Preparing for Transformation · 2016. 4. 5. · H E A LT H C A R E PA R T N E R S H I P / 2 0 1 2 ... Marsha Regenstein, PhD Alaina Dall Juliana Boyle, MBA Mark Zocchi Chuck Baucom

S A C R A M E N T O R E G I O NH E A L T H C A R E P A R T N E R S H I P / 2 0 1 2

A Market Analysis of the Sacramento Region Primary Care Safety Net

A Sierra Health Foundation initiative

Preparing for Transformation: Rethinking, Revitalizing and Reforming the Sacramento Region’s Health Care System

S A C R A M E N T O R E G I O NH E A L T H C A R E P A R T N E R S H I P / 2 0 1 2

A Strategic Plan for the Sacramento Region

A Sierra Health Foundation initiative

Preparing for Transformation: Rethinking, Revitalizing and Reforming the Sacramento Region’s Health Care System

S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P

This strategic plan for the Sacramento Region primary care safety net system was commissioned and funded by Sierra Health Foundation with additional funding from

The California Endowment and Sacramento Region Community Foundation. The strategic planning process was facilitated by The Abaris Group,

Public Health Institute and Hatches Consulting.

Consultant Team

The Abaris Group

Mike Williams, MPA/HSA, Project Lead

Marsha Regenstein, PhD

Alaina Dall

Juliana Boyle, MBA

Mark Zocchi

Chuck Baucom

Public Health Institute

Carmen Nevarez, MD, MPH

Marisel Brown, MPH, MSBA

Art Chen, MD, MPH

Nancy Shemick, MPP

Hatches Consulting

Barrett Hatches, PhD

The Abaris Group, Public Health Institute, Hatches Consulting, Mighty Pen Writing & Editing and Sierra Health Foundation

contributed to the writing and editing of this strategic plan report.

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Table of ContentsAcknowledgements 1

LetterfromtheFunders 4

LetterfromCongresswomanDorisMatsui 5

ExecutiveSummary 6

PreparingforTransformation 12

ProjectOverview 13

ProjectTimelineandProcess 14

SacramentoRegion’sCurrentSafetyNet 15

TheSuccessfulSafetyNet 16

DevelopingaStronger,HealthierRegionalSafetyNet 18

CareCoordination 19

Collaboration 21

CapacityBuilding 22

PrimaryCare/SpecialtyCareIntegration 23

What’sNext 24

Conclusion 26

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AcknowledgementsThank you to the many stakeholders who contributed their time, expertise and involvement with the development of this strategic plan. Sincere apologies to anyone who may have been inadvertently left off this list.

JonathanLehrman,MDAccessElDorado

ChristineSisonAccessElDorado

SandiSnelgroveAnotherChoiceAnotherChance

SeanAthaAnthemBlueCross

KerryBrownAnthemBlueCross

KimWilliamsBuildingHealthyCommunities

JosephHafkenschielCaliforniaAssociationforHealthServicesatHome

ChristineSmithCaliforniaConsortiumforUrbanIndianHealth

RosanaJacksonCaliforniaDepartmentofPublicHealth

LeticiaAlejandrezCaliforniaFamilyResourceAssociation

DorethaWilliams-FlournoyCaliforniaInstituteforMentalHealth

CarolLeeCaliforniaMedicalAssociationFoundation

ElissaMaasCaliforniaMedicalAssociationFoundation

EdMendozaCaliforniaOfficeofStatewideHealthPlanningandDevelopment

RonaldSpingarn CaliforniaOfficeofStatewideHealthPlanningandDevelopment

JonathanTeague CaliforniaOfficeofStatewideHealthPlanningandDevelopment

SandraPerezCaliforniaOfficeofthePatientAdvocate

MarthaTorres-MontoyaCaliforniaOfficeofthePatientAdvocate

KiranGrewalCaliforniaPharmacistAssociation

DeborahOrtizCaliforniaPrimaryCareAssociation

DavidQuackenbushCaliforniaPrimaryCareAssociation

SteveBarrowCaliforniaStateRuralHealthAssociation

AlHernandez-SantanaCalifoniaStateRuralHealthAssociation

MartyKealeCapitolCommunityHealthNetwork

AshelyTolleCapitolCommunityHealthNetwork

JohnAdamsCASAElDorado

DebbieBrussard CenterforAIDSResearch,Education&Services

RobertKamrath CenterforAIDSResearch,Education&Services

JanetParkerCenterforAIDSResearch,Education&Services

WendyPetkoCenterforCommunityHealthandWell-Being,Inc.

KarenShoreCenterforHealthImprovement

TaraDavisCenterForInnovativeCommunitySolutions

SheliaDuruisseau-SidqeCenterForInnovativeCommunitySolutions

AutumnValerioCenterforMulticulturalDevelopment

CathyFreyCentralValleyHealthNetwork

LisaDaviesChapa-DeIndianHealthProgram,Inc.

RobinAffrimeCommuniCareHealthCenters

LeonSchimmel,MDCommuniCareHealthCenters

AlanLangeCommunityLinkCapitalRegion

ArielLovettCommunityRecoveryResources

BrianGraafCommunityResourceProject

KellyBennett-WoffordCovertheKids

JoilXiongCovertheKids

MichaelNegrete,PharmD CPhAandCaliforniaNorthstateUniversity

KaciBaldiDignityHealth

RosemaryYountsDignityHealth

LizDowellDivideReadyby5

JohnBachman,PhDElDoradoCommunityHealthCenter

JamesEllsworth ElDoradoCommunityHealthCenter

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DeborahPalmer ElDoradoCounty

OliviaByron-Cooper,MPH ElDoradoCountyHealth&HumanServicesAgency

JoanMeisWilsonElDoradoCountyHealth&HumanServicesAgency

MichaelUngeheuer,RN,MN,PHNElDoradoCountyHealth&HumanServicesAgency

ChristyWhiteElDoradoCountyHealth&HumanServicesAgency

ChristineHoyt ElDoradoCountyPublicHealth

AlexBolteElHogarMentalHealthandCommunityServices

EileenSnickerFeministWomen’sHealthCenter

RickAlfordFirst5ElDorado

KathleenWalker First5ElDorado

DebraPayneFirst5Sacramento

JulieGallelo First5Yolo

DebraOto-Kent HealthEducationCouncil

RichardIkeda,MDHealthforAll

EffieRugglesHealthNetofCalifornia

MarthaGeraty HealthNetStateHealthPrograms

ScottSeamonsHospitalCouncilofNorthernandCentralCalifornia

JenniferAblogKaiserPermanente

EllenBrownKaiserPermanente

StephanieLandrum KaiserPermanente

MyrnaRivas KaiserPermanente

PatriciaRodriguez,RN,MPHKaiserPermanente

CarolSerreKaiserPermanente

ChaosarnChao LaoFamilyCommunityDevelopment,Inc.

ElisaHerrera LatinoLeadershipCouncil

BobLong,MD LatinoLeadershipCouncil

BillKennedy LegalServicesofNorthernCalifornia

FrankLemus,PhDLemusConsultingGroup

JenniferDwight-FrostMarshallMedicalCenter

SherryGeurinMarshallMedicalCenter

VernSaharaMarshallMedicalCenter

DennyPowellMercyGeneral

MarciaWells MercyNorwoodFamilyClinic

TonyBrowneMidtownMedicalCenterforChildren&Families

ElizabethCassin MidtownMedicalCenterforChildren&Families

RobertReichMidtownMedicalCenterforChildren&Families

RichardDanaMutualAssistanceNetwork

LeonardRanasinghe,PhD,MDNatomasCrossroadsClinic

BarbaraSayre-Thompson NCADDSacramento

GailCatlinNonprofitResourceCenter

RichardBurton,MD,MPHPlacerCountyHealth&HumanServices

JamesGandley,DDS,MPHPlacerCountyHealth&HumanServices

ElizabethFraley PlannedParenthoodMarMonte

RaquelSimentalPlannedParenthoodMarMonte

JenniferStorkPlannedParenthoodMarMonte

LindaWilliams PlannedParenthoodMarMonte

LorraineRinkerRinkerandAssociates

AliciaRossSacramentoAreaCongregationsTogether

AllisonSwanSacramentoAreaCongregationsTogether

NenickVuSacramentoAreaCongregationsTogether

JoeConcannonSacramentoAreaCouncilofGovernments

GordonGarrySacramentoAreaCouncilofGovernments

MonicaHernándezSacramentoAreaCouncilofGovernments

RebeccaThorntonSloan SacramentoAreaCouncilofGovernments

SharonSprowlsSacramentoAreaCouncilofGovernments

DiAnneBrownSacramentoCityUnifiedSchoolDistrict

JerryBliatoutSacramentoCommunityClinic/HALO

MiguelSuarezSacramentoCommunityClinic/HALO

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BradHudsonSacramentoCounty

PaulLakeSacramentoCountyDepartmentofHumanAssistance

SandyDamiano,PhDSacramentoCountyHealthServices

MarciaJo,PhD SacramentoCountyHealthServices

AnnEdwardsSacramentoCounty,CountywideServices

BruceWagstaffSacramentoCountyCountywideServices

KathyHarwellSacramentoCountyHealth&HumanServices

OliviaKasirye,MD,MS SacramentoCountyHealth&HumanServices

GlennahTrochett,MDSacramentoCountyHealth&HumanServices

DyannWolfeSacramentoFamilyMedicalCenter

KendraBridges SacramentoHousingAlliance

LisaBatesSacramentoHousingRedevelopmentAgency

EricEnriquezSacramentoNativeAmericanHealthCenter,Inc.

