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OCTOBER 2007 ISSUE

Safety Net Working Group develops committee structure

Safety Net Working Group members at the October meeting

Co-chairs Pettett and Haley

The Safety Net Working Group’s September retreat culminated in the development of a committee structure and identification of key activities for each committee to pursue. Co-chairs Gary Pettett and Michelle Haley, both of Children's Mercy Hospital, worked with members of the Working Group to identify more than 80 possible activities that have the potential to improve health care for the underserved in the Kansas City metropolitan area, and grouped these activities into four work areas to form a committee structure. The four committees are:

• Access to Care
• Provider Relations and Advocacy
• Outcomes/Information Sharing/Information Systems
• Continuum of Care

Working group members each chose at least one committee to join, and several members chose more than one. The committees will meet monthly and will report to the full Safety Net Working Group. Short summaries of the committee meetings will be provided in this newsletter each month, and approved meeting minutes will be available online.

October committee meeting summaries

Outcomes/Information Sharing/Information Systems

Lombardi

Davis

Committee members selected Gregg Lombardi, Western Missouri Legal Aid, and Linda Davis, KC CareLink, to serve as co-chairs. The committee discussed current local, regional and state technology initiatives, and members noted that very little technology information is available — and what is available is fragmented. To address this, the committee will recommend conducting a technology assessment — both internally, to determine the current technology capacity of the safety net providers, and externally, to identify outside technology initiatives that may impact safety net providers — once details are worked out.

Members determined that their primary role will be in relation to technology development and utilization rather than outcomes, and suggested that outcomes for the Safety Net Working Group should be developed by committee chairs. The group also expressed support for MARC’s work to develop a broad database of regional health indicators. The next meeting will be held on Nov. 19 at 9:00am.

Access to Care

Cindy Moore, Mercy and Truth Health Center, was selected as chair at the committee’s first meeting. Committee members reviewed a list of key activities and requested more information regarding existing transportation services to medical appointments. MARC staff will provide updated transportation information at the next meeting.

Committee members discussed the difficulty of navigating the safety net system and the role that case managers play in helping patients. Much of the discussion centered on services available in the community and the need for a coordinated system to disseminate information. Committee members also discussed a shortage of locations where patients can have their medical needs assessed and be referred to appropriate services.

Finally, committee members discussed the need to standardize screening procedures among safety net clinics. This would allow one screening to determine a patient’s eligibility for all clinics with similar requirements. Eligibility requirement information will be gathered from clinics as the first step in addressing this problem. The committee will meet again on Nov, 20 at 9:00am.

Provider Relations and Advocacy

Levin

McCandless

Committee members selected Bridget McCandless, Jackson County Free Health Clinic, and Liz Levin, Cabot Westside Clinic, to serve as co-chairs. After reviewing the activities assigned to the committee, members determined that their greatest advocacy impact would be at the local level. They noted that it is critically important for the Kansas City region to understand the urgency associated with providing health care to the uninsured and medically underserved.

Members determined that accurate data is key to the advocacy process and that not enough regional health care data is available. To begin gathering data, members will focus on patients with chronic disease management concerns. The committee will also work with local hospitals to try to obtain aggregate data on the top five medical diagnoses seen in both emergency rooms and hospitals. Ideally, this data will be categorized by insured and uninsured patients.

Members noted that it is essential to stay apprised of state legislation as health reform initiatives move forward in both Kansas and Missouri, and asked that future meetings focus in part on sharing information from the state and local level that might impact safety net services. Finally, committee members discussed methods to encourage relationships between safety net providers. The next committee meeting is scheduled for Nov. 14 at 11:00am.

Continuum of Care

Ampspacker

Jacque Amspacker was selected to chair the committee at its October meeting. Committee members reviewed a survey template designed to gather basic information regarding each safety net provider. This information will be compiled by clinics and disseminated to safety net providers, social service agencies and other interested stakeholders. The committee members modified the template for clarity and to ensure that it gathers all essential data, and agreed to share the template with the full Safety Net Working Group for review at its next meeting.

The group also discussed a definition for urgent care and agreed that urgent care should be defined as medical care provided during the day it is requested (including weekends and evenings). The next committee meeting has not yet been scheduled.

