Published on November 28, 2007
Maximize Access and Coverage: Maximize Access and Coverage A portfolio of best practices to provide better health for more people at less cost Kristen West CHOICE Regional Health Network October 2003 Our Regional Members: Our Regional Members Morton General Hospital Lewis Co. Department of Health & Social Services Providence St. Peter Hospital 16,000 low-income people show us how broken the system is: 16,000 low-income people show us how broken the system is 2001 2002 2003 Happy Endings Sad stories without happy endings Play Medical Deity: Play Medical Deity What can geographic regions really do? Focus on care delivered within region. Be an experiment for fundamental restructuring of finance and delivery. Assume existing limits. Assume no limits. Who do you target? Every resident. Low-income under age 65 below 250% of FPL. Uninsured. Where do you start? How much money do we have to spend? What service does everyone have a right to regardless of their ability to pay? What improves health status? How do you make insurance work better? How bold and how soon? Relieve immediate suffering. Allow the system to collapse as quickly as possible and prepare to implement something brand new. Sequential steps, growing in magnitude over a long planning horizon. By 2008, we will achieve 100% access to services we agree everyone has a right to: By 2008, we will achieve 100% access to services we agree everyone has a right to 85,000 low-income people 35% currently uninsured 65% are in an unstable mix of public programs 75% live in a home where one adult works Access to prioritized services Use health outcome evidence Fully fund enhanced primary care and prevention from a community pot Purchase catastrophic insurance Will cost $187 million a year Organize what’s currently spent: 80% Reduce costs: 10% New revenue: 10% Six Interdependent Principles for Achieving 100% Access: Six Interdependent Principles for Achieving 100% Access Stabilize the safety-net. Get small employers participating. Deliver evidence-based and patient-focused care through health teams. Enroll people with limited incomes in a medical home. Reduce costs and redirect savings to cover more people. Purchase services of greater value to the community. What principles does your community need to be in action on to achieve 100%/0?: What principles does your community need to be in action on to achieve 100%/0? Found Best Practices Achieving Impacts We Desired: Found Best Practices Achieving Impacts We Desired The Power of the Portfolio: The Power of the Portfolio Intersect, align and reinforce contributions (like a Lego set) Slide11: Portfolio of Best Practices Kentucky SKYCap Utah Access Health Slide12: Creates a local infrastructure for 100% access Human service providers use a common web-based, highly leveraged community resource referral system Organize care, acknowledge practitioners contribution and enhance well-being and access as a negotiable community asset Incent small employers to financially contribute for low-wage workers Facilitate enrollment in programs and access to medical home, specialists and interpreting services Slide14: What mix of best practices exist or need to be implemented to strengthen your local capacity? Parallel and interdependent processes You can pay for 100% Access if you…: You can pay for 100% Access if you… Combine and use what’s already being spent: Directly, through public programs Indirectly, through uncompensated care Reduce the cost of care and capture savings: Less fragmentation Less administration Augment with new revenue: Additional Medicaid reimbursement Employers Consumers Get started today!: Get started today! Be in action campaign mode: Create abundance through offers and requests Be clear about the what and let go of the how Don’t let criticism veto action Guide resources to local activity. Protect the vision. Boost local champions. Group Discussion Questions: Group Discussion Questions What portfolio of best practices could you put together? Are you willing to declare yourself the portfolio manager? What do you need from whom to get started?