BrittaGuerrero SacramentoNativeAmericanHealthCenter,Inc.

AllieShilinSacramentoNativeAmericanHealthCenter,Inc.

PriscillaEnriquezSacramentoRegionCommunityFoundation

JohnChuck,MDSerotoninSurgeCharities

WilliamSandbergSierraSacramentoValleyMedicalSociety

KristineWallachSierraSacramentoValleyMedicalSociety

AileenWetzelSierraSacramentoValleyMedicalSociety

KellyBrenkSutterHealth

TomGagenSutterHealth

HollyHarperSutterHealth

KeriThomasSutterHealth

JoseAlbertoArevalo,MDSutterIndependentPhysicians

MarlonCuellar TheCaliforniaEndowment

ChristineTienTheCaliforniaEndowment

EricFimbresTheEffort,Inc.

J.RodneyKennedyTheEffort,Inc.

BunryPinTheEffort,Inc.

JonathanPorteus,PhDTheEffort,Inc.

TomStanko,MDTheGatheringInnClinic

GraceRubensteinTheSacramentoBee

WarrenBarnesUCBerkeleySoPH/RightCareInitiative

SheltonDuruisseau,PhDUCDavisHealthSystem

LauraNiznikUCDavisHealthSystem

ClairePomeroy,MD,MBAUCDavisHealthSystem

CarolynRamirezUCDavisHealthSystem

RobertWaste,PhDUCDavisHealthSystem

CongresswomanDorisMatsuiU.S.HouseofRepresentatives

NathanDietrich OfficeofCongresswomanDorisMatsui

KariLacostaOfficeofCongresswomanDorisMatsui

DaleAinsworth,PhDValleyVision

CarlHeardWesternCliniciansNetwork

CharlaParkerWesternCliniciansNetwork

CasieParrishWesternCliniciansNetwork

AlexanderGiloffWesternSierraMedicalCenter

SherBarberWindYouthServices

KimSudermanYoloCountyAlcohol,DrugandMentalHealth

JillCook,MS,RN,PHNYoloCountyPublicHealth

TraciLucchesiYoloCountyPublicHealth

TrishaStanionisYoloFamilyServiceAgency

GregBergner,MD

DawnDunlapConsultant

GrantlandJohnsonFormerSecretaryofCaliforniaHealthandHumanServicesAgency

SierraHealthFoundation:

ChetHewitt

DianeLittlefield

RobertPhillips

AbrahamDaniels

SusanKing

KatyPasini

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Letter from the Funders

DearColleagues,

In2011,SierraHealthFoundationlaunchedtheSacramentoRegionHealthCarePartnershipwiththegoalof

findingwaystoimproveaccess,carecoordinationandthequalityoftheregion’sprimarycaresystem,witha

specificfocusoncommunityhealthcenters.Partnersinthisinitiativeincludedleadersfromcommunityclinics,

healthsystems,healthplans,associationsandcounties,aswellasphysicians,policymakersandothers.The

timingwasright,astheimplementationoftheAffordableCareActin2014offersanunprecedented

opportunitytoextendhealthinsurancecoveragetothosecurrentlyuninsured.

InordertofullyrealizetheopportunitiesoftheACA,weneedtounderstandboththestrengthsandthe

weaknessesofthecurrentregionalsystemthatservesresidentsofElDorado,Placer,SacramentoandYolo

counties.Accordingly,thePartnershipcommissionedtwostudies:amarketanalysisthatidentifiesthecurrent

servicecapacitywithintheprimarycaresafetynet,andastrategicplantodevelopanintegratedhealthcare

deliverysystemmodelthatefficientlylinkscommunityhealthclinicstoregionalproviders,thusexpanding

accesstohighqualityandculturallysensitiveservicesforlow-incomeadultsandchildreninourregion.The

CaliforniaEndowmentandSacramentoRegionCommunityFoundationwerefundingpartnersforthemarket

analysisandstrategicplanningprocess.

Wearepleasedtosharewithyouthemarketanalysisandthestrategicplan,whichilluminatewhatwecando

asaregiontoprepareforthetransformativeimpactsofhealthcarereform.Thestressesonourregionalsafetynet

aresubstantial;atthesametime,wearegalvanizedbythevisionofacollaborative,accessible,highqualityand

culturallycompetentprimarycarehealthsystemthatisoutcome-basedandsustainable.Thatisavisionwecan

andmustsupport,individuallyandcollectively.

Weofferthesereportstoinspireconversationandactionaboutthewaystocreateahighqualitypatientcare

systemthatwillbeready,willingandabletoserveournewlyinsuredresidents.Thisisatimeoftremendous

challengeandopportunity,andwemusttakewisestepstogetheraswecreateastrongerandwidersafetynet

toeffectivelyserveallofourresidents.

Sincerely,

ChetP.HewittDr.RobertK.Ross RuthBlank

President and CEO President and CEO CEO

Sierra Health Foundation The California Endowment Sacramento Region Community Foundation

Executive SummaryThe Patient Protection and Affordable Care Act (ACA) offers an unprecedented opportunity to rethink, revitalize and reform Sacramento’s regional health care system.

The primary care safety net of El Dorado, Placer, Sacramento and Yolo counties in Northern California is comprised of a diverse group of organizations, including community health centers, hospitals, health plans, counties and nonprofit agencies. The primary care safety net has been described regionally as strained, inefficient and inadequate to meet the growing needs of the community.

To absorb the anticipated influx of 227,500 newly insured residents under the Affordable Care Act in 2014, the Sacramento Region must address the safety net’s many vulnerabilities and inadequacies while building on its strengths.

We must work together to close the gaps between residents’ needs and the system’s ability to meet them efficiently.

The Sacramento Region Health Care Partnership convened health care and civic leaders to address this challenge. Through this initiative, they identified resources (ACA and other) that the region can apply to bolster safety net functioning to better meet current and looming resident demands.

About the Sacramento Region Health Care Partnership

At the request of several community stakeholders, in 2011 Sierra Health Foundation launched the Sacramento Region Health Care Partnership. The initiative grew out of conversations with policymakers, health systems and community health centers, who approached Sierra Health Foundation to serve as intermediary in preparing the Sacramento Region to implement health reform. The Health Care Partnership creates the region’s first coordinated philanthropic, county agency, nonprofit provider and community health center effort focused solely on regional health care reform preparedness and implementation.

The Health Care Partnership’s Goal

The Sacramento Region Health Care Partnership’s goal is to find ways to improve access, care coordination and quality of the region’s safety net primary care system through community-driven input. The Health Care Partnership’s ultimate vision is to increase and improve primary care access and quality for individuals and families in low-income communities and communities of color in El Dorado, Placer, Sacramento and Yolo counties.

How the Market Analysis Informs this Strategic Plan

The Sacramento Region Health Care Partnership brought together stakeholder groups from the Sacramento Region to prepare for implementation of the Affordable Care Act. The group was supported by a team of expert industry consultants to:• assess the current capacity and forecasted demand for

primary care safety net services, • measure the impact of health reform on the region and

its safety net, • facilitate and develop a strategic plan to help ensure

readiness for health reform, and • improve health access and services for safety net

populations.

The first deliverable for this project was a comprehensive safety net market assessment report, which was concluded in April 2012

1.

The regional strategic plan was developed by the same stakeholder-consulting team between April and May 2012. The market analysis findings informed the development of the strategic plan.


1SacramentoRegionHealthCareSafetyNetMarketAssessmentReport,April2012,TheAbarisGroup,Martinez,CA

Sacramento Region’s Current Safety Net

TheSacramentoRegionHealthCarePartnership’smarket

analysisidentified10criticalissuesimpactingsafetynet

performanceandsustainability:

1. RethinkPrimaryCare.Whilethecurrentsafetynet

intheregionhasmanychallenges,theadventofACA

allowsthecommunitytheopportunitytorethinkits

approachtoprimarycareascurrentlyprovidedbythe

safetynet.

2. GrowingDemand.227,500non-elderlyadultsand

childrenwillbeeligibleforhealthcarecoverageunder

ACA.Thesafetynetpopulationisgrowingandwill

continuetogrownaturally.Demandwillaccelerate

withtheadventofACA.

3. SickerCitizens.Communityhealthindicatorspredict

thenewlyinsuredpopulationwillbesickerthanthe

existingpubliclyinsuredpatientpopulationandhave

significantlyhigherlevelsofchronicdiseasesandrisk

factorssuchasasthma,diabetes,highbloodpressure,

obesity,smoking,andpreviouslyunmetneedsfor

healthcareand/ormentalhealth/alcoholordrughelp.

4. MaxedOutCapacity.Theprimarycarecapacityof

communityhealthcentersandemergencydepartments

totreatthesafetynetpopulationhasgrown,but

withoutfurthereffortswilllikelyreachcapacity

priorto2016.

5. RegionalCapacityBelowAverage.Thenumberof

communityhealthcentersintheSacramentoRegion

hasgrown,butfallssignificantlyshortofmanyother

similar-sizedregionsinCalifornia.

6. MoreMedi-CalPayments.Approximately60percent

ofthenewlyinsuredpatientswillbeinsuredby

Medi-Cal,makingitthesecondlargestpayer

sourceintheSacramentoRegion.

7. OveruseofHighCostHospitalandEmergency

DepartmentServices.Currently,thesafetynetisoverly

dependentonexpensivehospitals,andemergency

departments,inparticular,foroutpatientcare.

