MINUTES KDHE-KALHD P Public H Heal alth a h and nd M Medicai - - PDF document

MINUTES

KDHE-KALHD P Public H Heal alth a h and nd M Medicai aid A Advisor

• ry G

Group

• up

November 20, 2 r 20, 2015 015, 10: , 10:00a 00am – 3: 3:00p 00pm Top

• peka P

Public L Library, M Menning nger R Roo

• om 1515 SW

1515 SW 10 10th Avenu nue Topeka, K KS

Attendees: Cristi Cain, Michelle Ponce, Ed Kalas, Fern Hess, Sonja Armbruster, Katie Mahuron, Nick Baldetti

Anno nounc ncement The Wichita State University Center for Community Support and Research is now the Community Engagement Institute. The Community Engagement Institute has six centers; one of these centers is the Center for Public Health Initiatives. Additionally, the Center for Public Health Initiatives (and the Community Engagement Institute) has moved to Old Town on 258 N. Mead St. Current Syst stems I s Issu ssues a s and Updates

• Foundational Public Health Services and Capabilities – Discussion was held regarding the new model that has been introduced.

Michelle provided the group with a brief background on how the model was adopted.

• Public Health Systems Group – Michelle provided an overview of the most recent decisions, including a breakdown of the four

workgroups of the Public Health Systems Group:

• Finance Workgroup: Lead by Kansas University. They will look at the financial issues related to the model. It is likely they

will look at research that has already been completed by other states and organizations, such as the work of University of Kentucky.

• Legal Workgroup: KPHA will lead the group; they will review current statutes and potential options for future legislative
• activity. Will be trying to answer the question as to whether the current statutes support FPHSC model or if could they

potentially hinder the work.

• Policy Workgroup: KALHD will lead group. Group will look at other states to see how they have incorporated the model.

They will look at possible governance models, how multijurisdictional sharing might be a strategy, and other key policy areas.

• Assessment & Performance Management Workgroup: KHI will lead this group. They will be conducting systems
• assessment. The Center for Shared Public Health Services that is housed in KHI has already completed a lot of this work

(e.g. what the definitions would be for an assessment). This group will identify performance measurements to be used in future.

• Coordination of these four workgroups and the process: To be led by KALHD & CPHI
• Development of high level advisory group to meet 4 times/yr. - Want to engage some state and local policy makers

(Hoping to make champions)

• Summit to be held in conjunction with 2017 KAC conference to present the findings of the 4 workgroups.
• Other Items Discussed:

♦ May look at sharing/cross-jurisdictional sharing/multidistrict sharing as a part of delivering foundational public health services and capabilities. ♦ RWJ has competitive funding to be released related to states focusing on foundational public health services and

• capabilities. Kansas may be able to compete for some of this funding since the model has been adopted
• Current Issues local/state health department(s) are facing
• School inspections – Four to six weeks ago there was a lot of activity related to this issue on the KALHD listserv. LHDs were

asking if they were required to do school inspections and asking their peers if this was something they were already doing. Some counties are doing school inspections and some are not doing them. There are few LHDs that have local ordinances that they will not do school inspections (e.g. Harvey and possibly Sedgwick County).

• The question of the statutory requirements of the LHD in relation to school inspections was sent to the KDHE legal

department for review and interpretation. The initial interpretation was that KDHE no requirement to assist, and that LHDs could meet this need through MOUs with organizations already going into the schools.

• LHDs could have a lot of liability if they are not following the statute. If they do inspections, they would be covered

from liability.

• Through the KALHD Listserv the LHDs were asking: What are the checklist one uses to do a school inspection?

• Is there a requirement for swimming pool inspections?
• There is an EPA tool that can be adapted for the county’s use.
• There was discussion of how often this responsibility ends up falling in the Planning and Public Works Department of local
• governments. Getting rid of the responsibility for the inspections takes away from public health.
• Some of this work has already been done. KEHA has done 3-4 sessions on this with a panel of people that do inspections
• Hospital Closures/Medicaid Expansion
• Sunflower Foundation taking it on; trying to reengage former coalition members
• KHF taking a lead role also

Community H Health W Workers

• Insights and innovations from APHA were shared. Sonja shared some of the chief challenges identified by several CHW programs

in other states as presented at APHA. One of the key challenges identified at APHA was the difficulty in integrating CHWs into the health care team.