Insure Missouri update

In September, Missouri Governor Matt Blunt announced a new health care initiative called Insure Missouri. If fully implemented, the three-phase program would expand health coverage to 190,000 uninsured Missourians. However, the program is set up in three phases and Phases 2 and 3 will require approval by the state legislature.

The three phases of Insure Missouri are:

• Phase 1: The first phase would expand coverage to low-income working parents and caretakers with incomes at or below 100 percent of the federal poverty level (FPL). This expansion is expected to cover about 54,500 uninsured individuals. Enrollment would begin in February 2008, and service provision would begin on March 1, 2008.
• Phase 2: The second phase would expand coverage to working parents, caretakers and childless adults with incomes up to 185 percent of FPL. This expansion is expected to cover about 107,000 individuals in fiscal year 2009, with coverage phased in incrementally according to income levels. Implementation of this phase would require the Missouri General Assembly to pass legislation to expand coverage and appropriate necessary funds.
• Phase 3: The third phase would provide assistance to small businesses that provide health insurance to their employees. Details regarding this plan are not yet available. The state estimates that 28,000 individuals would participate in this phase, which would begin in January 2009. Implementation of this phase would also require legislation and appropriations by the Missouri General Assembly.

Insure Missouri will not restore coverage for seniors and people with disabilities who lost coverage under 2005 legislation. While eligibility for working parents could climb as high as 185 percent of FPL, without new initiatives the eligibility level for seniors and people with disabilities will remain at 85 percent of FPL.

The benefits package for Insure Missouri recipients is not equivalent to the MO HealthNet benefits package. Based on requirements listed in a Request for Proposals (RFP) released in early October, it appears that Phase 1 of the program will provide a majority of the services covered by MO HealthNet, but the program will not include dental care, vision services and hearing aids which were provided under the Missouri Medicaid program prior to the 2005 legislative cuts. Benefits to be included in later phases of the Insure Missouri program have not yet been announced.

State officials indicate that individuals will be able to apply for Insure Missouri in a variety of ways, including on the Internet, at family support division offices and perhaps at hospitals and health clinics. Parents with children who already receive MO HealthNet services will receive a letter indicating that they are eligible for the program and telling them how to apply for services.

In order for the program to be fully implemented, the Missouri General Assembly must enact legislation to expand coverage beyond 100 percent FPL and appropriate funds. The state does have current budget authority to enact Phase 1 for working parents and has issued an RFP to seek bids from health insurance plans on providing services under this program. The federal government (i.e., the Centers for Medicare and Medicaid) will also have a role in determining whether the program is fully implemented. Traditionally, CMS has been very involved in determining the criteria for waivers.

It is important for the Safety Net Working Group to closely follow the implementation of Phase 1 of Insure Missouri and monitor legislative activity related to Phases 2 and 3. Phase 1 will require $19.5 million in general revenue and will generate $32.1 million in federal matching funds. The amount of general revenue funds increases in 2009 to $43 million and plateaus at $48.6 million in 2012. However, other funds — including employee- and employer-paid premiums, disproportionate share transfers and federal reimbursement allowance funds — balloon to more than $445 million in 2012 and generate $487.6 million in federal matching funds. This results in total funding in 2012 of $980.7 million to support the program.

Kansas Health Policy Authority develops health care reform plan

The Kansas Health Policy Authority (KHPA) held a two-day meeting to discuss health care reform in October, completing a five-month process that was designed to gather health information from Kansas residents and national experts. The KHPA must submit a final report to the state legislature on November 1, 2007. This report will be used by members of the 2008 legislature to shape future health policy and procedures in Kansas.
 