8. FinanciallyChallengedCommunityHealthCenters.

Roughlyhalfoftheregion’scommunityhealthcenters

arefinanciallychallenged,withexpensesconsistently

exceedingrevenues.

9. LimitedFederallyQualifiedHealthCenters.The

numberandlocationoffederallyqualifiedhealth

centers(FQHCs)intheregionislowerthanthestate

averageandotherregions.Manycommunityhealth

centersarenotabletotakeadvantageoffinancial

incentivesaffordedtoFQHCs.

10.LackofCoordinatedLeadership.Thecurrenthealth

caresafetynetlacksaleadagency,coordination

andintegration.

The Successful Safety Net

SacramentoRegionstakeholdersrecommendedprinciplesof

asuccessfulsafetynet,whichinclude:2

• Strongcollaboration,coordinationandintegrationofhealthcareservices

• Anaccessible,affordableandequitableclinical,behavioral/mentalhealthsafetynetsystem

• Astrongconsumervoiceandrealconsumerchoice

• Prevention-focusedincentivesandeducation

• Useofevidence-basedandpractice-basedapproaches

• Ageographicfocusthatbalanceslocalandregionalconcerns

• Cost-effectiveandfinanciallysustainableproviders

• Unobstructedconsumeraccesstosafetynetproviders

• Shareddata,trainingandtechnologysystemdesign

Developing a Stronger, Healthier Regional Safety Net

Althoughalloftheidentifiedemergingtopicareasare

importanttotheregion’ssafetynetandalldeservetobe

addressed,theSacramentoRegionhasawindowofonly18

to24monthstoprepareforhealthreformimplementation.


2Oct19,2011SacramentoRegionHealthCarePartnershipnotes

Accordingly,thelistwasnarrowedbytheregion’s

stakeholderstothefourmostimmediatelyactionableareas:

1. Bettercarecoordinationforpatients

2. Bettercollaborationamongproviders

3. Capacitybuildingforproviders

4. Betterprimarycare/specialtycareintegration

Individuallyandcollectively,thesefourfocusareasoffer

immediateopportunitiestocreatereal,meaningfuland

measurableimprovementintheregion’ssafetynet.


Regional Strategic Planning Direction

Followingisagraphicdepictionofthefourtopicareasin

theircurrentstateandintheirfuturestate,oncethesafety

netistransformedbycoordinatedandevidenced-based

strategiestoamoresuccessfulversion.Thefutureprimary

caresystemcapitalizesontheopportunitiescreatedbythe

implementationofhealthreform.

Current Primary Care SystemPrior to Strategic Plan Implementation

CareCoordination:Theprovisionofpatientcare(i.e.,primaryandchronicdisease)lackscoordination,reducingthelikelihoodthatservices,careandhealthresourcesareefficientlyusedtocreatethebestoutcomespossible.

Collaboration:Insomepartsoftheregion,thehealthcaresystemisfragmented.Coordinationamongallsitesthatprovidehealthcareislacking,withminimalsharingofpatientcareplans,methodologiesorresources,resultingininconsistentpatientcareaccess(i.e.,primary,chronicdiseaseandspecialtycare)andgapsinservicedelivery.

Capacity:Currentcapacityisnotconsistentacrossproviders.Thesafetynetisvulnerabletorisingdemandandlimitedbyprovidershortagesandalackofbestandpromisingpractices.

PrimaryCare/SpecialtyCareNetwork:Therearelimitedspecialtycareprovidersforthosewithoutapayersource,oftenleadingtounnecessaryemergencydepartmentcare.

Future Primary Care SystemAfter Strategic Plan Implementation (18-24 months beginning September 2012)

CareCoordination:Evidence-basedpracticesforprimarycareandchronicdiseasemanagementwillbecoordinatedandimplementedsothatpatientswillachievethebestoutcomespossible.

Collaboration:Aregionalintegrateddeliverysystemframeworkprovidestheinfrastructureandalignedfundingincentivestoimprovepatientaccessibilityandqualityofcare.Increasedcollaborationincreasescooperationandlimitsinappropriateandinefficientcompetitionamongstakeholders.

Capacity:Capacitybuildingwillbedesignedinastrategicandcoordinatedmannerthatallowsforfullimplementationofcosteffectiveness,bestpractices,technologywhereneededandimprovedaccess.

PrimaryCare/SpecialtyCareNetwork:Safetynetproviderswillreferpatientstotimely,appropriatespecialtycarewithinafinanciallysustainablesystem.

1. Care Coordination Successfulcarecoordinationinvolvesthepropersystems,

access,communicationsandcontinuitytoensurethata

patientreceivestheappropriatequalityofcareamong

differentprovidersandsettings.Carecoordinationstandards

willprovidethestructure,processandoutcomemeasures

requiredtoassessprogresstowardcarecoordinationgoals

andtoevaluateaccess,continuity,communicationand

trackingofpatientsacrossprovidersandsettings.3

Care Coordination Goal

By January 1, 2014, safety net providers will meet agreed-upon

quality indicators for mental health, substance abuse, dental

care and chronic disease management through effective care

coordination/care management.

CARE MANAGEMENT – QUALITY

Improvinghealthcareservicequalityinvolvesa

combinationofcaremanagementandevidence-based

practicesfoundinqualityimprovementprograms.“Care

management”isdefinedasprograms[that]applysystems,

science,incentivesandinformationtoimprovemedical

practiceandassistconsumersandtheirsupportsystemto

becomeengagedinacollaborativeprocessdesignedto

managemedical/social/mentalhealthconditions

moreeffectively.4

FiveCareManagement–QualityActionSteps

wereidentified.

PATIENT NAVIGATION

Thereisgrowinginterestinpatientnavigationasavital

resourceforconsumersovercomingbarrierstoaccessing

care.A“patientnavigator”isapersonororganizationwho

assistsunderservedpopulationswithculturallyappropriate

informationandhelpspatientsaccesshealthservicesand

educationregardingoverallhealth.5

ThreePatientNavigationActionStepswereidentified.


PATIENT-CENTERED HEALTH HOME

AhealthhomeasdefinedbySection2703oftheAffordable

CareActisaperson-centeredsystemofhealthcarethat

facilitatesaccesstoandcoordinationofthefullarrayof

primaryandacutephysicalhealthservices,behavioralhealth

careandlong-termcommunity-basedservicesandsupports.6

Themodelaimstoimprovehealthcarequalityandclinical

outcomesandthepatientcareexperience,whilealso

reducingpercapitacoststhroughmorecost-effectivecare.7

ThreePatient-CenteredHealthHomeActionSteps

wereidentified.

2. CollaborationCollaborationandcooperationamongsafetynetprovidersis

criticaltomaximizingresourcesandefficienciesinthehealth

caresysteminunderservedareas.Asprovidersseeknew

opportunitiestocreateaccesstohighquality,coordinated

careformorepatientsundertheAffordableCareAct,

collaborationwillbecomeevenmoreimportant.

Collaboration Goal

By June 2013, safety net providers will have effectively

contracted with or made arrangements with health

plans/managed care organizations and/or hospital systems

to provide seamless patient-centered care. This includes

primary, secondary, tertiary and behavioral health care. These

arrangements will strengthen the quality of care and financial

sustainability of the safety net once the Affordable Care Act is

implemented and funding begins to flow through these

organizations.

SevenCollaborationActionStepswereidentified.

3Oct2010NationalQualityForum:PreferredPracticesandPerformanceMeasuresforMeasuringandReportingCareCoordination42007CenterforHealthCareStrategies,Inc.Care Management Definition and Framework5PLoSMed.2006July;3(7):e193.ReducingDisparitiesintheburdenofcancer:Theroleofpatientnavigators6TheHenryJ.KaiserFamilyFoundation:FocusonHealthReformMedicaid’sNew“HealthHome”Option,Jan.20117TheHenryJ.KaiserFamilyFoundation:FocusonHealthReformMedicaid’sNew“HealthHome”Option,Jan.2011

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3. Capacity BuildingServinganadditional227,500consumersseekingcare

asaresultoftheAffordableCareActwillrequire

increasedcapacitythroughouttheregion’ssafetynet.

Thecapacitybuildingactionstepsfocusonworkforce

development,technicalassistanceandtoolstoimprove

thequalityofthepatientexperience.

Capacity Building Goal

By January 2014, the safety net will have sufficient workforce

capacity to meet the needs of existing and newly insured patients

covered under the Affordable Care Act.

SixCapacityBuildingActionStepswereidentified.

4. Primary Care/Specialty Care IntegrationThemodelofapatient-centeredhealthhomeispremisedon

apersonalphysicianwhoworkswiththepatientandtheir

careteamtocoordinateallhealthservices.Successofthis

modelrequiresintegrationofspecialtycareandprimarycare

functionstoprovideintegrated,patient-centeredcare.

Primary Care/Specialty Care Integration Goal

By January 2014, primary care physicians and other providers

will meet safety net patient demand, reduce unnecessary specialty

care referrals, treat conditions at the lowest and most appropriate

level of care, and create a sustainable financing system that will

support patients’ access to specialty care in the Sacramento Region.

ThreeNetworkIntegrationActionStepswereidentified.

What’s Next

Implementationisanessentialpartofthestrategicplanning

process.Allthosewhoarecommittedtoimproving

healthgenerally,aswellaspolicymakersateverylevelof

government,areneededtomakesafetynettransformation

atoppriority.TheSacramentoRegioncanseizethe

opportunityoffederalhealthcarereformtofundamentally

strengthenhealthcarequalityandaccess.Itwilltakea

sustained,concertedefforttofullyrealizetheopportunities

oftheAffordableCareActandthisstrategicplan.