• There was discussion around the need for a defined scope of practice to ensure that other professionals were allies rather than

roadblocks.

• The potential for LHDs to house CHWs was discussed.
• CHWs can be practical navigators and promote existing LHD programs.
• They can provide access to care links – this is a foundational service found in the new model.
• Sonja shared her recent discussion with Kansas Health Institute and the proposal she presented to them for support funding.

Communities o

• f P

Prac actice

• Health Homes
• An update was provided on the project, including the success of the in-person Community of Practice that was held in August

through a two-day conference in Wichita.

• Discussion was held around the current legislative threat to the continuance of Health Homes. They are getting ready to move

to regular Medicaid match level rather than the first year Medicaid match (90% federal, 10% state). Additionally, the legislative pause that was put on the health homes for asthma and chronic conditions was discussed (until 2017).

• The question of who will advocate for this program was discussed. The potential for the mental health associations to

advocate was discussed.

• There was some fear that the issue would be bulked together with Medicaid expansion and the decision to continue

Health Homes would be affected by that association.

• KARP
• Successes shared included: individualized, in-person trainings at Riley County and Butler County, annual conference in

September, and webinars.

• It was suggested that the issue of accreditation has fallen off the radar for some LHDs. There is confusion as to whether it is no

longer important, especially with the shift in focus to the foundational services. LHDs may be asking if we are doing this instead of accreditation.

• There was discussion about the impact of turnover on the accreditation process: Shawnee corporate compliance person has

left. Trai aining ngs

• Billing Training – Business Process
• Informatics: Trends, data to watch, denial rate, turnaround time
• Thinking about what needed for billing piece:
• Fern wanted to emphasize the importance of this work. She recently lost a biller and knows that several other counties are

in the midst of hiring new billers as well (e.g. Butler).

• She had been hoping to look at billing through the lens of multijurisdictional sharing, but she does not have the time

to explore that concept now since her biller retired earlier than expected.

• There was discussion of the difference between a biller (or coder) vs. an auditor. The auditor provides a secondary level of

scrubbing; they are a system administrator for billing side of the EHR (when there is already autocoding/billing).

• Discussion was also held surrounding the differences between EHRs and KIPHS.
• KHI is the license holder of KIPHS and has made a huge investment in the system.
• Nick shared Reno County’s current bid process for a new billing system.
• The new position they are hiring will look over denials and be a health information position.
• Ed shared that Shawnee County has two accountants and he thinks they are probably already doing some of this work.

• Leadership Training – Integration Project
• A brief update on the work was given. Two questions were presented for feedback from the Advisory Group:
• When groups get together they often turn to influencing policymakers as preferred intervention – to what extent should

CPHI encourage/discourage?

• The advisory group said that CPHI shouldn’t discourage, but in terms of encouraging it needs to be placed in context.

Is it appropriate or logical to focus on influencing policymakers for the challenge? What is the challenge they identified in the first place? There may or may not be a role for policymakers in their particular challenge.

• What would happen if the integration project either became about or added a specific emphasis in assisting with local

public health director transitions?

• Yes, it makes sense to include in New Director Orientation.

♦ Requires staff education too on the health director’s role – sometimes staff thinks the LHD Director is out of the

• ffice too much. They don’t recognize the role of the health director as the Chief Health Strategist. As the Chief

Health Strategist, new directors (and their staff) need to know the importance of knowing partners, creating relationships, and being seen in the community.

