Transcript Document

Healthcare Reform and the
HIV Community: A model of a
local level, collaborative
approach to navigate
coverage changes
Presented by Michaela Hoffman
Mission Neighborhood Health Center
Courtney Mulhern-Pearson
San Francisco AIDS Foundation
Anne Donnelly
Project Inform
San Francisco HIV Health Care Reform Task Force
Objectives
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Provide an example of one local response to health care
reform implementation
Receive specific examples of tools that can help prepare HIV
Service Providers, patients/clients and decision makers for the
transition to ACA implementation
Identify next steps for your local setting that could contribute
to a smooth transition
San Francisco HIV Health Care Reform Task Force
GETTING TO KNOW YOU
San Francisco HIV Health Care Reform Task Force
Which best describes where you work?
a.
b.
c.
d.
e.
f.
Clinic
Community-based organization
Health department
University
Hospital
Other
San Francisco HIV Health Care Reform Task Force
Which best describes what you do?
a.
b.
c.
d.
e.
f.
g.
Clinician (MD, PA, NP, nurse, dentist, etc)
Case manager/benefits counselor
Health education (peer educator, promotora)
Administrator
Researcher
Consumer representative
Other
San Francisco HIV Health Care Reform Task Force
I feel I can explain ACA to a friend
a.
b.
c.
d.
e.
Yes---100%
Yes---75%
Yes---50/50
A little bit
No
San Francisco HIV Health Care Reform Task Force
HEALTH CARE REFORM IN THE
LOCAL CONTEXT: SAN FRANCISCO
San Francisco HIV Health Care Reform Task Force
Health Care Reform in San Francisco
Medicaid expansion
 Access to qualified health plans (QHPs)
through Covered California (Marketplace)
 Upcoming transitions:
 RW to Medicaid and Covered California
(CC)
 Low income health program to Medicaid
expansion & CC
 Pre-Existing Condition Insurance Program to
Medicaid expansion or CC

San Francisco HIV Health Care Reform Task Force
PLWH in SF – who will be most
impacted by HCR?
Percent of SF RW Consumers by Insurance type
~15,000 PLWH in SF
~7,000 received
Ryan White funded
Medicare,
15%
Uninsured, 24%
Private
Insurance, 5%
Other Public
Insurance, 5%
Medi-Cal, 44%
Data were obtained from the SFDPH HIV Health Services ARIES database. The reporting period for the data presented is from October 1,
2011 through September 30, 2012.
San Francisco HIV Health Care Reform Task Force
Challenges for PLWH and their
Providers
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Ryan White program (RW) – patient centered
comprehensive HIV care
Payer of last resort : RW can’t pay for services
that can be provided under other coverage
HCR expanded coverage means transitions
and integration of services
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Transitions to new plans, providers, pharmacies
Service integration: once in new coverage, may
need continued access to RW services:
Those not offered by other coverage: specific types of
case management, adherence, linkage to housing
 Help with costs: out of pocket and premium costs for care
and medications

San Francisco HIV Health Care Reform Task Force
Experience with Transitions in Care
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Medi-Cal: seniors and people with disabilities into managed
care plans – mandatory for all except dual eligibles - 2011
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Partial and temporary Medi-Cal expansion (Low Income
Health Programs – LIHPs ): RW clients to LIHPs – mandatory, if
eligible – 2011 - 2013
San Francisco HIV Health Care Reform Task Force
Upcoming Transitions
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RW clients to:
 Medi-Cal – if eligible, mandatory;
 QHPs through CC – voluntary but encouraged
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LIHP beneficiaries to:
 Medi-Cal expansion – mandatory;
 QHPs through CC – voluntary but encouraged

Pre-existing Condition Insurance Program (PCIP) clients to:
 Medi-Cal expansion – mandatory;
 QHPs in CC – voluntary
San Francisco HIV Health Care Reform Task Force
OVERVIEW OF SF HIV HEALTH CARE
REFORM TASK FORCE
San Francisco HIV Health Care Reform Task Force
Mission
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Develop recommendations and transition readiness
plans with the goal of:

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Minimizing disruption in client care and ensures access
Preparing community-based HIV providers for changes in
funding
Preparing the broader health care system
San Francisco HIV Health Care Reform Task Force
Members
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The Task Force is comprised of members from the
HIV prevention and planning councils, consumers,
SFDPH, the HIV/AIDS providers network, advocates
and other key stakeholders
San Francisco HIV Health Care Reform Task Force
Key Deliverables
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Research Best Practices for integration of HIV
services, models that ensure access and quality
Create recommendations for a re-envisioned local
system of care that builds on our historical success
Develop and share tools to inform and prepare HIV
Service Organizations and consumers for a smooth
transition
Share recommendations with key stakeholders,
decision makers, HSOs and consumers
San Francisco HIV Health Care Reform Task Force
RESOURCES DEVELOPED
BY THE TASK FORCE
San Francisco HIV Health Care Reform Task Force
“Provider
Considerations”
Providers often the last to know;
This was the first deliverable
released
Developed while collecting
data/interviews for
recommendations
Re-released as information
became available; Now on the
third version
Samples and a more
generalized checklist are
available for you today
San Francisco HIV Health Care Reform Task Force
“Client FAQ”
(for staff too!)
Short and clear (2 pages)
Reduce anxiety
Promote knowledge and
participation
Promote communication
with medical provider
General and EDITABLE for
organizations
Samples here today and
for download on our
webpage
San Francisco HIV Health Care Reform Task Force
Transition
Recommendations
Targeting policy makers and
leadership at both the local and
state levels.
Identifies key action steps to
ensure a safe transition
Proposes a post-ACA model of
care that builds on the
successes of Ryan White AND
the benefits of ACA
San Francisco HIV Health Care Reform Task Force
Community Forums
Outreach to PLWH
Three forums, different
dates/times/locations in
Oct/Nov/Dec
Provide participants with the
information they need to make
important decisions about their
healthcare coverage
For those with new coverage
options, give them enough info
to take the next steps towards
enrollment
Feature information
tables/representatives from
Medi-Cal, Covered California,
benefits counselors, etc.
San Francisco HIV Health Care Reform Task Force
SUCCESSES AND CHALLENGES
San Francisco HIV Health Care Reform Task Force
Successes
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Commitment from all key sectors was essential to success

All bodies represented at every meeting and among Task
Force leadership

Open communication and data sharing

Advanced and frequent information sharing with HIV
Organizations
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Identified their needs, answered their questions, engaged them and their
clients in learning about ACA impact
Prompt identification of potential challenges
San Francisco HIV Health Care Reform Task Force
Challenges

Open communication and data sharing
 Difficult to break out of silos, but essential for success in this
transition

Delays in decision making by Federal/State bodies

Time/funding: need a few dedicated people who will keep
the process moving
 Relied on a small group of volunteers for the majority of
content
San Francisco HIV Health Care Reform Task Force
OVERVIEW OF
RECOMMENDATIONS FOR A
SUCCESSFUL LOCAL TRANSITION
San Francisco HIV Health Care Reform Task Force
Goals
The Recommendations support the following goals:
 Goal 1: Promote successful community-based interventions
aimed at outreach, testing, and linkage to care.

Goal 2: Reduce barriers to timely engagement in quality,
affordable, patient-centered care.

Goal 3: Ensure culturally appropriate patient-centered care.
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Goal 4: Promote continuity of coordinated care.