The decisions made today will set the direction for health

care delivery in the Sacramento Region for generations

to come.

Therearefourimmediatestepsthatshouldbeundertaken

tostartbuildingaregionalframework:

Step 1 — Preparation

ThisisanambitiousworkplanfortheSacramentoRegion.

Beforewecanproceed,weneedtoknow:

• Isthereakeychampion,orchampions,whowillleadthiseffortinourregionandbringotherleaderstothetable?

• Arethereresources(staff,funding,etc.)thatwillsupporttheseleaders?

• Aretherightorganizationssignedonaspartners?

• Willthepoliticalandfiscalenvironmentsupportthiseffortinboththeshortandlongterm?

• Dotheregion’sleadersagreeonwhattheywanttoaccomplish?

• Istherearealappreciationofwhatitwilltaketogettheseeffortsupandrunning?

• Dowehavethefundingandotherresourcestocarry

outtheplanningandprogramdevelopment?

The Sacramento Region Health Care Partnership must

affirmatively answer these questions and establish a

functioning, funded planning coalition to make an

informed decision to proceed with the projects outlined

in this plan.


Step 2 — Analysis and Design

Decisionsregardingtheformtheregion’scollectiveeffort

willtakemustbebasedonaclearunderstandingofneed,

existingservices,thepoliticalenvironment,costestimates

andfinancingoptions.

The Sacramento Region Health Care Partnership should

generate: 1) a design document that describes the target

population(s), the financing models to be used, the program

requirements, and the planned structure for governance and

administration; and 2) a cost estimate for the proposed program

designs relative to the funds expected to be available.

Step 3 — Implementation Vision

Wemusthaveastrategicvisionof“howtochange”inorder

toachievethevisionof“whattochange.”Asharedvision

letseveryoneknowwhattheendresultshouldbeandwhy

itisimportant.Thisstepinvolvesclarifyingexactlyhowthe

elementsofthestrategicplanimplementationwillwork.


generate a business plan for the strategic plan that includes all

financial, operational and implementation details for the plan’s

program components.

Step 4 — Implementation Team

Animplementationteamcomposedofstakeholderswho

understandtheplan’spurposeandimplementationprocess

willbeneededtoshepherdthisplanfromconcepttoreality.

Asmallgroupsupportedby,andreportingto,asteering

committeethatcanencourageprogressandfieldquestions

oraddressproblemsastheyarisewouldservethispurpose.


develop a small team that has senior leadership, strong

financial skills and experience, and professional support to

implement the strategic plan recommendations.

Conclusion

WelaunchedtheSacramentoRegionHealthCare

Partnershipin2011withthegoaloffindingwaysto

improveaccess,carecoordinationandthequalityofthe

region’sprimarycaresystem,focusingspecificallyon

thesafteynet.Thecompletionofthemarketanalysisand

strategicplannowoffersusaroadmaptoachievethatgoal

ofcreatingastrongersafetynettoserveallresidentsof

ElDorado,Placer,SacramentoandYolocounties.

Certainly,thechallengesfacingourregionaretremendous,

butthetransformativeopportunitiessparkedbythe

AffordableCareActareequallygreat.Thisstrategicplan

spellsoutthestepswemusttake,individuallyand

collectively,toachievethevisionofhealthcarereform.

Wewillneedtoworktogetherandseizethisunprecedented

opportunitytocreateacollaborative,accessible,highquality

andculturallycompetentprimarycarehealthsystem.

Regionalsuccessiswithinreach,ifwereachforittogether.

Thepotentialrewardsareimmeasurable:ahealthierand

brighterfutureforall.


Preparing for TransformationBy rethinking, revitalizing and reforming the health

care safety net in the four counties of the Sacramento

Region, together we will create a coordinated and

integrated 21st-century patient care system for the

medically underserved.

ThePatientProtectionandAffordableCareAct(ACA)

offersanunprecedentedopportunitytorethink,revitalize

andreformtheSacramentoRegion’shealthcaresystem.The

primarycaresafetynetofElDorado,Placer,Sacramento

andYolocountiesinNorthernCaliforniaiscomprisedofa

diversegroupoforganizations,includingcommunityhealth

centers,hospitals,healthplans,countiesandnonprofit

agencies.Ithasbeendescribedasstrained,inefficientand

inadequate.Toabsorbtheanticipatedinfluxof227,500

newlyinsuredresidentsundertheAffordableCareActin

2014,theSacramentoRegionmustaddressitssafetynet’s

manyvulnerabilitiesandinadequacies,whilebuildingonits

strengths.Wemustworktogethertoclosethegaps

betweenresidents’needsandthesystem’sabilityto

meetthemefficiently.

TheSacramentoRegionHealthCarePartnershipconvened

healthcareandcivicleaderstoaddressthischallenge.

Throughthisinitiative,theSacramentoRegionHealthCare

Partnershiphasidentifiedresourcestheregioncanapplyto

bolstersafetynetfunctioningtobettermeetcurrentand

loomingresidentdemands.

Byplanningandtakingaction,asinformedbythe

SacramentoRegion’sMarketAnalysis,wecanbettermeet

theSacramentoRegion’shealthcareneedstoday,while

preparingourselvesforvastlyincreaseddemandunder

healthreform.

Health Reform Brings Opportunities for Improvement

IntheSacramentoRegion–ElDorado,Placer,Sacramento

andYolocounties–aprojected227,500non-elderlyadults

andchildrenwillbeeligibleforhealthcoveragethrough

expandedMedi-Calbenefitsorsubsidizedprivateinsurance

(healthcareexchanges).Withoutaction,manyofthese

newlyinsuredresidentswillenteranoverwhelmedand

alreadyfragmentedsafetynetsystem.

The Affordable Care Act (ACA) permanently authorizes

and expands Community Health Centers and the

National Health Services Corps. It provides a total of

$1.5 billion in new funding through 2015 to train more

primary care providers via scholarships and loan

repayment assistance.

ACA investments will double community health center

capacity. Through federal programs and grants to states,

the health reform law will help expand the nation’s

health workforce – physicians, nurses and public

health professionals – through scholarships and local

repayment assistance.

The ACA also aims to improve the diversity of the health

care workforce to assure care that is appropriate for the

entire population.

In short, the ACA provides many opportunities to

strengthen the safety net, but also poses real challenges.

Meeting the vastly increased demand for health care

services is no small task.

Withthisstrategicplan,weidentifyandquantifyaction

stepstoprepareourregion’sprimarycaresafetynetfor

successfulimplementationoftheAffordableCareAct.

About the Sacramento Region Health Care Partnership

Attherequestofseveralcommunitystakeholders,in

2011SierraHealthFoundationlaunchedtheSacramento

RegionHealthCarePartnership.Theinitiativegrewout

ofconversationswithpolicymakers,healthsystemsand

communityhealthcenters,whoapproachedSierraHealth

Foundationtoserveasintermediaryinpreparingthe

SacramentoRegiontoimplementhealthreform.The

SacramentoRegionHealthCarePartnershipcreatesthe

region’sfirstcoordinatedphilanthropic,countyagency,


nonprofitproviderandcommunityhealthcentereffort

focusedsolelyonregionalhealthcarereformpreparedness

andimplementation.

TheSacramentoRegionHealthCarePartnershipincludesa

broadrangeofhealthcarepartnersandleadersthroughout

theSacramentoRegionfromcommunityhealthcenters,

healthsystems,healthplans,associationsandcounties,as

wellasphysicians,policymakersandothernonprofitsthat

workwithinthesafetynet.SierraHealthFoundation,

TheCaliforniaEndowmentandSacramentoRegion

CommunityFoundationarefundingpartnersofthe

marketanalysisandregionalstrategicplan.

The Health Care Partnership’s Goal

TheSacramentoRegionHealthCarePartnership’sgoalis

tofindwaystoimproveaccess,carecoordinationand

qualityoftheregion’ssafetynetprimarycaresystem

throughcommunity-driveninput.TheHealthCare

Partnership’sultimatevisionistoincreaseandimprove

primarycareaccessandqualityforindividualsandfamilies

inlow-incomecommunitiesandcommunitiesofcolorin

ElDorado,Placer,SacramentoandYolocounties.

Betteraccesstoprimarycarewilllowerthecostofhealth

careoverall,moreeffectivelyallocatehealthcareresources

(e.g.,reduceexpensive,unnecessaryacutecareresponsesto

preventablechronicdisease)andimprovepublichealthin

theSacramentoRegion.

Project Overview Identifying and pursuing opportunities to optimize the region’s safety net system

Strategic Plan Goal

Developaregionalstrategicplanforanintegratedhealth

caredeliverysystemthatefficientlylinkscommunityhealth

centerstoregionalhealthsystemstoexpandaccesstohigh

qualityservicesforlow-incomeadultsandchildreninthe

SacramentoRegion.

Strategic Plan Vision

To create a collaborative, accessible, high quality and culturally competent primary care health system in the Sacramento Region of El Dorado, Placer, Sacramento and Yolo counties that is outcome-based and sustainable.

How the Market Analysis Informs this Strategic Plan

TheSacramentoRegionHealthCarePartnershipbrought

togetherstakeholdergroupsfromtheSacramentoRegionto

prepareforimplementationoftheAffordableCareAct.

