Sacramento Region Health Care Partnership Yolo County Stakeholder Meeting Notes and Stakeholder Input

Sacramento Region Health Care Partnership Yolo County Stakeholder Meeting Notes and Stakeholder Input
Sacramento Region Health Care Partnership
     Yolo County Stakeholder Meeting

       Notes and Stakeholder Input

              February 24, 2012
       Yolo County Health Department

      Compiled by the Public Health Institute
Sierra Health Foundation’s team of consultants was invited by the Future of the Safety Net Yolo County
to present preliminary data from a market assessment of the primary care safety net in Yolo County.
Approximately 35 members of the coalition attended the meeting, which was dedicated to the
Sacramento Region Health Care Partnership.

Meeting Objectives

1. To understand the impact that an increase in newly insured patients will have on the Yolo
   County safety net
2. To understand the strengths and weaknesses of the county’s safety net specific to health care
   reform implementation
3. To identify gaps/areas that may require support to successfully implement health care reform
4. To agree on some major activities or interventions that can strengthen the safety net and better
   prepare it for health care reform

Meeting Agenda

11:30 a.m.       Welcome and Introductions                                       Helen Thomson

11:35 a.m.       Review the agenda; agree on its outcomes, meeting               Sierra Health Foundation,
                 guidelines and participants’ roles for this meeting.            facilitators Barrett Hatches
                                                                                 and Nancy Shemick

11:40 a.m.       Update on CMSP activities                                       Jill Cook

11:50 a.m.       Background on the Sierra Health Foundation Initiative           Sierra Health Foundation
                                                                                 Abraham Daniels

11:55 a.m.       Data presentation:                                              Public Health Institute
                                                                                 Amy Neuwelt, Marisel Brown
                      The number of potentially insured in 2014
                      Primary care capacity
                      Specialty care capacity

                 Questions and Answers

12:35 p.m.       Based on information shared earlier in this meeting and          Sierra Health Foundation,
                 your experiences with this county’s safety net, what is          facilitators Barrett Hatches
                 required to successfully implement health care reform and        and Nancy Shemick
                 does not apparently exist right now?

 1:20 p.m.        Next Steps                                                      Sierra Health Foundation,
                                                                                  facilitators Barrett Hatches
                                                                                  and Nancy Shemick

 1:25 p.m.        Closing Remarks and Adjourn                                     Helen Thomson


Abraham Daniels, Program Officer at Sierra Health Foundation, thanked the Future of the Safety Net
Yolo County for creating time on the agenda for this discussion. The Sacramento Health Care
Partnership is an initiative to strengthen the health care safety net in El Dorado, Placer, Sacramento and
Yolo counties in preparation for health care reform implementation. Sierra Health Foundation
assembled a team of experts – The Abaris Group, the Public Health Institute and Hatches Consulting – to
conduct a market analysis to understand the region’s current and forecasted capacity of the primary
care safety net, and facilitate the development of a regional strategic plan.

Market Analysis

The Public Health Institute presented the market analysis on behalf of The Abaris Group. The
presentation featured the market assessment baseline of current service capacity of the Yolo County
primary care safety net and a forecast of community clinic capacity needs.

The preliminary Yolo County safety net market assessment presentation is online at:

Strategic Planning – Breakout Session Notes and Stakeholder Input

Hatches Consulting and the Public Health Institute facilitated a process for all attendees to provide
feedback in two breakout groups to answer the following question: Based on information shared earlier
in this meeting and your experiences with this county’s safety net, what is required to successfully
implement health care reform and does not apparently exist right now?

Summary of Responses
   1. Expansion, retention and training of workforce – clinical and allied health
   2. Need for data that describes current primary care safety net and specialty care capacity
   3. Need to ensure maximum enrollment with expanded coverage
   4. Strategy for health information exchange (HIE) across providers, health plans, public health

Grouped Responses

Safety Net Strengths:

       Existing federally qualified health centers (FQHCs) and providers
       Partnership with UC Davis for recruiting medical grads
       Should leverage strength of FQHCs
       Coordination among community health centers (CHCs)

Safety Net Gaps and Concerns:

