Transcript LifeLong Medical Care - California State Assembly

A View From the Ground
Better Care at Lower Cost
for High Risk Patients
LifeLong Medical Care
• Gray Panther founded FQHC in
Berkeley/Oakland/Richmond, California
• 12 licensed sites, 40,000 patients
• Emphasis on developing models of care to serve
elderly, disabled, homeless and complex patients
• Supportive Housing Provider
• Integrated primary care/behavioral health
Life Expectancy
USA
78
Japan
Mongolia
Ethiopia
USA Homeless 46
83
67
53
Health Issues Faced by
Homeless Patients
• Homelessness
• Serious mental illness
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Drug and/or alcohol addiction
Trauma – adverse childhood events and as homeless adults
Advanced chronic disease
Poor nutritional status
Lack of income – while Affordable Care Act will insure MediCal
coverage for most homeless lack of income will still be a significant issue
Service Models
That Work
• Data to identify which patients require intensive
services and to track outcomes
• Integrated team approach
• Intensity of services determined by need
• High frequency of interaction
• Strong linkages to community-based services,
especially access to housing
• Low Caseloads
• Highly individualized/relationship based
• Close communication with partners (primary care,
behavioral health, benefits advocates, ED, discharge planners)
So What Does a Health Home for the
Homeless Look Like?
• Care model and payment systems that support intensive services
• Flexible service models
– who provides care (non-licensed staff can be highly effective)
– where the care is provided (office, home, streets)
– what “care” is (medical and social case management, flexible funds for
transportation, basic needs)
• Marriage of medical and social services models to provide
responsive care coordination
• Fast access to supportive housing and other housing resources
• Linkages to benefits
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Change is Possible
CA Frequent User 2 Year Results for
Medicaid Population
*Indicates statistically significant
Policy Issues
• Payments for medical providers to support very intensive medical
and psychosocial services and that potentially reward for reducing
overall cost to the system
• Managed care plans must develop appropriate care and
reimbursement models, link community based services
• Case management as a recognized “medical” service
• Eliminate barriers to qualify for SSI/Medicaid
• Housing subsidies as cost effective health benefit
• Discharge policies and funding for medical respite to insure that
patients don’t get discharged to homelessness
• Community Health Centers as key providers for this high risk, high
cost population