Thegroupwassupportedbyateamofexpertindustry

consultantsto:

• assessthecurrentcapacityandforecasteddemandforprimarycaresafetynetservices,

• measuretheimpactofhealthreformontheregionanditssafetynet,

• facilitateanddevelopastrategicplantohelpensurereadinessforhealthreform,and

• improvehealthaccessandservicesforsafetynetpopulations.

Themarketanalysisfocusedoncommunityhealthcenters,

healthsystems,healthcareprovidersandnonprofitsthatare

partoftheentireenginethatservestheSacramentoRegion’s

safetynet.Thepurposeoftheanalysiswastobenchmarkthe

currentandforecastedcapacityoftheprimarycaresafetynet

topreparetheSacramentoRegionforAffordableCareAct

implementation.

Thisstrategicplanwascreatedbasedoninputfrom

stakeholdersrepresentingacross-sectionofsafetynetsystem

leaders,healthsystems,countiesandcommunityphysicians

andconsumersofcommunityhealthcentersservicesinthe

SacramentoRegion.

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Sacramento Region Health Care Partnership Phase I Process and Deliverables

ResearchontheSacramentoRegion’ssafetynetbeganin

October2011,withaconveningofsystemstakeholdersand

thoughtleaders.Participantsinthisandsubsequentmeetings

includedhealthcareproviders,healthsystemrepresentatives,

governmentofficials,electedgovernmentmembersand

variousnonprofits–allwithadesiretoseeimprovementin

thecurrentprimarycaresafetynetservicedeliverysystem

forthefour-countyregion.

Thefirstdeliverableforthisprojectwasacomprehensive

safetynetmarketassessmentreport,whichwasconcludedin

April20128.Thepublishedmarketanalysisisacompanion

documenttothisstrategicplan.Thesereportsareposted

onlineatwww.sierrahealth.org/healthcarepartnership.

Theregionalstrategicplanwasdevelopedbythesame

stakeholder-consultantteambetweenAprilandMay2012.

Themarketanalysisfindingsinformedthedevelopmentof

thestrategicplan.

Project Timeline and ProcessThechartbelowshowsthedevelopmentprocessand

timelinefortheSacramentoRegionsafetynetmarket

analysisandstrategicplan.


R E G I O N A L M E E T I N G S

APRIL 16TH SESSION• Rollout of Detailed Market Analysis

• Present Feedback Top �ve (5) areas for focus by the region Bene�ts/Challenges

• Respond to Top Areas Where are the gaps? What are the bene�ts/challenges? What are the risks/threats? What are the success factors needed to implement?

APRIL 30TH SESSION• Present SWOT Analysis by Opportunity• Complete SWOT Analysis• Design SMART Goals for each opportunity via group process• Group consensus on Goal Statement• Develop action necessary to achieve• Notify participants re: online survey purpose & deadline

VALIDATE DRAFT WITHADVISORY GROUP

DRAFTSTRATEGIC PLAN

INPUT FROM THECOMMUNITY, WRITTEN BY THE

CONSULTANT TEAM

SURVEY

MAY 7TH• Present online survey results• Priority items de�ned via group process• is is the reality check session where the facilitators discuss what factors are needed for success & resources available• SMART Goal concept developed

MAY 21ST• Present DRAFT Strategic Planning Document• Implementation Development• Strategic plan leadership• Timeline

ROLLOUTSTRATEGIC PLAN

Community-wide MeetingCongresswoman Matsui

and Key Policymakers

8SacramentoRegionHealthCareSafetyNetMarketAssessmentReport,April2012,TheAbarisGroup,Martinez,CA

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Sacramento Region’s Current Safety NetThe safety net is characterized by a fragmented group of small and financially fragile health centers that together offer limited outpatient capacity.9

Previousstudieshaveidentifiedspecificchallengesfacing

theSacramentoRegion’ssafetynet:

• Underdevelopedadministrativeandservicedeliverycapacity

• Limitedaccesstomedicalspecialistsanddentalcare

• Insufficientlinguisticandculturalresources

• Transportationbarriersforresidents

• Budgetreductionsthathaveledtoclosureofmanyprimarycareclinics

In2010,ajointventurebyfourlocalhospitalsystems

conductedaCommunityNeedsAssessmentoftheGreater

SacramentoRegion.Thereporthighlightedchallengesand

needswithintheunderservedpopulations,identifyingthese

majorobstaclesthathinderedorpreventedaccesstohealth

careamongtheunderservedpopulation:10

• affordabilityofhealthcareservices,especiallyhealthinsurance,

• locatingphysicians,specialists,dentists,mental/behavioralhealthandotherproviderswhoacceptMedi-Caland/orworkatreducedrates,

• navigatingacomplexandinefficientsafetynetandrelatedsocialservicessystem,and

• culturalbarriers,includinglanguageandsocialcustoms.

10 Stressors and Strengths Driving Regional Safety Net Performance

TheSacramentoRegionHealthCarePartnership’smarket

analysisidentified10criticalissuesimpactingsafetynet

performanceandsustainability:

1. RethinkPrimaryCare.Whilethecurrentsafetynet

intheregionhasmanychallenges,theadventofACA

allowsthecommunitytheopportunitytorethinkits

approachtoprimarycareascurrentlyprovidedbythe

safetynet.

2. GrowingDemand.227,500non-elderlyadultsand

childrenwillbeeligibleforhealthcarecoverageunder

ACA.Thesafetynetpopulationisgrowingandwill

continuetogrownaturally.Demandwillacceleratewith

theadventofACA.

3. SickerCitizens.Communityhealthindicatorspredict

thenewlyinsuredpopulationwillbesickerthanthe

existingpubliclyinsuredpatientpopulationandhave

significantlyhigherlevelsofchronicdiseasesandrisk

factorssuchasasthma,diabetes,highbloodpressure,

obesity,smoking,andpreviouslyunmetneedsforhealth

careand/ormentalhealth/alcoholordrughelp.

4. MaxedOutCapacity.Theprimarycarecapacityof

communityhealthcentersandemergencydepartmentsto

treatthesafetynetpopulationhasgrown,butwithout

furthereffortswilllikelyreachcapacitypriorto2016.

5. RegionalCapacityBelowAverage.Thenumberof

communityhealthcentersintheSacramentoRegion

hasgrown,butfallssignificantlyshortofmanyother

similar-sizedregionsinCalifornia.

6. MoreMedi-CalPayments.Approximately60percent

ofthenewlyinsuredpatientswillbeinsuredby

Medi-Cal,makingitthesecondlargestpayersourcein

theSacramentoRegion.

7. OveruseofHighCostHospitalandEmergency

DepartmentServices.Currently,thesafetynetisoverly

dependentonexpensivehospitals,andemergency

departments,inparticular,foroutpatientcare.

8. FinanciallyChallengedCommunityHealthCenters.

Roughlyhalfoftheregion’scommunityhealthcenters

arefinanciallychallenged,withexpensesconsistently

exceedingrevenues.

9CaliforniaHealthCareFoundation,SacramentoPowerfulHealthSystemsDominateaStableMarket.http://www.chcf.org/publications/2009/07/sacramento-powerful-hospital-systems-dominate-a-stable-market#ixzz1t5kNz6tN(Lastaccess4-25-12)10AinsworthD,DiazH,SchmidtleinM:2010CommunityNeedsAssessmentFortheGreaterSacramentoRegionhttp://www.healthylivingmap.com/CNA%20Report%202010.pdf


9. LimitedFederallyQualifiedHealthCenters.The

numberandlocationoffederallyqualifiedhealthcenters

(FQHCs)intheregionislowerthanthestateaverage

andotherregions.Manycommunityhealthcentersare

notabletotakeadvantageoffinancialincentives

affordedtoFQHCs.

10.LackofCoordinatedLeadership.Thecurrenthealth

caresafetynetlacksaleadagency,coordinationand

integration.

The Successful Safety NetSacramentoRegionstakeholdersrecommendedprinciplesof

asuccessfulsafetynet,whichinclude:11

• Strongcollaboration,coordinationandintegrationofhealthcareservices

• Anaccessible,affordableandequitableclinical,behavioral/mentalhealthsafetynetsystem

• Astrongconsumervoiceandrealconsumerchoice

• Prevention-focusedincentivesandeducation

• Useofevidence-basedandpractice-basedapproaches

• Ageographicfocusthatbalanceslocalandregionalconcerns

• Cost-effectiveandfinanciallysustainableproviders

• Unobstructedconsumeraccesstosafetynetproviders

• Shareddata,trainingandtechnologysystemdesign

Strategic Planning: Focusing Needs, Marshaling Resources

Withthissuccessfulmodelinmind,theSacramentoRegion

HealthCarePartnershipstakeholdersprioritizedthemost

criticalneedsidentifiedinthemarketanalysisintothe

strategicplanningprocess.Thestrategicplanisbasedonthe

followingkeycharacteristicsoftheregion’scurrentsafetynet

anditsproviders:

• Capacity(bothphysicalandprovider)isacontinuingchallengetothesafetynet.

• Currentservicesarefragmented,fragileandfinanciallyunsustainable.

• Stakeholdersacknowledgethatcollaborationandleadershiparethelargestmissingcomponents.

• Thereisastrongwillingnesstobeginaprocesstosolvethesekeyissues.

All Health Care is Local

Whendevelopinganyregionalcommunityhealthcare

system,itiswisetokeepinmindthatallhealthcareislocal.

WithintheSacramentoRegion,eachcommunityisunique.

However,therearecommonthemesofchallengesand

opportunities,which,whenaddressedcollectivelyasa

region,willimprovethequalityofservicesforconsumers.