• Regional Training Meetings - These have been successful and can be viewed as booster shots.
• Local Public Health Leadership Series - January through April - 24 participants enrolled at this point
• Succession Planning/COOP
• Different than the New Director Orientation
• The group suggested a format similar to KARP with an ongoing format.
• Commissioners need to understand value of succession planning
• There should be a component about how you prep your commissioners for succession planning? Perhaps, as a part of the

New Director Orientation a “Things You Need to Engage BOH/commissioners About: Succession Planning”

• The Advisory Group discussed the importance for succession planning on more than just an upper management level.
• How do you prompt your own staff to do their own succession planning? (i.e. the many billing personnel vacancies

that were discussed earlier)

• There was discussion about what succession planning should entail.
• Does it include recruitment and development? Workforce development?
• Some of the ideas and questions raised by the group to be addressed in a succession planning training included:

♦ Does everybody have a job description? Policies/procedures for each job? Drop dead book? ♦ Cross training ♦ SOG for the position

• It was also noted that many of these policies or needs fit the requirements in PHAB.
• Director Training for Engaging Boards of County Commissioners
• Important for LHDs to know what’s working for engaging with boards. This intersects with the foundational capabilities.
• It may be valuable to interview existing directors - Randall, Dennis, Melissa (if you get a design team together)
• This is something that has been on top five lists around regional meetings. What do you need from your commissioner for

a strong relationship?

• Michelle shared that KALHD has heard repeatedly from LHDs that the clerk has been a barrier to getting onto meeting agenda

to present something. In some counties, you cannot request to be on the agenda unless you go through the clerk.

• Tools and suggestions for what to review regularly to maintain relationship and rapport
• Encourage directors to use other staff to develop relationships with commissioners – encourage staff of every level to engage
• r go before commissioners “Walk the halls” strategy was previously employed by Sedgwick County

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KDHE- KALHD Medicaid Advisory Group Meeting

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3

New, New, News!!!

• Community Engagement Institute

and six centers…

• Center for Public Health Initiatives
• Center for Leadership Development
• Center for Organizational Development and

Collaboration

• Center for Applied Research and Evaluation
• Center for Behavioral Health Initiatives
• The ImpACT Center: Innovative Mobilization of

People to Act

4

238 N. Mead St.

Same Mailing address, Phone numbers and email addresses

5

Purposes of the Day Purposes of the Day

• Share

Share updates about work that has updates about work that has been done been done

• r begun
• r begun
• Discuss influencers in our system

Discuss influencers in our system

• Get direction and guidance

Get direction and guidance

So that we So that we build a system build a system that better serves Medicaid that better serves Medicaid beneficiaries in KS beneficiaries in KS

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Foundational Public Health Services and Capabilities

• KALHD
• Public

Health Systems Group

7

–School inspections –Workforce Development –Community Systems Engagement –Hospital Closures/Medicaid Expansion –Working with MCOs –Changes in Priorities How might these influence our work?

Current Issues Local/ State Health Departm ents Are Facing

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Intro to Com m unity Health Worker

• https://www.youtube.com/watch?v=kG1FB0ix7gA

Programs

Sinai Urban Health Institute

Chicago, IL

Prevention and Access to Care and Treatment

Boston, MA

Care Connections Program

Los Angeles, CA

Tumaini (Hope) for Health

Baltimore, MD

Challenges from the Program Perspective Challenges from the Program Perspective

• Role confusion

– Promotes fear of job encroachment

• Patient handoffs and communication
• Tracking of the value‐added work performed by CHWs
• Electronic Medical Records: compatibility and tracking

CHW home visits and outcomes

• Policy‐level challenges

– Budget crisis ‐‐‐ Pay first, save later? No, we can’t! – CHW Certification – Changes in health care

• “It’s not a sprint, it’s a marathon”

Challenges from the CHW Perspective Challenges from the CHW Perspective

• Competing priorities of patients
• Lack of available behavioral health services
• Lack of understanding of role and abilities of CHW

– CHWs as an asset to other health care staff

• “CHWs are the eyes and ears of doctors”
• Buy‐in cannot be limited to physician. There has to be

system buy‐in

• CHW serves as mediator between client and medical

system

– Missed appointments ‐‐‐ one month wait

• Sustainability of model ‐‐‐ job security

PACT Challenges

• Programmatic: funding, IT issues, constant turnover of medical

providers in teaching hospitals, data quality

• CHW: Territoriality/distrust from other providers: “we’ve been

working with this patient for a long time and we’re the ones who know him best;” also important to make sure there aren’t too many people calling one patient

