MINUTES Public lic H Healt lth and Me Medic icaid id Ad Advi - - PDF document

………………………………………………………………………………………………………………………………… WICHITA STATE UNIVERSITY | Community Engagement Institute | 1845 Fairmount Street | Wichita, Kansas 67260-0201 Tele: (316) 978-3843 | toll-free: 1-800-445-0116 | fax: (316) 978-3593 | web: www.communityengagementinstitute.org

MINUTES

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In order to increase the effectiveness and efficiency of Kansas Medicaid services, this workgroup is designed to help guide the planning, policy development, and coordination of services of KDHE (Kansas Department of Health & Environment), KALHD (Kansas Association of Local Health Departments), local health departments, and others interested in public health services for the Kansas Medicaid population. Obje bjectiv ctives: s:

• 1. Welcome, Purpose, Updates from the Group
• a. In attendance: AAron Davis, Kristina Helmer, Danielle Ast, Ty Kane, Tammy Von Busch, Janet

Wertzberger, Kasey Sorell, Edith Matthews, Jason Tiller, Katie Mahuron, Brooke Sisson (KDHE Intern), Michelle Ponce, Teri Caudle

• b. Updates:
• i. KDHE Division of Healthcare Finance - Kasey
• 1. API Modifier – effective November 1 – will have to itemize
• 2. Rates for adults vaccine will increase – August 1
• 3. Moving forward with 3 MCOs – United, Sunflower and Aetna starting January 1
• 4. Tobacco Cessation – covered service for all Medicaid beneficiaries (classes and

individual counseling)

• 5. LHDs can Administer and bill Makenna p17
• 6. Cover lactation counseling
• 7. To get bulletins go to KMAP
• ii. CPHI Updates (from April Advisory Meeting)
• 1. MCH Program feedback has been incorporated into 4 workgroups
• 2. Specific areas translating into work include:
• a. SDoH – conversations will begin in July meeting
• b. Increasing efficiency of LHDs – conversations will begin in July meeting
• c. Expanding LHD billable services
• d. Health Homes – this will start again soon.
• e. Community Coordination
• f. Local Public Health Leadership Series starting in August 2018 – cohort 9
• g. Partnership and Process in Public Health – concludes in December 2018.

Summary will be provided in early 2019

• h. CHW Symposium
• 2. KanCare 2019 Update/Discussion
• a. New MCO is Aetna
• b. Group discussed concerns and questions about the new MCO and the new contracts

• 3. Addressing Social Determinants in our Medicaid Population
• a. Identifying SDoH was included in the last round RFPs.
• b. Every Bureau is working on SDoH at KDHE in some way.

Brainstorming Activity

• 1. What role should LHDs play in addressing SDoH?
• Policy development/legislation **
• Tobacco 21
• Zoning/Access to food
• Clarifying/Identifying resources who is doing what.
• Networking – connectivity
• Advocacy**
• Involving the consumers/people in the conversation
• Leverage combined funding
• Communicate with everyone on all levels – consumers and government
• Establish a vision/get everyone pulling in the same directions
• Consistent
• Data
• Education
• Community Health Strategist
• Partnership development – building bridges**
• Need to work on relationship building (more that handing out a business card)
• Cross-train staff so they can help address multipole needs of clients – team case

management approach**

• 2. What is currently happening in your department or community that is addressing SDoH?
• Working on poverty through circles
• FC in the FPHS model
• Poverty issue as PH focus
• K-state Extension
• Transportation system
• KanCare 2019
• Implementing Medical case manager to connect pts to community resources
• Tobacco 21 at county and state level
• Community Development planner
• Community Health Workers
• Becoming a Mother (BAM)
• HD Services
• Bus passes/taxis
• HIAs – Health Impact Assessments
• Farmer’s market
• Summer picnic program
• FQHCs
• Coalition building
• Low income housing connector to other services (OPIS – Geary County)
• Farmworker Program
• Available services
• 3. What would you need move from the current state, to where we should be?