Removing Patient Obstacles

Conventionalwisdomholdsthatgoodhealthrequires

personalresponsibilityandasocietalcommitmentto

removingobstaclesthatpreventpeoplefromleading

healthylives.Improvingcommunityhealthrequiresa

combinationofpreventionandaccesstohealthcarefor

residentsononeside,andawell-developedand

evidence-basedhealthdeliverysystemontheother.

Therecommendationsinthisplanaddressthekeyobstacles

withsmallbutactionablestepstomoveforward,allowing

projectstoleverageexistingfundingsources,developnew

opportunitiesandfostercollaborationtoaddresstheneeds

ofthecommunity.

Leadership Enhances Coordination, Collaboration

ThemarketanalysisoftheSacramentoRegionidentified

alackofcoordinatedleadership,whichrepresentsa

significantchallenge.Nosinglestakeholder,entityorgroup

canaddressalloftheseneedseffectivelyorefficientlyalone.

TheSacramentoRegionhasanabundanceofexcellent

healthcareorganizationsandotherkeygroupsthatare

willingtoworktogethertosupportthiseffort.Stakeholder

cooperationandcollaborationisthecornerstoneofthis

strategicplan.


11Oct.19,2011SacramentoRegionHealthCarePartnershipnotes

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How the Consultant Team Set Strategic Plan Goals

Aftersignificantinputanddiscussionregardingthemarket

analysisdatainElDorado,Placer,SacramentoandYolo

counties,eachcountyidentifiedtopicstoworkonregionally

inpreparationforhealthreform.TheSacramentoRegion

HealthCarePartnershipstakeholdersprioritizedthelistof

10keyfocusareasfromtheregionalmeetingstofourtopic

areastobeaddressedinthestrategicplan.

Althoughalloftheseemergingregionaltopicareasare

importanttotheregion’ssafetynet,andalldeserveto

beaddressed,theSacramentoRegionhasawindowof

only18to24monthstoprepareforhealthreform

implementation.Accordingly,thelistwasnarrowedto

thefourmostimmediatelyactionableareas:

• Bettercarecoordinationforpatients

• Bettercollaborationamongproviders

• Capacitybuildingforproviders

• Betterprimarycare/specialtycareintegration

Individuallyandcollectively,thesefourfocusareasoffer

immediateopportunitiestocreatereal,meaningfuland

measurableimprovementintheregion’ssafetynet.

Emerging Regional Topic Areas

1. Collaboration

2. Funding

3. Workforceexpansion,retention,training

4. Capacitybuilding

5. Carecoordination

6. Primarycare/specialtycareintegration

7. IT-communicationintegration

8. Reduceunnecessaryemergencydepartmentvisits

9. Partnershipsbetweenhospitalsandcommunityhealthcenters

10. Culturallyappropriatepatienteducationonconsumerchoices

Regional Topic Areas Addressedin Strategic Plan 1. Carecoordination

2. Collaboration

3. Capacitybuilding

4. Primarycare/specialtycareintegration

SMART GoalsTheconceptofSMARTGoalswasintroducedduringthestrategicplanningprocesstoprovidestructureindevelopingwell-focusedandachievablegoals:

Specific:Goalsmustbeclearandunambiguous

Measurable:Cleardatapointthatispre-andpost-measureable

Attainable:Goalsmustberealistic(highleverageandhighyield)andattainable(within18to24months)

RelevantorRealistic:Goalsmustbeanimportanttoolinreachingthestrategicplan

Time-bound:Goalsmusthavestartingpoints,endingpointsandfixeddurations

Withthesegoal-settingdefinitionsinmind,thecommunitydevelopedSMARTGoalsforthefourkeytopicareasendorsedbythestakeholders.

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Developing a Stronger, Healthier Regional Safety Net

Regional Strategic Planning Direction

Belowisabefore-and-aftersnapshotoftheSacramento

Region’sprimarycaresafetynet.

Thechartprovidesanoverviewofthefourtopicareasin

theircurrentstateandintheirfuturestate,oncethesafety

netistransformedbycoordinatedandevidenced-based

strategiestoamoresuccessfulversion.Thecurrentstateis

basedonthefindingsofthemarketanalysis.Thefuturestate

istheSacramentoRegion’svisionofimprovedcaredelivery

thatwillresultfromstrategicplanimplementation.The

futureprimarycaresystemcapitalizesontheopportunities

createdbytheimplementationofhealthreform.


Current Primary Care SystemPrior to Strategic Plan Implementation

CareCoordination:Theprovisionofpatientcare(i.e.,primaryandchronicdisease)lackscoordination,reducingthelikelihoodthatservices,careandhealthresourcesareefficientlyusedtocreatethebestoutcomespossible.

Collaboration:Insomepartsoftheregion,thehealthcaresystemisfragmented.Coordinationamongallsitesthatprovidehealthcareislacking,withminimalsharingofpatientcareplans,methodologiesorresources,resultingininconsistentpatientcareaccess(i.e.,primary,chronicdiseaseandspecialtycare)andgapsinservicedelivery.

Capacity:Currentcapacityisnotconsistentacrossproviders.Thesafetynetisvulnerabletorisingdemandandlimitedbyprovidershortagesandalackofbestandpromisingpractices.

PrimaryCare/SpecialtyCareNetwork:Therearelimitedspecialtycareprovidersforthosewithoutapayersource,oftenleadingtounnecessaryemergencydepartmentcare.

Future Primary Care SystemAfter Strategic Plan Implementation (18-24 months beginning September 2012)

CareCoordination:Evidence-basedpracticesforprimarycareandchronicdiseasemanagementwillbecoordinatedandimplementedsothatpatientswillachievethebestoutcomespossible.

Collaboration:Aregionalintegrateddeliverysystemframeworkprovidestheinfrastructureandalignedfundingincentivestoimprovepatientaccessibilityandqualityofcare.Increasedcollaborationincreasescooperationandlimitsinappropriateandinefficientcompetitionamongstakeholders.

Capacity:Capacitybuildingwillbedesignedinastrategicandcoordinatedmannerthatallowsforfullimplementationofcosteffectiveness,bestpractices,technologywhereneededandimprovedaccess.

PrimaryCare/SpecialtyCareNetwork:Safetynetproviderswillreferpatientstotimely,appropriatespecialtycarewithinafinanciallysustainablesystem.

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ThefollowingsectionsdescribetheSacramentoRegion

HealthCarePartnership’sproposedgoals,tasksand

timeframesforaddressingthefourcoreimprovementareas.

Care CoordinationAdopting a systemic approach to seamlessly delivered patient care

Successfulcarecoordinationinvolvesthepropersystems,

access,communicationsandcontinuitytoensurethata

patientreceivestheappropriatequalityofcareamong

differentprovidersandsettings.Whencareispoorly

coordinated—withinaccuratetransmissionofinformation,

inadequatecommunicationandinappropriatefollow-up

care—patientswhoseemultiplephysiciansand

careproviderscanfacemedicationerrors,hospital

re-admissionsandavoidableemergencydepartmentvisits.12

TheNationalQualityForumdefinedcarecoordinationas

a“functionthathelpsensurethatthepatient’sneedsand

preferencesforhealthservicesandinformationsharing

acrosspeople,functionsandsitesaremetovertime.”13

Carecoordinationstandardswillprovidethestructure,

processandoutcomemeasuresrequiredtoassessprogress

towardcarecoordinationgoalsandtoevaluateaccess,

continuity,communicationandtrackingofpatientsacross

providersandsettings.14

Care Coordination Goal

By January 1, 2014, safety net providers will meet

agreed-upon quality indicators for mental health, substance

abuse, dental care and chronic disease management through

effective care coordination/care management.

CARE MANAGEMENT – QUALITY

Improvinghealthcareservicequalityinvolvesacombination

ofcaremanagementandevidence-basedpracticesfoundin

qualityimprovementprograms.“Caremanagement”is

definedasprograms[that]applysystems,science,

incentivesandinformationtoimprovemedicalpracticeand

assistconsumersandtheirsupportsystemtobecomeengaged

inacollaborativeprocessdesignedtomanagemedical/social/

mentalhealthconditionsmoreeffectively.15

Action Steps:

Identifycommongoalsamongpartnersspecifictocare

managementtargets.Identifybestpractices,suchastheTriple

AIMprogram.16

Reachagreementfortheselectedpractices.

Commongoalsincludeimprovingthepatientexperienceof

care(includingqualityandsatisfaction),improvingthehealth

ofspecificpopulationsandreducingthepercapitacostof

healthcare.

1. Identifyevidence-basedtoolsforproviderstomore

easilycommunicateandcollaborate,thussupporting

providerstogivepatientsthebestcarepossible.

2. Supportsafetynetprovidersthroughtrainingon

qualityimprovementandprocessimprovementsothat

theycanimplementthecaremanagementmodels.

3. Adoptappropriateclinicalcaredeliverypathwaysto

preventivechroniccaremanagementandpatient

empowerment.

4. Throughtechnologyandcollaborativemeasures,

developandimplement“load-leveling”modelsacross

thecommunityhealthcentersforpeakpatientintake.

