AUGUST 2009 ISSUE

Regional Health Care Initiative releases Safety Net Capacity Report

The Mid-America Regional Council’s Regional Health Care Initiative released a report on the status of safety net services in the Kansas City region in July 2009. The report concludes two years of research that gathered local data from safety net providers and area hospitals, statewide health-disparity data and census data. The report identifies capacity issues that the safety net community must address in order to meet the needs of the uninsured and medically underserved. The report also identifies needs and outlines strategies for increasing the capacity of the safety net system as the demand for services increases. <Full report>

Key conclusions:

1. There is a substantial and increasing need for safety net services in the region — a need that cannot be met with the existing system capacity.
2. The safety net's physical plant is adequate to serve additional patients, as measured by exam room space, but that capacity is not evenly distributed across the metro area.
3. The system is currently slightly strained in terms of medical staff per patient and clearly cannot add any capacity without adding additional medical, clinical and administrative staff. The needs for and availability of staff are not matched across the region. In addition, clinics have a difficult time hiring and retaining medical staff.
4. Evening and weekend services for the safety net population are inadequate.
5. Safety net clinics and other safety net providers do not currently have the technology capacity to participate in electronic health records and a health information exchange. There is no single health information exchange system in which all health providers can reliably participate.
6. Standardized, accessible data for the region, both on the health of the population and the state of health care, is inadequate.
7. Although the Regional Health Care Initiative focuses on primary care, specialty care and chronic disease management are also major issues in providing comprehensive, quality health care to those who are uninsured or medically underserved.

The full report includes a set of findings and documentation that supports each of these conclusions. The report concludes with recommendations:

1. Monitor the demand for safety net services and the capacity of the safety net system to meet that demand. Develop a better understanding of both the nature of the demand and the capacity of the safety net system to meet it.
2. Expand weekend and evening hours for safety net clinics and generally take every opportunity to use existing facilities to their fullest extent as a strategy to expand the capacity of the safety net system, serve additional patients, and provide improved access to care.
3. Invest in additional health care professionals for safety net clinics and provide aid and assistance to safety net clinics in recruiting and retaining health care professionals.
4. Expand safety net capacity in Johnson County, north of the river, south Kansas City and Cass County.
5. Work with the safety net community to enhance the ability to implement and use electronic medical records and participate in a health information exchange.
6. Expand the region’s ability to access and analyze public health and disease incident data in order to better understand where the most effective interventions may be.
7. Continue to monitor and assess the need for enhanced specialty care in the region and support specialty care and chronic disease management initiatives.

Safety Net Collaborative secures $500,000 grant to implement evening and weekend care proposal

In July, the Health Care Foundation of Greater Kansas City announced an award of $500,000 to the Safety Net Collaborative (SNC) to expand the capacity of the safety net system by 63 hours each week and more than 15,000 patient encounters each year. Combined with a recent award of $200,000 from the REACH Healthcare Foundation, these funds will be sufficient to implement the new program this fall.

Over the last year and a half the SNC, composed of safety net providers and community stakeholders, examined the capacity of the safety net system. After assessing a wide variety of options, the committee recommended that the most effective way to increase the capacity of the safety net system is to expand use of the existing physical plant capacity of the safety net clinics by adding evening and weekend hours. This strategy also has the additional benefit of providing care during hours that will better serve many medically vulnerable working people and school children.

Clinics participating in the first phase of the project include:

• Health Partnership of Johnson County: Primary care with specialty referral, including acute illnesses, chronic conditions, prevention/health maintenance, health procedures, dispensary services and laboratory services.
• KC Free Health Clinic: Primary care medical services, including treatment for acute and chronic conditions, health maintenance, dispensary, phlebotomy and lab services. Other services include a variety of specialist care, such as optometry, podiatry, chiropractic, women’s health, HIV prevention and treatment, and behavioral health.
• Swope Health Services: Primary care medical services, including treatment for acute illness, prevention/health maintenance, chronic conditions, laboratory services, radiology, dispensary services, phlebotomy and health procedures.
• Southwest Boulevard Family Health Center (530 Quindaro, Kansas City, Kan.): Primary care medical services, including acute illness, chronic conditions, prevention/health maintenance, dispensary services, phlebotomy and lab services.
• Northland Health Care Access-Crestview School: Primary care for children and adults, including acute illness, prevention/health maintenance, chronic conditions, laboratory services, dispensary services and immunizations.

More information about evening and weekend schedules and start dates will be available in future newsletters.

KC-BHIE notes key achievements

Stakeholders involved in the development of the Kansas City Bistate Health Information Exchange (KC-BHIE) noted several significant accomplishments in July. First, funding was secured from the Health Care Foundation of Greater Kansas City to complete planning and begin the technical design phase of the KC-BHIE. Second, a request for proposals was released nationally to select an entity to develop the technical design and help stakeholders build or buy the technology infrastructure that will enable health and behavioral health providers to exchange real-time clinical data.

