MAY 2008 ISSUE

Safety Net Working Group Update

At the May 27 meeting of the Safety Net Working Group (SNWG), members discussed the process by which decisions are made for the full group. The current SNWG structure is informal, with decisions based on a broad consensus of the group. However, as the group tackles more difficult decisions it may be necessary to establish a more formal voting structure. The SNWG members decided that they will continue to work in an informal manner, but will work to better define what is meant by consensus and implement that definition.

The SNWG also heard reports from each of the committees on their work during May. (See associated committee reports.) Action items are summarized below.

• Health Information and Exchange Committee
  Two focus groups will be held on June 16 — from 7:30-9:00 a.m. and from 3:00-4:30 p.m. —  to gather information from Safety Net administrators and clinical staff regarding their information needs. Additional focus groups will be held with other members of the safety net community, such as hospitals, specialty care programs, health departments and other key stakeholders. After compiling information from these focus groups, the committee will explore technology solutions that meet the needs of all members of the safety net system.
  
  
• Provider Relations and Advocacy Committee
  Members will hold focus groups on June 10, from 8:30-10:00 a.m., and June 11, from 3:00-4:30 p.m., to gather information from safety net providers regarding the content of the message being developed to “tell the story” of the safety net system and the uninsured. The goal is to develop a message and have it ready to share with stakeholders by fall 2008.
  
  
• Access to Care Committee
  Members discussed how patients enter the safety net system and how they navigate through it. They acknowledged that it is a very complex process and it is unclear what safety net providers are doing to address the issue. Committee members directed MARC staff to determine care coordination strategies currently in use by safety net providers. A list of interview questions was shared with the full SNWG. Interviews with care coordinators will take place in June, and information regarding the status of care coordination in the SNWG will be compiled to help to determine what additional care coordination strategies could be used to improve care.
  
  Committee members also expressed interest in pursuing a federal Health Resources and Services Administration (HRSA) grant on patient navigation and chronic disease management. An exploratory meeting is scheduled for May 30 at 2:00 p.m. at the MARC offices.
  
  
• System Capacity Committee
  Members discussed MARC’s analysis of the capacity of the safety net system. They suggested continuing to compile data, but agreed that it is essential to increase the capacity of the safety net system immediately. Members agreed that this could best be accomplished by developing a regional strategic direction focused upon immediate solutions to increase capacity. This would be supported by the data developed by MARC’s research services staff. Members will identify their immediate capacity needs and bring this information to the next committee meeting. MARC staff and committee members will compile this into a regional capacity strategy.

May Committee Meetings

Provider Relations & Advocacy

The Provider Relations and Advocacy committee met on May 8 [Meeting Minutes]. Committee members discussed the role and responsibilities of the Provider Relations and Advocacy committee. They reconfirmed the need to develop a shared message that “tells the story” of the uninsured and how the safety net system meets the needs of the community. The committee members generated a list of key stakeholders who would need to be contacted in order to communicate the message of the uninsured and the safety net system. MARC staff will compile a list of specific names and addresses for these stakeholders and present it at the June committee meeting for input.

The committee members began discussions on the best method for developing a message to educate the stakeholders and others on the safety net system in the Kansas City region. The committee members agreed that SNWG member input will shape the message. Members felt that the best way to gather this information is to hold two focus groups with SNWG members. [The focus groups were later scheduled for June 10, from 8:30-10:00 a.m., and June 11, from 3:00-4:30 p.m.] The committee discussed the need to develop a message quickly and set a deadline of July 2008.

Committee members felt that ideally the message would consist of a video that tells the general story of the safety net system but can be customized so that each safety net provider can use it for marketing purposes.

System Capacity

The System Capacity Committee met on May 6 [Meeting Minutes]. Committee members reviewed the MARC Safety Net Capacity Strategy, which includes an analysis of the need for primary care for the uninsured, an analysis of the current capacity of the safety net system to meet those needs, identification of gaps in services, and how those gaps can be filled.

Members of the committee discussed these elements and agreed that it would be difficult to complete the analysis due to a variety of limitations in the quality and validity of the data. The committee members agreed to refocus the capacity strategy on identifying ways to increase capacity for the safety net system. MARC staff will continue to gather basic data for capacity building that can be used to support a regional capacity strategy

Committee members discussed a variety of activities such as workforce recruitment and retention, shared purchasing and HR support that would be valuable to some of the clinics. Some members questioned the value of the community clinic cooperative idea since several of the larger safety net clinics have already established cooperative agreements with vendors. It was noted that clinic size was related to the amount of cooperative resources available and smaller clinics could benefit from working together.

Access to Care

The Access to Care Committee met on May 20 [Meeting Minutes]. Members reviewed their committee description and agreed to replace the term “medical home” with “appropriate medical care and effective care coordination.” The new description reads:

The Access to Care committee has an external focus on the needs of the patients. The committee’s principal mission is to assist patients in gaining appropriate medical care and effective care coordination.

Committee members began discussions of how patients are referred into the safety net system in the Kansas City region. Members of the committee identified programs such as the emergency room, Riverview Health Services, personal contacts, schools, and Ask-a-Nurse as entry points. The committee members agreed that further investigation of how clients enter the safety net system and how the process works would be valuable. Committee members asked MARC staff to develop a list of entry points and report to the committee at the June meeting.