12Oct2010NationalQualityForum:PreferredPracticesandPerformanceMeasuresforMeasuringandReportingCareCoordination13Oct2010NationalQualityForum:PreferredPracticesandPerformanceMeasuresforMeasuringandReportingCareCoordination14Oct2010NationalQualityForum:PreferredPracticesandPerformanceMeasuresforMeasuringandReportingCareCoordination152007CenterforHealthCareStrategies,Inc.CareManagementDefinitionandFramework.16TheInstituteforHealthcareImprovementdevelopedaframeworktooptimizehealthsystemperformance.ThedesignconsistsofthreedimensionscalledtheTripleAim:1)Improvethepatientexperienceofcare,2)Improvethehealthofpopulations,and3)Reducethepercapitacostofhealthcare.


PATIENT NAVIGATION

Thereisgrowinginterestinpatientnavigationasavital

resourceforconsumersovercomingbarrierstoaccessing

care.Apatientnavigatorisapersonororganizationwho

assistsunderservedpopulationswithculturallyappropriate

informationandhelpspatientsaccesshealthservicesand

educationregardingoverallhealth.17

Action Steps:

1. Determineafinanciallysustainableregionalmodelthat

supportspatientnavigators,“promotores”andcare

managerstolinkpatientstoappropriatecareand

promotecommunity-basedhealtheducationand

preventioninamannerthatisculturallyand

linguisticallyappropriate.

2. Takeaninventoryofcurrentbestpracticesspecificto

eachcountyorhealthsystem’spopulationneedsand

usepeoplewhocaneducate,connectwithandsupport

patientstoreduceinappropriateemergencydepartment

use,repeathospitalizations,ambulatorycare-sensitive

admissions,etc.

3. Agreeonaweb-basedsystemthatcanbeusedby

multiplepartnerstosupporthealthliteracy.This

technologymaybeavailablethroughpatientportals.

PATIENT-CENTERED HEALTH HOME

AhealthhomeasdefinedbySection2703oftheAffordable

CareActisaperson-centeredsystemofhealthcarethat

facilitatesaccesstoandcoordinationofthefullarrayof

primaryandacutephysicalhealthservices,behavioral

healthcare,andlong-termcommunity-basedservicesand

supports.18

Thepatient-centeredhealthhome(PCHH)

modelofservicedeliveryexpandsonthetraditionalmedical

homemodelsthatmanystateshavedevelopedintheir

Medicaidprograms,buildingadditionallinkagesand

enhancingcoordinationandintegrationofmedicaland

behavioralhealthcaretobettermeettheneedsofpeople

withmultiplechronicillnesses.19

Themodelaimsto

improvehealthcarequalityandclinicaloutcomesandthe

patientcareexperience,whilereducingpercapitacosts

throughmorecost-effectivecare.20

Action Steps:

1. Identifysafetynetprovidersthathavethepotential

tobecertifiedasapatient-centeredhealthhome

(PCHH).

2. Identifyexistingtrainingprogramsthatsupport

PCHHcertification,sothatinterestedcommunity

healthcentersmayparticipate.

3. Identifyfinancingstrategiestomitigatelossofrevenue

duetoproviderunavailabilityforpatientcareduring

PCHHcertificationtrainingsessions.

17PLoSMed.2006July;3(7):e193.ReducingDisparitiesintheburdenofcancer:Theroleofpatientnavigators18TheHenryJ.KaiserFamilyFoundation:FocusonHealthReformMedicaid’sNew“HealthHome”Option,Jan.201119TheHenryJ.KaiserFamilyFoundation:FocusonHealthReformMedicaid’sNew“HealthHome”Option,Jan.201120TheHenryJ.KaiserFamilyFoundation:FocusonHealthReformMedicaid’sNew“HealthHome”Option,Jan.2011



CollaborationHealth centers surveyed seek decreased competition, increased collaboration.

Collaborationandcooperationamongsafetynetproviders

iscriticaltomaximizingresourcesandefficienciesinthe

healthcaresysteminunderservedareas.Asproviders

seeknewopportunitiestocreateaccesstohighquality,

coordinatedcareformorepatientsunderACA,

collaborationwillbecomeevenmoreimportant.

Collaborationandcarecoordinationcanbeespecially

criticalinruralareas,whichfaceuniquechallengesin

providinganintegratedsystemofcareduetoanumber

offactors.Challengesincludeattractingcliniciansand

difficultyachievingeconomiesofscaleinservicedelivery.

Collaborationhelpsreducegeographicandotheraccess

barriersbetweenprovidersandpatients.Inadditionto

fillingcaregaps,contractingwithexistingprovidersmay

alsohelpavoidduplicationofinfrastructureandservices.

Collaboration Goal

By June 2013, safety net providers will have effectively

contracted with or made arrangements with health plans/

managed care organizations and/or hospital systems to provide

seamless patient-centered care. This includes primary,

secondary, tertiary and behavioral health care. These

arrangements will strengthen the quality care and financial

sustainability of the safety net once ACA is implemented and

funding begins to flow through these organizations.

Action Steps:

1. Identifytechnicalassistanceneedsandremoveobstacles

forsafetynetproviderssotheycannegotiatecontracts

withhealthplans/managedcareorganizationsand/or

hospitalsystems.

2. Toreduceadministrativecosts,developa(orcoordi-

natewithanexisting)primarycare“innovationcenter”

toprovidetechnicalassistanceandgrouppurchasing

(e.g.,financial,humanresource,legal,payroll,supplies

acquisition,federaldesignations,etc.)tocommunity

healthcenters.

3. CoordinatethisstrategicplanwiththeSacramento

Medi-CalManagedCareStakeholderAdvisory

Committee’seffortstostudy,defineoptionsand

improvetheexistingGeographicManagedCare

(GMC)model.

4. CoordinatethisstrategicplanwithLowIncomeHealth

Program(LIHP)effortsinSacramentoandPlacer

counties,aswellaswiththeCountyMedicalServices

Program(CMSP)representingYoloandElDorado

countiestoestablishenrollmentandcare

pathwaymodels.

5. ThroughLocalExtensionCenters(LECs),safetynet

providerswilluseacommonregionalinformation

technologytoexchangehealthinformationtomore

effectivelycollaborateamonginstitutionstorepatriate

patientstotheirhealthhome.

6. Createaforumorjointoperationsteamforsafetynet

providerstomeetwithpartnerproviderseverymonth.

Theseforumswillidentifyfundingopportunities;

discusscollaborativemodelstoimproveoperational,

financialandutilizationmanagementissues;andcome

upwithsolutions.

7. Createorexpandinventoryofresourcesforthehealth

caresafetynetpatientsandhealthprovidersondelivery

optionsandotherkeyareas.


Capacity BuildingStaffing up to meet increased demand under ACA

Servinganadditional227,500consumersseekingcareasa

resultoftheAffordableCareActwillrequireincreasedcapacity

throughouttheregion’ssafetynet.Conversationswithsafety

netleadersandphysiciansshowedthattheyarealready

thinkingabouthowbesttomeetincreasingdemand,and

manyaretakingstepstopreparefortheAffordableCareAct

byincreasingstaffandphysicalinfrastructureandpursuing

financialresources.Thecapacitybuildingactionstepsfocus

onworkforcedevelopment,technicalassistanceandtoolsto

improvethequalityofthepatientexperience.

Capacity Building Goal

By January 2014, the safety net will have sufficient workforce

capacity to meet the needs of existing and newly insured patients

covered under the Affordable Care Act.

Action Steps:

1. Providetechnicalassistanceandcoachingforsafetynet

providerstostrengthenaccessandimproveclinic

throughput.

2. Providetechnicalassistancetoensurethattheprimary

careworkforceismaximized(throughoperational

improvementsandleveragingadiversegroupofnurse

practitionersandcommunityhealthworkers)tomeet

futuredemandprojections.

3. Createpartnershipswitheducationalandtraining

institutionstosupportaworkforcedevelopmentplanfor

safetynetproviders.Thisincludesdevelopingrecruitment

strategiesandprovidingmentoringandon-siteinternship/

fieldpracticumopportunitiesatsafetynetsites.

4. Maketechnicalassistanceavailabletosafetynet

providerssothattheyhavethetoolstoimprovethe

patientexperience,makingthemprovidersofchoice.

5. Increaseinformationandlinkagestotransportation

resourcesintheSacramentoRegion.Evaluatepolicy

opportunitiesanddefineoperationalstrategiesto

planforthefuturetransportationneedsofsafety

netconsumers.

6. Createalternativepathwaysusinginformation

technologytoconnectconsumerswithsafety

netproviders.



Primary Care/Specialty Care IntegrationHealth information exchange facilitates cross-organizational patient data sharing.

Themodelofapatient-centeredhealthhomeispremised

onapersonalphysicianwhoworkswithpatientsand

theircareteamstocoordinateallhealthservices.Success

ofthismodelrequiresintegrationofspecialtycare

andprimarycarefunctionstoprovideintegrated,

patient-centeredcare.TheSacramentoRegion’seffortsin

thisareafocusoninnovationstobetterlinkprimarycare

andspecialtycareproviders(especiallytechnology-based

informationsharing)tohelpimprovecontinuityofcare

andinformationtransfer,whilereducingspecialtycare

referralsforconditionsthatcouldbetreatedbyaprimary

careclinician.Atthesametime,integrationeffortsseek

tofacilitatepatientaccesstoappropriatespecialtycare,

whichhasbeenlackingintheSacramentoRegion.

Network Integration Goal

By January 2014, primary care physicians and other

providers will meet safety net patient demand, reduce

unnecessary specialty care referrals, treat conditions at the

lowest and most appropriate level of care, and create a

sustainable financing system that will support patients’

access to specialty care in the Sacramento Region.

Action Steps:

1. Createaspecialtyregionalcarenetworkthatincludes

specialistsandcommunityhealthcenterphysicians.