• Money **
• Infrastructure staff – state and local level ***
• Stability funding/money **
• Right people in the room – including PH existing groups
• New partners
• More formalized/routine way of sharing ideas – what others are doing
• Policy development – need legislative support
• Advocacy, research, commission support
• Innovation and outside the box thinking
• Flexible use of money
• Stronger partnership
• Community support
• 4. What questions do you still have that need answered?
• MCO activities on SDoH
• Do we have an overarching goal? – Does everybody know the goals?
• What is the cost of doing nothing?
• What is the current impact (including money) of PH on SDoH?
• What is the consistent message from KS PH on SDoH to our partners (including

commissioners)? **

• What are LHDs and others across the staff doing? *
• What do clients need? – from their point of view. How do you get their input?
• Where do we start? What are greatest needs?
• Would it be helpful KS to “adopt” a SDoH model? * FPHS Link
• How is KDHE engaging the system about financial opportunities?
• 4. Building Capacity in Local Health Departments to help improve Medicaid Services
• a. Who else provides leadership to advance LHD capacity building efforts?
• Legislator raised the heat to build capacity around childcare (Wabaunsee)
• Community
• PHAB – changing LHD culture
• Academic institutions – partner with K-State, KWU, KU Salina as a site for

MPH/nurses/etc. interns (Saline).

• b. Identified TA Needs, KDHE ATL Survey (2018)
• Community engagement: 48%
• i. Surprised about community engagement listed so high
• Develop public health policies and plans: 43%
• Performance management and QI: 27%
• Workforce development: 25%
• Conduct research and use evidence-based practices: 24%
• Conduct and disseminate assessments: 24%
• Inform and educate about public health: 22%
• Investigate health problems and environmental health hazards: 21%
• c. Taking the Temperature about the Need for Capacity Building
• d. What resonates with you about what you’ve heard so far?
• Pre-requisites for PHAB are important for all LHDs not just the LHDs going through

accreditation

• CHA/CHIP/SP – How did that go? What was the impact? LDHs didn’t sign up. Lessons

learned about methods.

• Particular topic needs to be important to them and how it can relate to their work?
• Who has to sell it to have it viewed important?
• e. What are “your” greatest capacity building needs?
• Staff – reliable and sustainable funding (staff and current funding are barriers)
• Tough to get staff out of the office
• Develop and execute cross jurisdictional sharing agreement and how to get commissioners

to support these ideas

• Engaging providers around Key PH issues
• f. When it comes to you LHDs ability to build capacity, what’s possible now given your current

environment?

• Some grants require training
• Staff turnover and succession planning
• Unionized employees
• Gaps in key roles during staff transitions
• Retirement
• i. Opens new creativity and new direction. But miss the connection and history

(retirements also mean new opportunity)

• ii. COOP planning is important
• g. When it comes to your ability to fulfill your vision and mission, what’s getting in the way? (Do you

have a vision and mission)

• Damage control and misinformation (i.e. community member routinely likes to send

information to County Commissioners about how the health department isn’t doing their

• job. Director has to take time to dispute this information)
• Competing priorities that may not be our brand of PH = Department of Health and

Human Services Opioid Initiative – not part of their mission/vision. But this is their biggest funder

• h. Are Kansas LHDs too comfortable with their current level of performance? Are they afraid of

change? Why? What’s getting in their way?

• Some LHDs want to, but can’t work on C.B efforts
• Not just “soft skills” and capabilities; also essential PH functions
• i. Our current Thinking About “ How”
• Online resources of tools and resources
• Expert guided peer learning opportunities
• Pilot programs (e.g. KARP)
• Individualized support for specific sites
• Educations webinars
• Communities of practice (e.g. ESSC, QI, etc.)
• Regional or statewide gatherings
• j. Brainstorming and Prioritization Activity
• Anticipated outcome: A short list of what’s needed (and not needed) for this initiative to be

successful

• Clarify our purpose statement – In terms of capacity building, what’s needed to help LHDs

close the gap between where they are now and where they need to be to accomplish their mission and vision?

• Generate a list of ALL “must do” and “must-not-do” ideas (programs, activities, resources,

etc.)

