2013 NACHC WINTER STRATEGY MEETING HEALTH CENTERS HEALTH CENTERS A SOLUTION OF CHOICE.

2013 NACHC WINTER STRATEGY MEETING

HEALTHCENTERSHEALTH

CENTERS

ASOLUTIONOFCHOICE

CHARGE

All components of the health center movement must continue to work together on policy issues while helping build the capacity to respond to a changing health care marketplace and ensure health center operations are efficient and effective.

Develop a clear set of time specific actions that enable NACHC, PCAs, Networks & Health Centers to lead the way in achieving positive results related to access, quality, and cost.


HEALTH CENTER ASSETS AND VULNERABILITIES

ASSET• Expertise in serving

vulnerable populations -- services under one roof; staff with cultural/ linguistic competencies

• Relationship with patients/communities we serve - we know them best & can communicate with them

VULNERABILITY• Improve the patient

experience or lose patient loyalty

• Lack detailed outreach, enrollment, and navigation strategies


ASSET• Existing programs, e.g.,

NHSC, help retain and recruit providers

• Have the data to make the health center value proposition

• Largest primary care network (patients, providers, etc.) – a “precious” commodity

VULNERABILITY• Strong competition, including

inability to match salaries offered

• Not using the data we have to its full potential, e.g., comparative performance analysis

• Don’t act like a “precious commodity”; improve alignment and use of assets


ASSET• Knowledge of Medicaid;

flexibility to experiment with APMs

• PCMH, including experience with EHRs, chronic care management and service integration

• Consumer-based boards

• ETC.!

VULNERABILITY• Limited Medicaid partner-

ships; dependent on payment model that is bound to change

• Care coordination and behavioral health capacity need to be increased

• Consumer-based boards – without proper training, development, and communication, become a liability

• ETC.!

CROSS-CUTTING CONCERNS1. UNITY – “We are all stronger when we stand

together and act together!”

2. DATA – We have data that we are not using to define performance measures and compare performance.

3. PATIENTS – “Our patients are potentially someone else’s enrollees!”

4. STAFF AND BOARDS – We must ensure that our staffs and board members are well informed.


CROSS-CUTTING CONCERNS5. TRANSFORMATIONAL LEADERSHIP –

“NACHC and the health center movement must embrace transformational leadership as a core value…”

6. SENSE OF URGENCY – We must create a sense of urgency that results in health centers being a major and trusted source of essential information for their patients, community, legislators, partners, etc.


RECOMMENDED ACTIONS FOR REACHING

ALL HEALTH CENTERS

1. Message reinforcement via NACHC and PCA meetings and communications.

2. Sharing of patient stories, best practices and lessons learned.

3. NACHC and PCAs target and reach out to those health centers that are not active participants in either or both associations – including “a buddy system.”


RECOMMENDED ACTIONS FOR REACHING

ALL HEALTH CENTERS

4. Regular updates presented to NACHC, PCA, and Network board members.

5. Communication strategy that uses more than usual venues – maximize social media.

6. Use other forums to reach staff other than health center CEOs (CFO trainings, clinician trainings, board member trainings, etc.).


HEALTH CENTER OPERATIONSFor health centers to be both providers of choice and employers of choice, they must be able to operate efficiently and effectively and be able to document impact on quality and cost. What actions are required for health centers to operate successfully in the new health care environment?


GROUP A

Outreach/Enrollment: current and prospective patients

What should health centers be doing to keep existing patients and attract newly insured patients?


GROUP A RECOMMENDED ACTIONS• Tools, rooted in a client-driven belief system, that

inform staff, patients and communities of ACA and reflect health centers as reliable sources of patient advice• State-focused resources that enable PCAs to

work with state legislators/regulators to ensure health centers are viewed favorably• Client empowerment/navigation tools that can

assist existing and potential health center patients identify that they are with a “community health center”


GROUP B

PCMH Model

Including clinical workforce

How do we get to at least 40% of health centers recognized as PCMH by 2014 and what are the clinical workforce implications of doing that?


GROUP B RECOMMENDED ACTIONS• Segment and target at least 288 health centers to

be PCMH recognized by 2014• Target health centers already recognized/

accredited to sustain practice transformation and outcome documentation• Develop a framework to coordinate PCMH training

and TA• Develop business case and practical models for

sustainable PCMHs, and demonstrate clear and intuitive value for health centers, payers, and stakeholders


GROUP C

Leadership:

Management teams and boards

How do we work to retain, recruit, and create strong leadership at health centers?


GROUP C RECOMMENDED ACTIONS• Acknowledge that leadership development is a

strategic priority on par with advocacy efforts• Develop a “plan for enhanced leadership” that

reflects innovation and transformational leadership• In concert with PCAs and Networks, execute the

Plan across the country


GROUP D

Efficient and Effective

Operational Systems

What business tools, e.g., financial benchmarks, patient flow analysis, practice improvements, etc., are needed to have business and clinical practices that produce sufficient resources to ensure stable operations?


