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NOVEMBER/DECEMBER 2007 ISSUE

Safety Net Working Group finalizes principles, approves survey template

The Safety Net Working Group (SNWG) met on Oct. 30, and finalized its Principles of an Effective Safety Net System. The principles define a vision for the safety net system in Greater Kansas City and provide a gauge which can be used to assess future activities. The group also approved a template for a survey of safety net providers. This survey will gather basic information regarding each safety net clinic and the resulting data will provide the basis for development of a searchable information sharing system that can be used by clinic personnel as well as other social service agencies. 

The SNWG defined parameters for member participation in committee meetings, agreeing that all members may attend any committee meetings in which topics of interest to them are discussed, although decision makers must be members of the committee. Lastly, the Safety Net Working Group agreed to revise its committee structure and add a stand-alone committee on outcomes. This committee’s membership will comprise the co-chairs of the Safety Net Working Group and committee chairs. This change will allow the Information Sharing and Technology committee to focus its efforts on technology initiatives. The Outcomes committee will convene in December and further define its role and responsibilities. Full SNWG Minutes are available online at www.marc.org/healthinitiative

November Committee Meeting Summaries

• Provider Relationship and Advocacy

The Provider Relations and Advocacy Committee met on Nov. 14. Committee members focused on developing data to support advocacy efforts, beginning with a process to gather data from hospital emergency departments. The intent is to quantify inappropriate use of emergency room services, for both patients and hospitals, often caused by access barriers or lack of prevention for chronic diseases. The committee developed a set of questions for the Missouri Hospital Association and Metropolitan Ambulance Services Trust. The committee will use the information gathered to formulate policy and program recommendations for the full Safety Net Working Group.

The lack of a strong, organized health advocacy voice in the metro area — particularly on the Missouri side of the state line — was also discussed. The committee decided to investigate the formation of a metro health advocacy network or organization, possibly modeled on the Child Abuse Roundtable.

Finally, the committee talked about holding a conference in September 2008 to better engage the community in these issues and to provide accountability for the work of the Safety Net Working Group. The conference will feature national speakers and provide a venue to share the achievements of the Safety Net Working Group.

• Continuum of Care

The Continuum of Care committee met on Nov. 14. The committee reviewed safety net survey data and made decisions regarding the public and private data portions of the survey. Private data from the survey will be used by the committee to identify gaps in services, but it will not be a part of the public access Web site. The committee hopes to have the data compiled and analyzed by the January meeting.

The committee reviewed a list of urgent care providers in the Kansas City area, and decided that the SNWG’s focus in urgent care should be on providing access to care during non-traditional hours. The committee defined “urgent care” as immediate care anyone can get during non-traditional hours. The committee also defined “extended hours” as non-traditional clinic hours that serve urgent needs and extend accessibility for patients unable to access service during traditional hours. The committee then determined next steps:

• Identify who provides urgent and extended care.
• Determine whether the urgent care and extended hours are used or needed.
• If necessary, develop a strategy for expanding urgent care and extended hours.

Lastly, the committee examined the issue of pharmaceutical assistance for safety net clinics. Because of the availability of low-cost generic medicines this is now seen as a lower priority. The committee requested more research to identify those going without prescriptions.

• Information Sharing & Technology

The Information Sharing and Technology committee met on Nov. 19. The committee members discussed the importance of having an internal technology assessment for Safety Net Clinics. The primary purposes of the assessment are: to identify current technology capacity; to evaluate communication and information sharing among safety net providers; and to determine readiness to build IT capacity. The assessment will result in a one-page technology assessment for each clinic and a coordinated technology strategic plan for all safety net providers.

The committee discussed several other issues, including the unique characteristics of each safety net clinic and the importance of maintaining clinic autonomy; how funding might be sustained with a streamlined technology process; and how a reporting system could be developed to gather and prioritize data for local, state and federal officials.

Lastly, the committee reviewed and approved a “best practices” document, agreeing to take the concept to the Safety Net Working Group for approval.