Goal 5: Improve individual and community health outcomes.
San Francisco HIV Health Care Reform Task Force
Goals are informed by
the Continuum of Care
San Francisco HIV Health Care Reform Task Force
Recommendation #1
Ensure that resources are in place to preserve the continuum of
HIV services including outreach, primary prevention, and
status awareness.
GOAL 1: Promote successful community-based
interventions aimed at outreach, testing, and
linkage to care
GOAL 2: Reduce barriers to timely engagement
in quality, affordable, and patient-centered care
GOAL 3: Ensure culturally appropriate patientcentered care
GOAL 4: Promote continuity of coordinated care
GOAL 5: Improve individual and community
health outcomes
San Francisco HIV Health Care Reform Task Force
Recommendation #2
Reduce barriers to care and enhance client engagement and
retention through coordinated and streamlined benefit
eligibility screening/enrollment processes.
GOAL 1: Promote successful community-based
interventions aimed at outreach, testing, and
linkage to care
GOAL 2: Reduce barriers to timely engagement in
quality, affordable, and patient-centered care
GOAL 3: Ensure culturally appropriate patientcentered care
GOAL 4: Promote continuity of coordinated care
GOAL 5: Improve individual and community
health outcomes
San Francisco HIV Health Care Reform Task Force
Recommendation #3
Ensure a sufficient number of culturally and linguistically
competent benefits counselors/advocacy workers are trained
and available throughout the community to support the
education, screening, and enrollment and retention needs of
PLWH who require multi-program enrollment/re-certification,
including ADAP/RW, Medi-Cal and/or access to an insurance
product through the Health Benefits Exchange.
San Francisco HIV Health Care Reform Task Force
GOAL 1: Promote successful communitybased interventions aimed at outreach,
testing, and linkage to care
GOAL 2: Reduce barriers to timely
engagement in quality, affordable, and
patient-centered care
GOAL 3: Ensure culturally appropriate
patient-centered care
GOAL 4: Promote continuity of coordinated
care
GOAL 5: Improve individual and community
health outcomes
Recommendation #4
Ensure affordability of insurance coverage, including Medi-Cal
managed care and qualified health plans offered in Covered
California.
GOAL 1: Promote successful communitybased interventions aimed at outreach,
testing, and linkage to care
GOAL 2: Reduce barriers to timely
engagement in quality, affordable, and
patient-centered care
GOAL 3: Ensure culturally appropriate
patient-centered care
GOAL 4: Promote continuity of coordinated
care
GOAL 5: Improve individual and community
health outcomes
San Francisco HIV Health Care Reform Task Force
Recommendation #5
Ensure that HIV service organizations (HSO) and PLWH have
accurate and useful information in advance of ACA
implementation and as systematic changes are implemented in
the future.
GOAL 1: Promote successful communitybased interventions aimed at outreach,
testing, and linkage to care
GOAL 2: Reduce barriers to timely
engagement in quality, affordable, and
patient-centered care
GOAL 3: Ensure culturally appropriate
patient-centered care
GOAL 4: Promote continuity of coordinated
care
GOAL 5: Improve individual and community
health outcomes
San Francisco HIV Health Care Reform Task Force
Recommendation #6
Ensure that HIV safety-net medical providers, private physicians,
and community based pharmacies have the opportunity and
technical assistance required to engage with the multiple
insurance products offered through Covered California and
Medi-Cal.
GOAL 1: Promote successful communitybased interventions aimed at outreach,
testing, and linkage to care
GOAL 2: Reduce barriers to timely
engagement in quality, affordable, and
patient-centered care
GOAL 3: Ensure culturally appropriate
patient-centered care
GOAL 4: Promote continuity of
coordinated care
GOAL 5: Improve individual and
community health outcomes
San Francisco HIV Health Care Reform Task Force
Recommendation #7
Engage both SF Medi-Cal managed plans (San Francisco Health
Plan and Anthem Blue Cross Partnership Plan) as key partners in
ACA.
GOAL 1: Promote successful communitybased interventions aimed at outreach,
testing, and linkage to care
GOAL 2: Reduce barriers to timely
engagement in quality, affordable, and
patient-centered care
GOAL 3: Ensure culturally appropriate
patient-centered care
GOAL 4: Promote continuity of
coordinated care
GOAL 5: Improve individual and
community health outcomes
San Francisco HIV Health Care Reform Task Force
Recommendation #8
Continue to support and enhance the role of the public health
community in coordinating with primary care to ensure
continuous quality improvement, optimum health outcomes for
PLWH, and decreased risk of HIV transmission.
GOAL 1: Promote successful communitybased interventions aimed at outreach,
testing, and linkage to care
GOAL 2: Reduce barriers to timely
engagement in quality, affordable, and
patient-centered care
GOAL 3: Ensure culturally appropriate
patient-centered care
GOAL 4: Promote continuity of
coordinated care
GOAL 5: Improve individual and
community health outcomes
San Francisco HIV Health Care Reform Task Force
Recommendation #9
Ensure that Ryan White funds continue to be utilized to address
gaps in service and improve health outcomes for PLWH.

There will still be a substantial, ongoing need for funds for core
medical services
GOAL 1: Promote successful communitybased interventions aimed at outreach,
testing, and linkage to care
GOAL 2: Reduce barriers to timely
engagement in quality, affordable, and
patient-centered care
GOAL 3: Ensure culturally appropriate
patient-centered care
GOAL 4: Promote continuity of
coordinated care
GOAL 5: Improve individual and
community health outcomes
San Francisco HIV Health Care Reform Task Force
CONSIDERATIONS FOR OTHER
LOCAL PLANNING EFFORTS
San Francisco HIV Health Care Reform Task Force
Why does HCR require community
planning?

