Partnership Development & Increasing Access

1. Partnership Development & Increasing Access June 2010 Allison Dubois, MPH Hudson River HealthCare, Inc.

2. Article 28 Federally Qualified Health Center NCQA certified, JCAHO accredited, Planetree Health Care Organization Mission: To increase access to comprehensive primary and preventive health care and to improve the health status of our community, especially for the underserved and vulnerable.

3. Community Health Sites (16) Pine Plains New Paltz Amenia Walden SULLIVAN Poughkeepsie (2) Monticello Dover Plains Beacon Goshen Peekskill Haverstraw Health Center Yonkers Migrant Health Migrant Voucher program Greenport Public Housing Riverhead

4. Organizational Overview Network of 16 sites (Migrant, Homeless, Public housing, Ryan White, Community Health Center) Secured NCQA Level 3 Medical Home Designation for network of sites, adding additional revenue ($6/MA patient/month) Full electronic health record implementation across 16 sites by April 2009 Maintained provider productivity at 3600 visits/physician Improved Medicaid and Medicaid Managed Care from 29% of visits to 39% of visits Increased federal grants by over $3.5 Million in 5 years

5. Daily Challenges “Free Clinic” Image The Growing Uninsured Static Funding Medical Home Underserved communities

6. Partnership Priorities • Increase services or improve services for our patients • Enhance efficiencies or reduce duplication • Expand to meet community need • Increase funding • Manage risk

7. Partnership Case Studies • Healthy Communities Access Program (PCAP clinic) • Voucher Program • Technology (RHIO, EMR implementation, medical home, meaningful use) • Care Solutions – linkages for patients • Legislative partnerships

8. HCAP • Purpose of the grant: to create a formal the HCAP consortium of community partners to increase access to high quality, effective, efficient and coordinated healthcare for uninsured and under insured individuals in the City of Poughkeepsie, New York. • Partners: FQHC, DOH, private practitioners, 2 hospitals, homeless shelter, mental health provider, supportive community services

9. HCAP Goals • Coordinate and strengthen the overall "Safety net" services for uninsured and underinsured individuals • Bridge or eliminate organizational, financial and delivery gaps and barriers that often create fragmented systems of care for the uninsured and under insured • Develop a more efficient, comprehensive and higher quality system of care, regardless of ability to pay • Link residents of Poughkeepsie to a medical home to improve health outcomes

10. “Uninsured? That needn’t be a problem. We can refer you to a very fine doctor in Ottawa.”

11. HCAP Projects & Successes • Community Care Partners at our partner sites to provide patients with assistance in navigating their health care • A pharmacy assistance program that will help bring access to lower cost prescription drugs to residents of the city • Programs to improve the care for individuals with chronic diseases including diabetes, heart disease and asthma • Additional dental services to the community • Ongoing partnership to coordinate care beyond funding cycle

12. Additional Outcomes • Prenatal focus • Contract for prenatal services at the FQHC • Exploration of transitioning 700 delivery hospital based PCAP program into FQHC model • Transition of DOH prenatal clinic to FQHC • Specialty access agreements with hospital based clinics • Community based, DOH sponsored community needs assessment of new immigrants

13. Health Information • Partnership with Regional Health Information Office (RHIO) THINC • Partner in implementation of electronic health record across network of 16 sites • Coordinated pilot for medical home implementation, provided technical assistance and application support

14. HIT Funding partnership • Partnership with FQHCs in the region to focus on care management of diabetics utilizing technology • Review the technology applications as a mechanism to support care delivery • Shared services for care coordination • Shared data analysis and creation of benchmarks • Shared expertise • Online enrollment in public benefits

15. Care SolutionsReframing of the cost of health care & how we communicate it

17. Care Solutions The Care Solutions Benefit is presented in a face-to-face meeting with an Access Coordinator and provide orientation to program: • Create your medical home and selection of primary care giver • Assess all demographic information to verify it is correct • Render a Care Solutions ID card with picture • Examine ways to make your care affordable ***

18. Critical Partnerships • Medicaid managed care for facilitated enrollment • Supportive services referrals • Food pantries • Housing support • Soup kitchens • Energy savings, transportation, etc • Tracking mechanisms • Cross referrals

19. “Unfortunately , you have what we call ‘no insurance’.”

20. Voucher Program • Virtual health center model to provide access to migrant and seasonal farmworkers • Partnership/contracts with community based providers to provide access, wrap around services provided directly • Currently providing care to 4,000 farmworkers through this model • Mobile medical service delivery

21. Voucher Outcomes • Increased awareness of larger community need • Increased awareness of health care delivery landscape for under and uninsured Opportunities • New health center location (Greenport) & additional opportunities on the horizon • New partnerships to expand and coordinate care

22. “Pardon me, but could you tell us where the public trough is?”

23. Legislative Partnerships • Collaborative effort among Migrant FQHCs in NY to secure dedicated state funding to support care for agricultural workers • Dedicated funding to provide specialty coverage for farmworkers • Joint education of elected officials • Partner with the Farm Bureau, growers

24. Key take home messages • Look for commonalities, despite history or lack of history of partnership • Let your champions be your cheerleaders • Finding win-win opportunities • Identifying low hanging fruit for partnership to build trust that will open doors for other opportunities • Cross pollinate • Not all partners benefit proportionally • Understand your risks and manage them to the best ability possible

25. Questions?