEAs: Current Sources of Funding • Some have school based health centers with foundation, state, local, and third party revenue • Third party revenue (Medicaid); primarily for OT, PT, speech, and nursing services • Local/state funds • Dedicated millage • Federal funds associated with Title 1 and special education

32. LEA’s: Potential Sources of Funding • Partnership with an FQHC -- NP and LCSW • State Medicaid program – RN and mental health providers • Medicaid -- Upper Payment Limit How you organize partnerships, revenue, and costs defines your clinical model; the reverse is also true. .

33. Steps in a Plan • Understand the State Medicaid Plan and how it applies to an LEA; consider amending the plan if necessary • Develop a healthcare plan for the LEA (address needed capacity, access, sustainability, care coordination [includes and emr, chronic disease management, and a management information system], and leadership)

34. Steps continued • Develop an implementation schedule that is manageable and allows movement to scale • Secure key commitments (the state Medicaid agency, LEAs, hospitals, FQHCs, CCNs [medicaid managed care firms], healthcare corporations) for necessary partnerships

35. The largest obstacle is our fear of change______as though change is not inevitable.

36. Picard Center for Child Development and Lifelong Learning University of Louisiana at Lafayette www.picardcenter.org John LaCour, MSW Director of Health Services 6120 Perkins Road, Third Floor Baton Rouge, LA 70808 Office: 225-763-5570 Cell: 225-937-8834 Email: john.lacour@louisiana.edu