• Access to Care

The Access to Care committee met on Nov. 20. Committee members reviewed transportation options currently available for non-emergency medical transportation (NEMT).

The findings indicated that most NEMT transportations services have a fee system and cover small, specific geographic areas. Only four vendors offer free transportation services to low-income clients. Generally, those who are over 60, disabled, have HIV or cancer, or are on Medicaid have access to free transportation. The committee examined the complexities surrounding NEMT and determined that additional research should be done regarding liability issues, funding and non-traditional social services that may provide NEMT transportation.

The members also reviewed a care management model. The model comes from Community Health Access Project (CHAP) based in Mansfield, Ohio. The committee approved of the model and thought it would be an excellent choice for care management because of the different pathways to final outcomes for clients. Also, they could see the potential for additional funding from Kansas and Missouri Medicaid. They agreed to fully investigate the model and to invite representatives that have implemented the model to Kansas City.

Web-based mapping for Safety Net Providers

The Mid America Regional Council (MARC) is developing a Web-based mapping application that will provide information about the location and attributes of safety net providers to the public, social service agencies and health care providers. The easy-to-use program will allow the user to search by a variety of criteria through drop down menus, and enter information about a patient’s specific needs to search for services. For example, a social service agency might search for a clinic that provides services to children, accepts Medicaid, is on the bus line and is located in a particular city. The application will display a list of safety net providers that fit the search criteria and provide a map with directions to each clinic. The application will also allow the user to zoom and change the map view, and will provide links to photos of clinics, lists of clinic eligibility requirements and transportation options.

Before the application is finalized, a password-protected Beta site will be used to test the functionality. The test site will be shared with community members to gather input on the site design and the ease of use. The anticipated timeline for completion is Spring 2008. A sample map page is available online.

Journey into Wellness Strategic Planning

MARC is working with Journey into Wellness to undertake a comprehensive review of wellness initiatives in the Kansas City region. Recognizing the connection between wellness and life style, many local organizations have initiated programs or strategies that promote healthy living styles.  However, there is no coordinated or coherent effort to bring these organizations together to measure health outcomes or guide future initiatives based on outcome data. 

In order to understand the composition and structure of local wellness programs, MARC will complete an assessment of the current scope of work being done in the area of wellness in the Kansas City area. This will begin with interviews with key organizations and stakeholders involved in wellness initiatives. The interviews will be used to determine the scope of work currently underway, funding resources and relationships between organizations. Information gathered during the interviews will also be used to assess the merits of and strategies for developing a regional Journey into Wellness initiative and identify potential participants in a regional wellness effort. 

MARC will also conduct a national scan to determine how other communities and regions have approached this issue and whether national models exist that could be replicated in the region. 
This work will form the basis of a draft strategy to build a regional wellness coalition or alternate model. The draft will offer an outline of the initiative’s structure, leadership, potential members, goals and principles. The draft strategy should be completed in Spring 2008.

Kansas Premium Assistance Plan

The Kansas Health Policy Authority (KHPA) anticipates issuance of a Request for Proposals (RFP) in December 2007. Health insurance plans interested in participating in Healthy Choices, the new Kansas premium assistance program, are encouraged to submit proposals. The Healthy Choices program will use federal and state Medicaid funds to subsidize the purchase of employer sponsored health insurance or provide a state procured private health insurance plan to low-income workers. The program was authorized in May 2007 with the signing of Senate Bill 11, and is slated for implementation in January 2009.

A Request for Information (RFI) issued in October 2007 resulted in significant input from interested stakeholders regarding the Healthy Choices program.  A synopsis of the RFI responses is available on the KHPA Web site. Stakeholders and KHPA agree on the following basic concepts:

• Healthy Choices is likely to be a managed-care product.
• Consumers will have a choice of products but will be limited to three basic plans.
• Plans will be required to offer statewide coverage.
• Plans will be required to meet or exceed Medicaid network geographic access requirements.
• Premiums will not be charged to currently authorized populations.
• KHPA is committed to working toward full-year eligibility.