Providers and clients need up to date reliable and
local information from multiple agencies – federal,
state & local
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Information is rapidly changing & complex
 Requires much more knowledge than just enrolling in insurance
Ongoing changes in requirements, & specific procedures
Systems are at different levels of readiness
 Need to understand interim procedures
Providers need consistent and detailed training to be
able to counsel clients about HIV issues
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Clients who will not be making changes
Clients who will be transitioned because of payer of last resort
Clients who will have choices about new coverage
San Francisco HIV Health Care Reform Task Force
Why does HCR require community
planning?

Providers need to share sustainability strategies in new
coverage environment
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Need to build networks to successfully screen and enroll clients
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Medicaid expansion clients
Clients who have options in the Marketplace
Need to build networks to ensure that clients get help with
access problems and that problems get reported to decision
makers

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For clinic operations
For reimbursement
Monitoring is up to us!
Advocates and program providers need to work closely
together to ensure that they are sharing information

Need to understand what is working and what is not to build
sustainable systems
San Francisco HIV Health Care Reform Task Force
Some Key Components that Can
Emerge From Collaborative Planning

Leadership and/or point people to gather, digest, and
disseminate important information
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Information changing quickly, especially in the first year
Allows organizations to share a “health care reform guru” position
Can also represent your group with key decision makers at the state
and local level
 Medicaid, your Marketplace, your Health departments

An effective HIV-specific communications network

New formal and informal partnerships and better sharing of
resources

Better understanding of the impact of changes on clients and
providers
San Francisco HIV Health Care Reform Task Force
Some Key Components that Can
Emerge From Collaborative Planning

Local and specific education and training and training
materials for providers and clients

Clear that HIV specific information will be necessary in most
places to supplement formal ACA information

Shared and coordinated advocacy efforts

Appropriate local systems development
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HCR brings new systems and differs regionally – local input is
critical
Can allow the mapping and creation of networks to enroll,
engage and assist clients with new coverage
Develop of a comprehensive community plan to navigate
changes
San Francisco HIV Health Care Reform Task Force
PLANNING FOR YOUR LOCAL
AREA
San Francisco HIV Health Care Reform Task Force
QUESTIONS?
San Francisco HIV Health Care Reform Task Force
MORE INFORMATION
San Francisco HIV Health Care Reform Task Force
Resources
 State HCR Information www.statereforum.org
 Enroll America
www.enrollamerica.org
 Center for Budget and Policy
Priorities - www.cbpp.org
 Treatment Access Expansion Project –
www.taepusa.org
 Kaiser Family Foundation –
www.kff.org
 Families USA – www.familiesusa.org
 National Health Law Program –
 NASTAD – www.nastad.org
www.nhelp.org
 Health Resources and Services
Administration –www.habhrsa.gov
San Francisco HIV Health Care Reform Task Force
Resources
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SF HIV Health Reform Task Force http://www.sfhiv.org/resources/health-care-reform-transition2/
Covered California – www.coveredca.com
Health Access - www.health-access.org
Western Center on Law and Poverty – www.wclp.org
National Senior Citizens Law Center – www.nsclc.org
Health Consumer Alliance – www.healthconsumer.org
San Francisco HIV Health Care Reform Task Force
Please Visit
www.HIVHealthReform.org
to access slides from today’s presentation
San Francisco HIV Health Care Reform Task Force
Evening Town Hall:
Health Care Reform Open Forum

Presented by the HIV Health Care Access Working
Group, Ryan White Working Group, Federal AIDS Policy
Partnership and HIVHealthReform.org

Join national and state policy experts and your peers for
a relaxed, open forum where you can ask burning
questions about health care reform implementation,
share your concerns, and learn more about
implementation efforts.

Monday, September 9
6:15 – 8:00 p.m.
Strand 12A, Level 2
Hyatt Regency New Orleans
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San Francisco HIV Health Care Reform Task Force
Evaluation
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Session ID: 141
SHORT URL LINK: http://goo.gl/Nx3NYP
QR Code:
San Francisco HIV Health Care Reform Task Force
Contact Information

Contact:
 [email protected]
 [email protected]
 [email protected]
 [email protected]
San Francisco HIV Health Care Reform Task Force