Charlie Alfero, MA presents on financing for community health work.
Description
This workshop will report on the development of “CHISPAS” a Medicaid Community Health Worker service and payment model that is being piloted in New Mexico. CHISPAS provides PMPM (per member per month) for Basic Patient Support, Intensive Care Coordination and support policy, systems and environmental changes to improve health and reduce costs. It is a national model for providing an on-going financing / payment source for CHW services.
Dehradun Call Girls 8854095900 Call Girl in Dehradun Uttrakhand
Community Health Work: Financing & Sustainability
1. Charlie Alfero, Executive Director
Southwest Center for Health Innovation
NM Primary Care Training Consortium
National Center for Frontier Communities
calfero@swchi.org
Community Health Workers
Address Health and Social
System Failures, Cost
(Financing and Sustainability)
2. Arthur Kaufman, MD
Vice Chancellor for Community Health
University of New Mexico
akaufman@salud.unm.edu
5. US Spends much less on Social Services than other
Western Countries
6. “Saving Money” in the US
Means Testing
In or Out
Qualified or Out of Luck
Engraining Discrimination and Divisiveness
Age, Sex, Race, Economic Condition Based Criteria
Disproportionate / Targeted Responses and Exacerbation
of the Problem (Divide and Conquer)
Social Justice
Is Systemic
If Everyone is IN –
No one is OUT!
7. The Language of Failed Policy
Racism
Minority
Poverty
Social
Determinants
of Health
Disparities
/ Inequities
Unaffordable
Education
Rural
Disproportions
(Older, Sicker,
Poorer, Life
Expectancy)ACES
Home
Less
Ness
Categorical and
Soft
Money
Discretionary /
Entitlement
8. A Diagram of the Medical Model – Patient View
Complex Health Systems
Strategies for Tomorrow –
Brown
Where are
Social Services,
Employment
And
Education?
9. We Get What We Pay For!
0
1
2
3
4
5
6
7
8
9
0 5 10 15 20 25
Diminishing Returns of Complexity
Complex Systems
And Cost
ROI –
Health / Well-Being
US – Spend More / Get Less
10. Clinical Involvement in Social Issues
Social Determinants
Referral to Community
Health Worker for:
Food Assistance
Housing Assistance
Utilities Assistance
Transportation
Assistance
Daycare Assistance
Legal Assistance
Employment Assistance
Education Assistance
Substance Abuse
Assistance
Safety Assistance
Domestic Violence
Assistance
Other
Each Social Determinant of Health has an
ICD-10 code ex.
Lack of Food – Z59.4
Inadequate Housing – Z59.1
Lack of Education – Z55.9
Lack of Transportation – Z59.8
Problems Employment - Z56.89
Insufficient Income – Z.56
Also Abuse Codes – T74
11. Excellent Health Average Health Very Poor Health
% Population
Population
Health Strategies
Comprehensive
Patient Support
Intensive
Care
Coordination
% of Cost
Primary Care
Linked Strategies
Specific Strategies are Necessary to Address
the Underlying Causes of Ill Health
12. Medicaid: Comprehensive Intervention Strategy
Comprehensive Patient Support with
Community Health Workers (CHWs)
Social Assessments Support Clinical Strategies
Non-Clinical Interventions and Education
Facilitated Access to a Wide Range of Services as
Indicated
Supportive Services to Achieve Primary Care Goals
13. Medicaid: Comprehensive Intervention Strategy
Intensive Care Coordination Lead by CHWs
High Risk / Cost Patients with Favorable Patient Ratios
Patient-Specific Plans
100% Case Review by MCO
Cost Evaluation
14. Medicaid: Comprehensive Intervention Strategy
Population Health Strategies
Social Assessments Inform Internal Policy and Systems
Changes
Clinical Priorities Inform Community Health
Improvement
Community Engagement
Stakeholders / Partners
Other Vehicles
17. CHISPAS: Links Clinics and Communities
CHW links within Clinic
Providers
Front Desk
Medical Assistants
EHR, Referral System, Warm Handoffs, Team Huddles
CHW links in Community
Community-Engaged CHWs
Social Services Referrals and Development
Other Sectors (ex. Transportation, Food, Utilities)
18. Anticipated Cost Savings by Program
Maurice Moffett, PhD
Health Economist, Office for Community Health
Mmoffett@salud.unm.edu0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
Year 1 Year 2 Year 3
Comprehensive
CHW
19. CHISPAS Contract Features
Contracts with Medicaid and MCOs to Develop
Pilot Program – Still There – Will do One more Year
Contract / Service Standards and Guidelines
Targeted Curriculum
Training and Technical Assistance
Tele-Education and Program Support
Roll Out Plan – Adding Four More Sites
Evaluation, Research, Publication
20. Standards and Guidelines – (Excerpt/Draft)
COMPREHENSIVE PATIENT SUPPORT
Standard Requirement Framework/Model
Element A – Assess and stratify members’ individual needs
1. Document the number of Medicaid
members that access the clinic annually
for preventive services and / or care.
Policy showing how the
information is consistently
collected.
Monthly report
CMS Accountable Health
Communities (CMS-AHC)
1. Verify Medicaid eligibility, contact and
demographic information.
Log of contact or record
review
Proof of Medicaid eligibility
documented in patient
record.
CHISPAS – protocol
1. 100% of CE patients who access the clinic
are surveyed to identify social
determinants of health [using the Well Rx
and / or CMS Z-Codes in patient health
records]
Policy
Completed WellRx in
patient record
Annual report with analysis
of Well Rx results
Analysis of Z Coding in EHR
CMS-AHC
PI-CCHH
PCMH
CHISPAS Protocol
SIM
21. What Incentives to Different Payment
Systems Have?
Model Volume Cost Quality
Fee-For-Service High / Low High / Low High / Low
Capitation High / Low High / Low High / Low
Global Budgets High / Low High / Low High / Low
Value-Based, Shared
Savings
High / Low High / Low High / Low
22. We Chose PMPM Service Contracting
Budget-able
Scalable
Service Contracts
Report-Based Payments
Specific
Separate from Medical Payments
Moves Health Equity from a Soft Money Concept to
an Administrative Unit
23. PAYMENT MODEL
Comprehensive Patent Support and
Community Health
$5.75 PMPM
Intensive Care Coordination
$321 PMPM
Limited Numbers
24. Primary Care Providers
• Medical
• Dental
• Behavioral
• Patient / Family /
Community Health
Range of Care
• Prevention
• Diagnosis
• Treatment
• Management
4 Core Primary Care Service Payment
Equity Model
PAYMENT
SYSTEM
25. Charlie Alfero
301 West College, Suite 16
Silver City, NM 88061
Calfero@swchi.org
575-538-1618