GROUP D RECOMMENDED ACTIONS• Develop a methodology and training to assist

health centers track/monitor/explain total costs• Develop tools related to practice redesign –

principles, techniques, best practices, etc.• Convene Networks and PCAs to develop strategy

on how to engage health centers not yet involved in networks or data warehouses• Develop and implement strategy for consistency

or integration across organizations hosting data warehouses


MARKETPLACEUltimately, success in this area will require that health centers are appropriately recognized in new payment arrangements, i.e., both Medicaid Expansions and State Insurance Exchange offerings, and have entered into strategic partnerships with other groups in the health care industry. What actions are required to assist health centers to be successful in what will continue to be a changing and challenging health care marketplace?


GROUP E

Partnerships

and Linkages

What actions can be taken to assure that health centers are forming appropriate partnerships/linkages and executing contracts that allow for success?


GROUP E RECOMMENDED ACTIONS• Develop training, tools, and best practices to

assist with negotiations• Promote a national payment model that allows

payers to risk adjust for social determinants of health• Identify and remove HRSA roadblocks regarding

mergers, change of scope, and other innovative approaches to care that require HRSA approval


GROUP F

Insurance Exchange

Implementation

What are the practical health center operational strategies that will enable them to maximize opportunities of participating in the new State Insurance Exchanges?


GROUP F RECOMMENDED ACTIONS• Define timelines and decision trees for State Exchanges that

clearly articulate the process moving forward (including key dates) and how health centers and patients will be impacted• Develop a curriculum for training health center staff on State

Exchanges to be carried down to patients via health center staff• Advocate at federal/state levels for additional health center

funding for Outreach, Enrollment, and Navigator purposes • Promote and disseminate information on IPA and ACO state

and/or local best practice models


GROUP G

Strategic Understanding

and Positioning

What can be done to assure that all health centers recognize, understand, and are positioned to take advantage of the ACA opportunities?


GROUP G RECOMMENDED ACTIONS• Develop internal and external analytical tools to

inform strategic decision-making• Strengthen health center brand identity, i.e.,

F – fees based on ability to pay

Q – quality health care to all people regardless of

insurance status

H – highly competitive health care professional teams

C – community controlled by patient majority boards


POLICYOur responsibility is to inform all members of the health center movement, including patients, of what is at stake and provide them with a direction of how to proceed. What actions are needed to inform and mobilize all parts of the health center movement to deliver the value proposition of health centers to elected officials and policy makers?



POLICY: Taking It To The Street

We must have a UNIFIED message for all levels of officials

• This includes federal, state, and local officials

• For advocate champions and new advocates

alike

• Legislative, regulatory, and all policy-related

actions

GROUP J

Negotiating State

Medicaid Payments

What will it take to effectively work with State officials to ensure that the Medicaid Expansions have appropriate reimbursement?


GROUP J RECOMMENDED ACTIONS• Create a method for sharing state negotiations

regarding Medicaid payments in real-time• Collect data to develop risk adjustment models

recognizing the social determinants of health• Expand training on new and existing payment

models


GROUP I

State/Federal

Regulatory Policies

How do we prioritize and respond to critical state and federal regulatory policies that will define the actual details of how Medicaid Expansions and State Insurance Exchanges will operate?


GROUP I RECOMMENDED ACTIONS• Continue to support appropriate payment

methodologies within CMS– Medicaid– Exchanges– CMS demonstration projects

• Ensure HRSA & CMMS regulatory policies are timely– “The bureaucracy should respond at the

speed of the marketplace”• Align consistent messages with our policy

agenda


GROUP H

Elected Officials:

Value proposition of health centers

What actions are needed to educate elected officials, including those at the state and local levels, on the role health centers can play as we move forward, including what the health return on investment is?


GROUP H RECOMMENDED ACTIONS• Build “Key Contact” infrastructure and program• Arrange in-house visits at CHCs for every

federal, state, and local elected official, every year

• Raise visibility of advocacy at all meetings


Mark BryantMary BufwackLindsay FarrellKathy Grant-DavisBruce GrayRicardo GuzmanStephanie HarrisonPaloma HernandezSherry HirotaCraig Hostetler

Kevin KearnsWalter KeeleyAnnette KowalLolita LopezToni McGuireBen MoneyLouise ReeseCheri RinehartBobbi RyderSusan Wilson


Thank you, Group Leaders!

2013 NACHC WINTER STRATEGY MEETING HEALTH CENTERS HEALTH CENTERS A SOLUTION OF CHOICE.

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