• Both patients and CHWs sometimes feel disrespected or
• verlooked by clinic staff
• Not always learning about cancellations/changes to

appointments in time

• Difficulty accessing lab results/bloodwork that are essential

for our program

• Easing patient concerns about confidentiality and home visits

if they’ve never had home visits before

Integrating Into the Team: CHW Perspectives

 Unfamiliarity with CHW scope of practice  Creating structure for communication with PCP  Resistance from those outside of the complex care

management team

 Learning the medical language  Prioritizing social needs within the medical setting  Being an advocate for patient centeredness within

the County system

Integrating Into the Team: Programmatic Perspective Organizational issues Structural issues

 Leadership buy‐in  Seen as a external program  Medical homes are

relatively new

 Cultural challenges  Professional hierarchies  Siloed health care delivery  Massive scale leading to

coordination challenges

 Logistical challenges  On‐site supervision limited

Programmatic Challenges to Primary CareIntegration CHWCM Perspective

• Buy‐in and trust from consumers
• Lack of provider familiarity with CHWCM role and

theTumaini program

• Limited access to various health IT systems

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Com m unity Health Workers

• Conducted 13 interviews for an ongoing CHW database
• f organizations in Kansas that have CHWs.
• Eight interviews were conducted with key stakeholders.
• Organized and facilitated monthly CHW discussions with

KDHE team and staff affiliates.

• Presented findings at the Partnering for Health

Conference on October 27th.

• APHA
• Development of design team to focus on planning a

statewide summit.

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Synthesis: CHW Actions Needed

• 1. Providing infrastructure support by establishing

a CHW network/alliance/association.

• 2. Defining a CHW scope of practice.
• 3. Determining whether to adopt a CHW

certification or training process, and if so, developing that process.

• 4. Developing/adopting a standard curriculum with

core skills.

• 5. Addressing reimbursement for CHW services.
• 6. Integrating CHWs into health care teams.

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Health Hom es

• First Health Homes Conference
• Health Action Plan Training
• Community of Practice
• The eight quarters for SMI end June 2016. Their fate

will be decided by the legislature this session – both for continuation of SMI and the implementation of Chronic Conditions.

• The Health Homes dashboard is available on the

KanCare Health Homes website for people to get information – this is updated monthly.

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Kansas Accreditation Readiness Project (KARP)

• July webinar on Domains 10 & 11
• Annual Conference on September 30th attended

by 7 local health departments.

• On November 19, the first webinar of this

financial year’s project was held. The focus was Performance Management Systems.

• On-Site TA and Presentations
• Development of brief, asynchronous webinars

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Discussion Questions: KARP

• As we continue to develop readiness in
• ur state to support high-performing

health departments:

–What is needed? –Are we doing the right things? –What else?

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Trainings

• Billing Training – Business Process
• Leadership Training – Integration Project
• Regional Training Meetings
• Local Public Health Leadership Series
• Succession Planning/COOP
• Director Training for Engaging Boards of

County Commissioners

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Billing Training

• Business Process
• Business Process training to be on KS

Train by the end of the year

• Metrics training draft developed
• Two pilot departments needed to pilot

metric details and training

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Discussion Questions: Business Process

• As we continue to business processes

to support delivery of services to the Medicaid population:

–What is needed? –Are we doing the right things? –What else?

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Integration Project

• “Making hay while the sun shines” in

Riley/Pottowatomie/Geary. (Brenda is the sun.)

That partnership is interested in influencing policymakers.

• Trying to jumpstart work in Cowley and Reno.
• Recruiting after Thanksgiving

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Discussion Questions: Integration Project

• When groups get together as in

Riley/Pott/Geary, they often turn to influencing policymakers as their preferred intervention. To what extent should we encourage/discourage this?

• What would happen if the integration project

either became about or added a specific emphasis in assisting with local public health director transitions?

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Other Trainings

• Regional Training Meetings
• Local Public Health Leadership Series

– 21 participants currently enrolled – Still recruiting

• Succession Planning/COOP

– Needs a plan

• Director Training for Engaging Boards of County

Commissioners

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Wrap Up Next meeting is tentatively scheduled for February 26, 2016