KC-BHIE stakeholders have also completed other key tasks:

• Established an interim steering committee and governance structure to guide decisions while the KC-BHIE is still in a formative state.
• Finalized and approved six committee charters, deliverables and timelines. The committees are Governance, Security and Privacy, Finance and Services, Communication, Education and Collaboration, Outcomes and Quality, and Technology.
• Identified services to be provided by the KC-BHIE and aligned with the “Meaningful Use” criteria required to access enhanced Medicaid and Medicare reimbursement (see chart).
• Developed a process to gather input from providers on the most “valued” services the KC-BHIE can provide.
• Developed general design concepts for a KC-BHIE website.
• Developed a crosswalk that aligns Kansas and Missouri security and privacy requirements.

The contract to develop the technical design of the KC-BHIE will be awarded by Sept. 1, 2009 with work to commence immediately. The contractor has a maximum of three months to complete the work. For more information, please contact Doug Smith.

Regional Extension Center planning commences

On July 30, the Mid America Regional Council sponsored a meeting with health providers from both Kansas and Missouri to identify the key components of a Regional Extension Center (REC) and determine what existing assets might be leveraged in the development of a REC. More than 40 organizations were represented at the meeting.

The meeting began with a short overview of RECs. Under American Recovery and Reinvestment Act (ARRA) guidelines, Regional Extension Centers are intended to help health care providers "...adopt, implement, and effectively use certified EHR technology that allows for the electronic exchange and use of health information.”

REC responsibilities will include:

• Assisting health care providers with the implementation, effective use, upgrading and ongoing maintenance of health information technology, including electronic health records.
• Encouraging broad participation of individuals from industry, universities and state governments.
• Actively disseminating best practices and research.
• Participating to the extent possible in health information exchanges.
• Integrating health information technology into the training of health professionals.

The group also reviewed the defined priority groups that the RECs are charged with supporting, which are:

• Public, nonprofit and critical access hospitals.
• Federally qualified health centers.
• Entities entities that serve rural areas and the uninsured, underinsured and the medically underserved.
• Individual or small group practices focused on primary care.

Participants discussed the critical elements of an REC, including both hands-on and virtual support for providers in the analysis, selection and implementation of an electronic health record and connection to a health information exchange. The group also spent a considerable amount of time discussing the workforce development that will be necessary to staff and support RECs. Representatives from Kansas State University, the University of Kansas, the University of Missouri and the Metropolitan Community Colleges all discussed plans to augment existing certification and degree programs.

The group concluded by identifying next steps. These included clearly defining the priority groups listed above and gathering local and state data to compile a matrix that will provide an overview of the number of health providers needing REC support. The group also agreed to identify potential partners who were not in attendance at the meeting and notify them of upcoming meetings. The group will meet again in mid-September, once the matrix is developed.

Final recommendation made for Children’s Behavioral Health Services

In March, Dr. Joe Parks, Missouri Department of Mental Health, asked behavioral health stakeholders in Kansas City and the western region of Missouri to suggest recommendations for the reallocation of $1.2 million that had previously been used to support the children’s unit at Western Missouri Mental Health Center (WMMHC). The unit was closed in December 2008. Dr. Parks noted that the funds must be used to support the development of a comprehensive system of care for children with significant behavioral health needs who might have used the services at WMMHC.

MARC convened stakeholder meetings in May, June and July, chaired by Mary Ellen Schaid, CEO of Gillis Center for Children. More than 75 people participated in the discussions and in the development of the recommendations for the Department of Mental Health.

The stakeholders reviewed a great deal of information about the current availability of acute and sub-acute behavioral health services in the Kansas City area. After much consideration, stakeholders unanimously agreed that instead of a “new place” where children would be, the funds should be leveraged to transform the current system of care to allow children to remain in their homes and communities, with services wrapped around them to meet their unique needs. The stakeholders concurred that creating a structure to provide individualized, sub-acute levels of support in the child’s home and community is the best use of the reallocated funds. (See the full description and visual of the project). For more information about the project, please contact Laura McCrary.

Coalition seeks funds to expand enrollment and outreach for S-CHIP

On Aug. 6, a coalition of Kansas City organizations submitted a federal grant application that outlines a model for expanding outreach efforts to Missouri children who are eligible for the State Children’s Health Insurance Plan (S-CHIP) but, due to a wide variety of barriers, are not yet enrolled. The enrollment of eligible children is a critical issue for the bistate Kansas City community, due in part to the difficulties families encounter in dealing with the differing Medicaid systems in place in Kansas and Missouri. Recognizing this, the United Way of Greater Kansas City has identified the enrollment of eligible children as one of its three priority areas for the community.     

Many barriers may prevent children from receiving the health care that they need. Often parents are not aware that their children are eligible for government-sponsored health coverage. Language and cultural barriers further complicate this issue, as do a lack of transportation and limited understanding of the complex health care system. This grant is designed to break down these barriers and establish a continuum of supports in the children’s natural environments.

The coalition includes representatives from faith-based organizations, United Way, MARC, Cabot Westside, Partnership for Children, health advocacy organizations and others. These organizations worked together to develop a comprehensive system of care to ensure that eligible children are able to receive government-sponsored health care.

The grant will be awarded in late September. For more information, contact Carol Smith at United Way of Greater Kansas City.