Informing SBHCs About Opportunities Presented by Health Care Reform
If you are work in school-based health care and are not sure whether or how health care reform applies to you, you are not alone. Many of the changes taking place in health care are unfolding first in populations that generate the highest costs such as older people with chronic conditions.
By contrast children are mostly health and therefore relatively inexpensive, so the imperative to transform their care is not as pressing. However there is widespread recognition that prevention must begin early, so we are seeing interest from health plans and hospitals in connecting with school-based health center (SBHCs).
Below are some resources that we put together to give you an orientation to the type of issues and ideas being discussed as far as delivery system reforms.
Payment Reform & Financing Prevention
- Payment Models that Promote Comprehensive Prevention Services –Establishing reliable funding from public and private sectors for comprehensive prevention services provided by California SBHCs is essential to the long-term sustainability of SBHCs, and for improving the health of the populations they serve. This issue brief and inventory explores innovative payment reform strategies and policy changes that could support California SBHC comprehensive prevention services.
- Financing Prevention: How States Are Balancing Delivery System & Public Health Roles – There are payment reform opportunities and models within the Affordable Care Act that may impact the sustainability of prevention services and education offered by SBHCs. This report provides an introduction and overview of these opportunities, and discusses how they can be used to align health care delivery with public health systems.
- Medicaid Funding of Community-Based Prevention – This report looks at current strategies using Medicaid dollars to finance prevention, outlining several myths surrounding Medicaid reimbursement for community-based prevention and including examples of how some states are maximizing Medicaid for these services.
Models for Prevention
- Addressing Patients’ Social Needs: An Emerging Business Case for Provider Investment – Lots of attention is being paid to how the conditions in which people are born, grow, live, work, and age impact their overall health. We are working to explore how SBHCs can strengthen their work beyond the exam room to address the social determinants of health. This report outlines examples of how to integrate social determinants of health in the primary care system.
- Community Health Workers in California: Sharpening Our Focus on Strategies to Expand Engagement – The role of CHWs has been recognized in many areas of health care reform including patient centered care, accountable care communities, and workforce development. We believe that it is valuable for SBHCs to think about how CHWs or promotores can be integrated into their health care team, or examine opportunities to strengthen the role of their current CHWs. This report has some important recommendations on effective integration of CHWs into team based care models.
- Accountable Communities for Health – Accountable Communities for Health (ACH) are gaining traction in conversations around health care reform because they improve health outcomes and practices for whole communities. ACHs take into account how all different aspects of community life affect health in that region. ACHs engage stakeholders across a community such as health care, public health, and community organizations to comprehensively improve health in a specific region. SBHCs are well positioned to play a key role in local initiatives to address community health. Learn more about this model of clinic and community partnership.
Medi-Cal Managed Care
- Medi-Cal Managed Care: Raising the Bar for Quality and Outcomes – This report provides a good overview of Medi-Cal managed care models throughout California. Now that many children and families are enrolled in the managed care system, it is important that SBHCs continue to think about how they can work with their respective managed care plans to promote quality services and patient engagement, while exploring payment reform strategies that support this work. Look up your local health plan’s performance measurement (HEDIS) report to see how it is doing on pediatric and adolescent care.
Health Care Reform Webinars
Schools and SBHCs in Health Care Reform: Learn about CSHA’s Health Care Reform Initiative and hear about our lessons learned from the past year of having policy conversations with health plans and launching pilot projects throughout the state. We will discuss the state of schools and SBHCs in health care reform. Play the recorded webinar and download the webinar slides. (February 2016)
Medicaid Preventive Services: In 2013, the Centers for Medicaid and Medicare Services (CMS) made changes to Medicaid regulations that, if implemented in California, might allow for reimbursement of services provided by a non-licensed provider, e.g. a medical assistant or community health worker. This webinar provides an overview of the regulations, discusses this opportunity for SBHCs, and begins a conversation school health advocates about how this rule might impact delivery of school-based health services. Play the recorded webinar and download the webinar slides. (January 2015)
Health Care Reform Q&A: This webinar provides a summary of opportunities within California’s health care reform process that may be used to sustain school health services. Play the recorded webinar. (December 2014)
Additional Resource: California Opportunities for Financing Asthma Prevention and Management – Our partners at Regional Asthma Management & Prevention (RAMP) hosted a webinar that provides an excellent overview of pending statewide reforms that could impact funding for school health services.