• Test EACH idea against the purpose statement: If we ignored this idea could we still

achieve our purpose? If yes, cross it off your list

• i. Videoconferencing (and a recorded version)
• ii. include front line workers in development of trainings
• iii. include people doing the work to provide training
• iv. include participants beyond LHD
• v. Include appropriate staff
• vi. Market to appropriate staff
• vii. Face to face is more productive
• viii. Record meetings
• ix. Combine with existing meetings
• x. Statewide (1) = okay – regional (multiple) = better
• xi. Consider when webinars are okay
• xii. Make it relevant
• xiii. Train with strategic direction and clear objectives
• xiv. Not all training should be in Topeka or eastern Kansas
• xv. Consider when in person vs. online is most effective/appropriate
• xvi. Keep in mind the different learning styles
• Where does CEI focus their efforts?
• i. Community engagement – survey LHD staff with what types of community

engagement they need

• ii. Workforce development – creating hiring practices/ hiring an RN on a PRN status
• iii. What are the gaps in the current services that LHDs have to provide? i.e. Provide

support QI on a specific MCH topic

• 5. Closing and Evaluation

Save the Date: Next Meeting October 26, 2018 at 10:00

Public Health and Medicaid Advisory Group Meeting

July 27, 2018

Agenda

• Welcome, Purpose, Updates from the Group
• KanCare Update/Discussion
• Addressing Social Determinants in our Medicaid

Population

• Current activities & future possibilities discussions
• Lunch Provided (Noon)
• Building Capacity in Local Health Departments to help

improve Medicaid Services

• Current activities & future possibilities discussions
• Closing and Evaluation (2:30-3:00)

CPHI Updates

AAron Davis

April Meeting

• MCH Program feedback has been incorporated into 4

workgroups.

• Specific areas translating into work include: SDoH,

increasing efficiency of LHDs, expanding LHD billable services, Health Homes, Community Coordination

• Framing for next year’s work plan

KanCare Update

Social Determinants

• f Health

AAron Davis

Healthy People 2020 tells us…

• Achieving health requires more than just controlling

disease.

• Healthful social conditions can ensure that all

members of society—especially the most vulnerable—benefit from the same basic rights, security, and opportunities.

• Population health is also of critical importance to

national prosperity and security.

Social Determinants of Health

• ‘The conditions in which people are born, grow, live, work

and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices.

• The social determinants of health are mostly responsible

for health inequities – the unfair and avoidable differences in health status seen within and between countries.’

• World Health Organization (WHO)

Social Determinants of Health

Life-enhancing resources, such as food supply, housing, economic and social relationships, transportation, education and health care, whose distribution across populations effectively determines length and quality of life.

Social Determinants of Health

Determinants of Health

Social Determinants of Health

• Economic Stability
• Employment
• Food Insecurity
• Housing Instability
• Poverty
• Education
• Early Childhood Education and

Development

• Enrollment in Higher Education
• High School Graduation
• Language and Literacy
• Social and Community Context
• Civic Participation
• Discrimination
• Incarceration
• Social Cohesion
• Health and Health Care
• Access to Health Care
• Access to Primary Care
• Health Literacy
• Neighborhood and Built

Environment

• Access to Foods that Support

Healthy Eating Patterns

• Crime and Violence
• Environmental Conditions
• Quality of Housing

Clarifying Discussions

Brainstorming Activity

• Divide up into groups of two
• 6 minutes at each station
• Brainstorm as many topics, issues, ideas as you can.

Discussion Questions

• 1. What role should LHDs play in addressing SDoH?
• 2. What is currently happening in your department or

community that is addressing SDoH?

• 3. What would you need move from the current state,

to where we should be?

• 4. What questions do you still have that need

answered?

LUNCH

Building LHD Capacity

AAron Davis

Our Current Thinking

WHAT? Improve the system’s ability to provide technical

assistance, resources, tools and subject matter experts to LHDs so they can be more effective at accomplishing their mission.

WHY? All Kansas LHDs have a gap between where they

are now and where they’d like to be, and many need help getting there. There’s lack of clarity among LHDs about where help is available.

IMPACT: Kansas communities are better served by high

performing LHDs that are part of a strong public health system.

The Kansas Public Health System

• Decentralized system

(local control)

• 105 counties
• 100 local health

departments

• 2 multicounty departments
• Most governed by Board
• f County Commissioners

serving as Local Boards of Health

26

Variations in Local Public Health Service Delivery Models

• Hospital led: Cheyenne, Haskell, Stanton, Morris
• EMS led: Ellis, Phillips, Dickinson, Leavenworth
• FQHC led: Lyon
• Multi-jurisdictional: NEK (Brown, Atchison, Jackson)

and SEK (Bourbon, Allen, Anderson, Woodson)

• City-County: Lawrence-Douglas County, City-Cowley

County

• The remaining are county departments.

