John Schlitt National Assembly on School-Based Health Care

John SchlittNational Assembly on School-Based Health Care

School Health in Era of Health Care Reform

School Health: A Force

• 74,000 school nurses• 14,000 SWers• 99,000 counselors• 30,000 psychologists• 2,200 SBHCs• Unknown #s physicians, mental health and substance

abuse specialists

Source: Lear JG. Health at school: a hidden health care system emerges from the shadows. Health Aff (Millwood) 2007;26:409–19.

School Health: A Force

• Surveillance data• Extensive child development knowledge• Cross-disciplinary competencies• System infrastructure

Triple Aim

Better health care experience

Improved outcomes

for population

Lower cost

Shifts in Health Care

OUT INVolume Value

Quantity Quality

Units Outcomes

Carve out/silos Integration

Lone rangers Multidisciplinary teams

Individual Population

Clinic Community

Redesign Experiments in State Medicaid Programs

• Health Homes• Pay for Performance• Integrated Care Models

Health Homes

• Primary care redesign• Building block for most reforms• Patient-centeredness at the core• Care coordination/management• Enhanced access (24/7)• Electronic linkages to health neighborhood • Quality improvement

Pay for Performance (P4P)

• Provider incentives for tracking quality measures, adopting new roles/behaviors – Enhanced rates/fees– Augmented payments/bonus– Behavioral health????

Integrated Care Models

• Accountable Care Organizations– “vertical integration”– Provider-driven, not insurance-driven– Emphasis on accountability = performance– Shared savings as incentive to drive down costs, make

smarter investments in front end

Realigning Health with Care

• Product: broaden concept to ameliorate effects of nonclinical determinants– Inadequate food, housing, safety

• Place: beyond medical complex neighborhoods

• Provider: nontraditional team members–Community outreach workers, heath

educators, coaches, resource coordination

Integrated Health Neighborhood

Learning Supports

Primary Care

Behavioral Health

Public Health

Asthma

Depression

School failure

Substance use

Teen pregnancy

Obesity

Schools in the Health Neighborhood

• Point of entry to primary prevention, risk reduction and care management system

• Inter-disciplinary team: whole child approach that unifies mind and body

• Screen/address behavioral health needs often undetected and unmet by mainstream PC system

• Meets young people where they are (literally) in terms of problems, pain, social and developmental challenges

• Unprecedented opportunity for population health

SBHC Lessons for Reformers

• Co-location > collaboration > integration• Structural issues related to integration -

space, data, scheduling – are not insurmountable

• Breaks down hierarchy; maximizes skill sets• Minimizes stigma by normalizing within school

setting

New Competencies for School Health

• Think “SYSTEMS.”• MEASURE quality.• Get WIRED. • Get COUNTED (and paid). • Know your VALUE.• Get to the TABLE.• Practice INTER-DISCIPLINARILY.

New Competencies for School Health

• Think “SYSTEMS.”• MEASURE quality.• Get WIRED. • Get COUNTED (and paid). • Know your VALUE.• Get to the TABLE.• Practice INTER-DISCIPLINARILY.

General Reform Resources

• National Academy of State Health Policy• Health Affairs• Kaiser Family Health Foundation

SCHOOL-BASED HEALTH ALLIANCE

NASBHC =

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