2. Identifybestpracticesfromthosehospitalssystems

thathavereduceddemandforspecialtycarereferrals.

Considerideassuchas:

i. Telemedicineforprimary,dentalandmental

healthservicesaswellasspecialtycare.

ii. Developamapshowinglocationsofspecialists

intheregionbyspecialty.

iii. Shareinformationandconnectpatient

navigatorsandconsumerswithnetworksof

specialtyprovidersintheregion.

3. Identifyandaddressotherbarriersimpactingpatients’

accesstocare,suchastransportation.


What’s NextTheurgencytopreparetheSacramentoRegionsafetynet

torespondtoneedsofthenewlyeligibleconsumersis

reflectedinthisstrategicplan.Astrategicplanisoflittle

usewithoutameansofputtingitintoaction.Infact,an

implementationplanincludingaprocessandatimelineis

anessentialpartofthestrategicplanningprocess.Wehave

ashorttimeframetotakeadvantageofwhattheAffordable

CareActoffers(someofwhichisalreadyinprocess)and

addressimmediatequestionsposedbyourregion’sstrained

healthcaredynamics.

Right nowwehavetheopportunitytomakemeaningful

changesinourregioninawaythatwill:

• transformpeople’slivesthroughbetterhealthcare,and

• providethepeaceofmindthatcomeswithgoodhealthandwell-being.

Thedecisionsmadetodaywillsetthedirectionforhealth

caredeliveryintheSacramentoRegionforgenerations

tocome.However,giventheSacramentoRegion’s

challengingenvironment,realizingthisopportunitywill

notbeeasy.Tobesuccessful,theregionalcommunitywill

needtocometogetherandworktogethertoexpand

publicawarenessandsupport,transformpublicagencies,

andcreatenewandinnovativepublicpolicies.

Meeting These Regional Health Care Challenges – Together

WhatmustbedonetohelptheSacramentoRegionseize

thisunprecedentedopportunityandmeetitschallenges?

Allthosewhoarecommittedtoimprovinghealth

generally,aswellaspolicymakersateverylevelof

government,areneededtomakesafetynettransformation

atoppriority.TheSacramentoRegionhasademonstrated

historyoftacklingtoughpolicyissuesandcreating

modelsthatnotonlyworkhere,butareadoptedbyothers

nationally.Tocontinuebeingtrendsettersinthehealthcare

arena,healthcarestakeholdersintheSacramentoRegion

mustrecommittoleadership.Healthcarestakeholders

mustpropeltheSacramentoRegiontoseizethe

opportunityoftheAffordableCareActtofundamentally

strengthenhealthcarequalityandaccess,whileaddressing

thelong-standingissuesthathavepreventedthisreality.The

transformativechangesneededintheregionandafforded

byACAimplementationwillimprovethelivesofchildren,

familiesandtheregion’scommunities.

Inpracticalterms,itwilltakeasustained,concertedeffortfor

theSacramentoRegiontofullyrealizetheopportunitiesof

theAffordableCareActandthisstrategicplan.

Herearefourimmediatestepsthatshouldbeundertakento

startbuildingaregionalframework:

Step 1—Preparation

ThisisanambitiousworkplanfortheSacramentoRegion.

Allwhohavecontributedtodevelopingthisplanrecognize

themagnitudeofchangerequiredtoachievethesegoals.

Improvingprovidercoordination,increasingconsumeraccess

toqualityservices,andimplementinginformationexchanges

withinandacrossestablishedsystemsofcaretopromote

wellnessisaconsiderableundertaking.Addtothisthe

complexityofasafetynetsystemthatoperatesunderrigid

paymentrulesunconnectedtoqualityandlargelyrelianton

informalreferralrelationships,andsystemicchangebecomes

anevenmoreformidablechallenge.

Suchmonumentalhealthsystemschangesaremorelikely

tosucceediftheplanmeetscertaincriteriafromtheoutset.

Beforewecanproceed,weneedtoknow:

• Isthereakeychampion,orchampions,whowillleadthiseffortinourregionandbringotherleaderstothetable?

• Arethereresources(staff,funding,etc.)thatwillsupporttheeffortsoftheseleaders?

• Aretherightorganizationssignedonaspartners?

• Willthepoliticalandfiscalenvironmentsupportthiseffortinboththeshortandlongterm?

• Dotheregion’sleadersagreeonwhattheywanttoaccomplish?

• Istherearealappreciationforwhatitwilltaketogettheseeffortsupandrunning?



• Dowehavethefundingandotherresourcestocarry

outtheplanningandprogramdevelopment?

The Sacramento Region Health Care Partnership must

affirmatively answer these questions and establish a

functioning, funded planning coalition to make an informed

decision to proceed with the projects outlined in this plan.

Step 2 — Analysis and Design

Decisionsregardingtheformtheregion’scollectiveeffort

willtakemustbebasedonaclearunderstandingofneed,

existingservices,thepoliticalenvironment,costestimates

andfinancingoptions.Wemust:

• Understandandagreeonwhatthestrategicplanis(andisnot).

• Highlightanyplanelementsthatmightbeespeciallychallenging.

• Identifyanyelementsthatmightbeunrealisticorexcessiveincost(timeand/ormoney).

• Keepotheralternativeideasinmind,incasetheoriginalapproachprovesunsuccessful.

TheSacramentoRegionHealthCarePartnershipmust

soberlyfacedecisionsonhowtoproceed.Howdoesthe

SacramentoRegionHealthCarePartnershipcollectively

thinkitsstrategicdesign,includingthefinancingplan,can

bestsucceed?Isthereenoughseniorleadershipinvestment

andcommunitysupportforitsproposal?Doesitneedto

revisititsdesign,andperhapsevenitsprogramobjectives?


generate: 1) a design document that describes the target

population(s), the financing models to be used, the program

requirements, and the planned structure for governance and

administration; and 2) a cost estimate for the proposed

program designs relative to the funds expected to be available.

Step 3—Implementation Vision

Thestrategicplanvisionistheoverarchingguidestarfor

theSacramentoRegionHealthCarePartnership’sefforts.

Theremustbeastatementofgoalsandastep-by-step

outlineofresponsibilitiesandtasks.Inshort,theSacramento

RegionHealthCarePartnershipmusthaveatactical

visionof“howtochange”inordertoachieveitsvisionof

“whattochange.”TheprogramdesigncreatedinStep2,

forexample,willdescribeidentifiedtargets.InStep3,the

SacramentoRegionHealthCarePartnershipstakeholders

willdeterminethestepsneededtogetitstargetedeffortsup

andrunning.

HavinganimplementationvisionallowstheSacramento

RegionHealthCarePartnershiptocollectivelybecertain

aboutitsstrategysostakeholderscancommunicateit

consistently.Asharedvisionletseveryoneknowwhatthe

endresultshouldbeandwhyitisimportant.Itprovidesa

clearimageofwhatthestrategicplanisintendedto

accomplish.Thisstepinvolvesclarifyingexactlyhowthe

elementsofthestrategicplanimplementationwillwork.

The Sacramento Region Health Care Partnership should generate

a business plan for the strategic plan’s components that includes

all financial, operational and implementation details for the

plan’s program components.

Step 4—Implementation Team

Inordertoactuallybeginworkonanyelementofthisplan,

therewillneedtobewillingparticipants.TheSacramento

RegionHealthCarePartnershipwillneedtoassemblean

implementationteamtoimplementthestrategicplan’s

components.Thisteamshouldbecomposedofstakeholders

whounderstandtheplan’spurposeandimplementationprocess.

Theywillneedtobringtogethertherightskills,experiencesand

intereststomatchidentifiedcontentareas.Toensureanefficient

andeffectiveprocess,asmallgroupsupportedby,andreporting

to,asteeringcommitteethatcanencourageprogressandfield

questionsoraddressproblemsastheyarisewouldbethe

bestapproach.

The Sacramento Region Health Care Partnership should develop

a small team that has senior leadership, strong financial skills

and experience, and professional support to implement the

strategic plan recommendations.


SierraHealthFoundation

1321GardenHighway

Sacramento,CA95833

[email protected]

www.sierrahealth.org

ConclusionWelaunchedtheSacramentoRegionHealthCarePartnership

in2011withthegoaloffindingwaystoimproveaccess,care

coordinationandthequalityoftheregion’sprimarycare

system,focusingspecificallyonthesafetynet.Thecompletion

ofthemarketanalysisandstrategicplannowoffersusaroad

maptoachievethatgoalofcreatingastrongersafetynetto

serveallresidentsofElDorado,Placer,Sacramentoand

Yolocounties.

Certainly,thechallengesfacingourregionaretremendous,but

thetransformativeopportunitiessparkedbytheAffordableCare

Actareequallygreat.Thisstrategicplanspellsoutthestepswe

musttake,individuallyandcollectively,toachievethevisionof

healthcarereform.

Wewillneedtoworktogetherandseizethisunprecedented

opportunitytocreateacollaborative,accessible,highquality

andculturallycompetentprimarycarehealthsystem.

Regionalsuccessiswithinreach,ifwereachforittogether.

Thepotentialrewardsareimmeasurable:ahealthierand

brighterfutureforall.

www.sierrahealth.org

Preparing for Transformation · 2016. 4. 5. · H E A LT H C A R E PA R T N E R S H I P / 2 0 1 2 ... Marsha Regenstein, PhD Alaina Dall Juliana Boyle, MBA Mark Zocchi Chuck Baucom

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