      Competing with surrounding counties for recruiting primary care medical graduates
      Shortage of specialty care providers
               ‐ Special mention of psychiatrists, particularly child psychiatrists
      Shortage of primary care providers
      Will need certified application assistants (also promotoras, educators, etc.) to help safety net
       patients with enrollment. Existing availability of these providers is an asset Yolo has, but will be
       understaffed with new patients entering system with Affordable Care Act (ACA)
      Need resources and infrastructure to train new safety net providers
      Need to think about engaging with employers and their responsibilities for offering coverage
      Distinction of “reactive” charity care by hospitals versus “proactive” community investment via
       community benefit programs (need system to work with CHCs to demonstrate improved
       outcomes and cost savings for IRS 990 and to communicate value of proactive investments to
       hospital presidents)
      Concern with ACA of providing care coordination to patients
      Concern of epidemics, lack of specialty care and availability of primary care medical homes
      Clinic consolidation to reduce administrative overhead
      Fear ACA won’t be implemented if Republican president is elected
      Concern of timely enrollment, education, support and information being provided to newly
       eligible patients
      Concern of insufficient providers
      Undocumented – where do they go in safety net now
                ‐ What are implications for CMSP?
      Where are uninsured that are not seen in clinics getting care?

What needs to happen in Yolo to get ready for 2014:

      Develop enrollment strategies
      Address unmet specialty care access/need
      Outreach and enrollment
              ‐ Navigators available to assist w/enrollment
              ‐ Have experience but lost application assistants in cuts = increased need w/ACA
              ‐ Currently, word not getting out about coverage options – even low knowledge of
                   YCHIP persists
                      ‐ Need multilingual staff/messaging
                      ‐ Need phone banking and helpline
                      ‐ Need to “compel” folks to apply AND finish the application process
      HIE need coordination across health plans/clinics/hospitals/public health/private providers
              ‐ Example: Health Share Bay Area (RHIO)
              ‐ Relationships/collaboration
              ‐ Facilitates care coordination – patients move around region (Sacramento and
                  Eastern Solano)

   Funding needed
              ‐ Workforce development #1
                    ‐ Expand scope of duties/practice of community health educators and
                         community health workers as well as medical assistants.
                    ‐ RN case management/coordination skill building needed
                    ‐ SDH (social determinants of health)
                    ‐ Primary care/obesity extends to community‐based prevention –
                         food/nutrition and physical activity
              ‐ Workforce development #2
                    ‐ Use NPs a lot, but still need MDs and pharmacists
                    ‐ Need to talk w/education institutions (community colleges/colleges RN
                         programs as example) to get better skill match between training and
                         skills/competencies needed in primary care safety net clinics
      Need to work with schools, park and recreation departments, expand number of farmer’s
       markets, sports activities for kids/teens/families/clubs
              ‐ Examples of community‐based strategies taking root
                    ‐ Sacramento project – Children’s Alliance
                    ‐ Build on First 5 channels to get eligible parents into HBX pipeline
      Need to continue advocacy to fund programs for target population – CHDP, CMSP

Data Gaps:

      Need to include Woodland and Sutter clinics as part of safety net capacity, depending on what
       types of patients they will be seeing, including CMSP and uninsured.
      Need to differentiate “other” payer category instead of lumping into one
      More detail on Yolo CHC capacity (# providers, no‐show rate, patient volume capacity, etc.) to
       link with current and forecasted demand data
      Economic analysis on how to cover upcoming pocket of those over 200% FPL with tiered
       coverage who will also be coming to safety net and paying out of pocket
      Need data on ED re‐admission rate to demonstrate costs hospitals could be investing in
       community‐based preventive care; opportunities for hospitals and CHC systems to collaborate in
       terms of safety net infrastructure
      Requested metrics for the following:
                ‐ Specialty care demand projections
                ‐ Capacity of existing safety net providers beyond clinics including PMDs
                ‐ Capacity of existing mental health services for low‐income population
                ‐ Capacity of existing substance abuse services for low‐income population
                ‐ Capacity of existing dental services for low‐income population
                ‐ Capacity of existing vision care services for low‐income population
      Determine reimbursement threshold of PMDs for payment by MediCal versus Health Benefits
       Exchange health plans for low‐income beneficiaries. MediCal reimbursement should be
       somewhat competitive with commercial plans that cover newly insured under to health reform.
                ‐ Should PMDs be surveyed to determine payment level at which they will not see
                    low‐income patients
      Drill down to determine quality of care in safety net
      Quality improvement – where are we now

Next Steps
Abraham thanked everyone for their input. The feedback and suggestions from this meeting will assist
in the regional planning meetings.

The California Endowment and Sacramento Region Community Foundation are funding partners for the
Health Care Partnership’s market analysis and strategic planning process.

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