27

Population Density of Kansas Counties

• 36 Frontier
• 34 Rural
• 19 Densely-Settled
• 10 Semi-urban
• 6 Urban
• U.S. Census Bureau,

Population Estimates, Vintage 2016

28

S

• urce: US

Censur Bureau, Census 2000 S ummary File 1 population by census tract.

The Kansas LHD Workforce

• Number of employees: ranges 1–139
• Providing services to counties with populations ranging

from ~1,300 to ~580,000

• 72% of local health departments in KS have fewer

than 10 employees

• 34% have fewer than 5 employees
• Staff losses due to budget cuts
• 24% of KS health departments lost staff in either FY2014
• r FY2015

29

S

• urce: 2016 KS

Local Health Dept. S urvey (Aid to Local Grant Program)

Capacity Building in LHDs: Who Drives?

• Internal
• LHD leadership
• Umbrella agency (County government)
• Commissioners / Board of health
• External
• KDHE
• Funders like Blue Cross and Blue Shield, Kansas Health

Foundation, Local Community Foundation, National partners

• Other statewide public health system partners like CEI, KHI,
• ther academic partners
• What’s missing? Who else provides leadership to advance

LHD capacity building efforts?

Current Capacity Building Supports

• Kansas Association of Local Health Departments (e.g.,

resources/tools, peer learning, workshops, conference sessions)

• KDHE (e.g., Governor’s Public Health Conference,

Regional Meetings, program level support)

• Kansas Accreditation Readiness Pilot
• Community Health Assessment, Community Health

Improvement Plan and Strategic Planning resources from Kansas Health Institute.

• Community Toolbox from KU Center for Community

Health and Development

Current Capacity Building Challenges

• A 2017 capacity assessment of 80 Kansas LHDs

revealed that LHDs have greater confidence in skills, expertise and knowledge (capability) and lower confidence in the staff, time and funding (capacity).

• Specific capacity building gaps were identified in the

2018 Aid to Local Survey.

• Administrator needs
• Staff needs
• Greatest gaps/need for technical assistance

Identified Technical Assistance Needs, KDHE ATL Survey (2018)

• Community engagement: 48%
• Develop public health policies and plans: 43%
• Performance management and QI: 27%
• Workforce development: 25%
• Conduct research and use evidence-based practices: 24%
• Conduct and disseminate assessments: 24%
• Inform and educate about public health: 22%
• Investigate health problems and environmental health

hazards: 21%

Taking the Temperature About the Need for Capacity Building

1. What resonates with you about what you’ve heard so far? 2. What are “your” greatest capacity building needs? 3. When it comes to your LHDs ability to build capacity, what’s possible now given your current environment? 4. When it comes to your ability to fulfill your vision and mission, what’s getting in the way? (Do you have a vision and mission!) 5. Are Kansas LHDs too comfortable with their current level of performance? Are they afraid of change? Why? What’s getting in their way?

Our Current Thinking About “How”

• 1. Online resource of tools and resources.
• 2. Expert-guided peer learning opportunities.
• 3. Pilot programs (e.g. KARP)
• 4. Individualized support for specific sites.
• 5. Educational webinars.
• 6. Communities of Practice (e.g. ESSC, QI, etc.)
• 7. Regional or statewide gatherings.

Brainstorming and Prioritization Activity

Anticipated outcome: A short list of what’s needed (and not needed) for this initiative to be successful. 1. Break into groups. 2. Clarify our purpose statement – In terms of capacity building, what’s needed to help LHDs close the gap between where they are now and where they need to be to accomplish their mission and vision? 3. Generate a list of ALL “must-do” and “must-not-do” ideas (programs, activities, resources, etc.). 4. Test EACH idea against the purpose statement: If we ignored this idea could we still achieve our purpose? If yes, cross it off your list. 5. Compare across small groups and consolidate the list. 6. Evaluate

Closing/Summary

• Continued Discussion
• FY19 Task Order

Save the Date

• October 26th

Thanks for joining us! Drive home safe