The committee members discussed the definition and purpose of care coordination in the safety net system. Members agreed that care coordination is navigation within the system and that care coordination goes beyond medical care; it is holistic approach to working with clients to ensure healthy outcomes. The committee members discussed identifying care coordination programs both within and outside of the safety net system. Members of the committee and MARC staff will develop a set of questions for the staff to use when interviewing safety net clinics. This will help determine the models of care coordination in the region. The committee asked MARC staff to give a report from the interviews at the next committee meeting in June.

Several committee members mentioned a request for proposals for grants from the Health Resources and Service Administration [HRSA] related to patient navigation and care coordination. Committee members expressed strong support for submitting a grant application. MARC staff will review the grant and send a recommendation to the committee.

Health Information Exchange

The Health Information and Exchange Committee met on May 21 [Meeting Minutes]. Committee members reviewed their plan for holding health information technology focus groups with safety net providers, and agreed to start with two focus groups consisting of no more than 15 safety net clinic administrators and clinic providers. The focus groups will be held on June 16 from 7:30-9:00 a.m. and from 3:00-4:30 p.m. Questions for the focus groups will come from the vision matrix developed at the February committee meeting. The questions need to ensure that the committee members have a clear understanding of the information needs of safety net clinic administrators and providers.

The committee members discussed local and state health information technology initiatives in the region. Members agreed to start gathering information at the state level with representatives from the Kansas Association for Medically Underserved (KAMU) and the Missouri Primary Care Association (MPCA). Representatives from these organizations will be invited to a future meeting to update committee members and the SNWG on state-level health technology initiatives.
 
The committee members reviewed the template for the E-Library pilot project and discussed how the E-Library would be managed. Members asked that research on software applications in use by SNWG members be added to E-Library to build a complete resource.

Members of the committee discussed how and by whom the E-Library would be managed. MARC staff agreed that the E-Library would be housed at MARC for one year. At the end of the first year, an assessment will be made of the value and usage of the E-Library. Once the assessment had been completed and the value of the E-library is established, further planning for sustaining the E-Library will take place.

Proclamation recognizes Cover the Uninsured Week

On May 1, Kansas City Mayor Mark Funkhouser presented a proclamation recognizing Cover the Uninsured Week to members of the community who provide care to the uninsured and medically underserved. The proclamation specifically recognizes Kansas City safety net providers that have been working together as a part of the Regional Health Care Initiative to improve and expand access to health care. Councilwomen Cathy Jolly specifically thanked the group for their work in launching the new www.kchealthresource.org web site to help people find convenient safety net health clinics.

Pictured from left to right: Laura McCrary, Ed.D, director of the Regional Health Care Initiative at Mid-America Regional Council; Bridget McCandless, MD, medical director, Jackson County Free Health Clinic; Mayor Mark Funkhouser, Kansas City, Mo.; Liz Levin, vice president of charity care for the St. Luke’s Health System and executive director of Cabot Westside Clinic; Hilda Fuentes, executive director of Samuel Rodgers Health Clinic; Christine Parrish, program director, Kansas City’s Medicine Cabinet; and Rex Archer, MD, director of the Kansas City, Mo., Health Department.

Health Coverage Working Group

An exploratory meeting of stakeholders interested in discussing innovative health coverage options will take place on June 9, from 9:00-11:00 a.m., at the MARC Conference Center. The meeting is designed to gauge interest in the development of a local working group to identify strategies that could be implemented in Kansas City to expand health coverage for members of the community that do not have health insurance. If formed, the group could explore a variety of models (such as the Memphis Plan) from other communities throughout the nation. Many of the models include health coverage and low cost health insurance products for the uninsured. For more information contact Laura McCrary.

Behavioral Health Transformation Proposal

Members of the Metropolitan Kansas City behavioral health community have worked together since January 2008 to develop a proposal to improve access to an integrated and well- coordinated system of quality behavioral health and primary health care in the Kansas City metropolitan area. The fundamental premise of the proposal is that all residents of the Kansas City metropolitan area — especially those that are uninsured or underinsured or who receive Medicaid — need improved access to quality behavioral health services.

The concept of improved access to quality behavioral health services is widely recognized. The Missouri Mental Health Transformation Initiative, funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), concluded its first planning cycle by recognizing that improved access to quality behavioral health services is essential. Likewise, the Metropolitan Mental Health Stakeholders Group — consisting of consumer advocates, mental health professionals and organizations, public administrators, correctional institutions, the legal community, etc. — concurs that access to quality behavioral health services is a priority concern for each of their respective clients and consumers. The Regional Health Care Initiative has also identified an overriding need for improved access to quality behavioral health care for those with co-occurring physical and mental health diseases.

Kansas City Medicine Cabinet announces new public-private partnership

On May 13, the Kansas City Medicine Cabinet, a program of the Baptist-Trinity Lutheran Legacy Foundation, announced a new collaborative partnership with Price Chopper grocery stores. The partnership will help increase access to emergency prescriptions for those who are unable to pay for medically necessary items due to a short-term crisis. Pharmacists at Price Chopper stores are learning about the Kansas City Medicine Cabinet program and will provide information about the program and the location of its intake sites to individuals who cannot pay for their prescriptions. To qualify for the program, people must have an urgent need for assistance and must earn less than 200 percent or the federal poverty level — about $42,000 for a family of four. For more information contact Christine Parrish, Program Director, Kansas City Medicine Cabinet.