During the meeting, KHPA members reviewed 21 health reform recommendations that had been previously developed and prioritized them into three categories: critical — to be implemented immediately; medium — with a short delay in implementation; and low — to be implemented later. The recommendations include the following:

Critical

• Expand premium assistance to cover childless adults up to 100 percent of the federal poverty level
• Aggressive marketing and enrollment for Medicaid/SCHIP eligible children not currently enrolled; if 90 percent of children are not enrolled after three years, consideration of mandatory health insurance for children under 19 years of age
• Small Business Market health insurance reforms, including:
• Section 125 plans
• Redefining small groups
• Reinsurance and development of new high-risk pool
• Web-based insurance clearinghouse
• Pilot projects
• Promotion of health literacy for Medicaid and Health Wave enrollees
• Statutory definition of a Medical Home
• Increased Medicaid provider reimbursement for primary care and prevention services
• Increased tobacco user fee of 50 cents per pack of cigarettes, raising $50 million annually
• Statewide ban on smoking in public places
• Inclusion of the commissioner of education on the KHPA Board
• Encouraging the collection of BMI (body mass index) data on all Kansas children
• Promotion of healthy food choices in schools
• Provision of dental care to pregnant women enrolled in Medicaid
• Increased physical education in schools and expansion of coordinated school health programs
• Improved tobacco cessation programs within Medicaid
• Expanded cancer screening through early detection works program

Medium

• A Quality Transparency Project to collect and publicize health care quality and cost data
• Increased state partnerships with community agencies
• Wellness grant program for small business
• Healthier food options for state employees

Low

• Implementation of a statewide community health record (funding already included in KDHE budget)
• Promotion of insurance card standardization

KHPA estimates that with full implementation of the reforms listed above the number of uninsured Kansans would decrease by 86,000. The KHPA Board and staff will present a report on these recommended options to the Joint Committee on Health Policy Oversight on November 1, 2007. For more information visit the KHPA Web site.

Premium assistance plans move forward in Kansas and Missouri

Premium assistance plans that will expand Medicaid coverage to working low-income parents and their families are moving forward in both Kansas and Missouri. The premium assistance plans in both states will use a combination of state and federal Medicaid funds to subsidize the purchase of private health insurance plans, either through an employer sponsored plan or through a state-procured health insurance plan.

The Kansas Health Policy Authority issued a Request for Information (RFI) on Oct. 8, and the Missouri Department of Social Servicesissued a Request for Proposals on Oct. 10.

Kansas sought input on various aspects of the structuring of state-procured plans, including the minimum level of benefits, the number of plans available and the plan type. Responses were due earlier in October. Missouri is seeking proposals from the health carrier community interested in providing coverage through the Insure Missouri program. Proposals are due by January 2, 2008.

New health care advocacy organization recommended

The Missouri Health Care Advocates Network has developed a list of recommendations related to health care legislative advocacy. The recommendations include the formation of a new advocacy organization that is inclusive, diverse, and complementary to existing advocate groups and collaborative efforts already underway in Missouri. The purpose of the new organization would be to enhance the health advocacy capacity that currently exists in Missouri without duplicating current efforts.

The report identifies numerous health care advocacy efforts; however, it notes that Missouri does not currently have the a single unified and collective voice that is devoted solely to working on the overall goal of affordable, reliable, adequate health care for all Missourians. A new entity would fill that gap, and enhance the efforts of already existing groups. See full report.

Blue Cross and Blue Shield hosts health care summit

Mongan

In October, Blue Cross and Blue Shield of Kansas sponsored a Health Care Summit at Liberty Memorial called Health Reforms: National Trends and how Kansas City Measures Up. The keynote speaker was James Mongan M.D., president and CEO of Partners in HealthCare, Boston, Mass. Dr. Mongan discussed the implementation of universal health care in Massachusetts and shared some of the unique demographic and policy perspectives that led to legislation requiring all Massachusetts residents to have health insurance. Dr. Mongan shared his experiences in developing and implementing health policy and the difficulties that partisanship created. He noted that very often partisanship prevented meaningful change and used the president's recent SCHIP veto as an example.

Kansas Governor Kathleen Sebelius also spoke at the summit. She said that there are currently more than 300,000 uninsured Kansans and that health care problems have reached such a high level of concern that the state and the nation have reached a tipping point. Governor Sebelius said that it is critical to incorporate evidence-based practices into health care and that labor and business are now working together to develop a health care solution. She informed summit participants that the Kansas Health Policy Authority (KHPA) will provide a report on reform options for the legislature to consider during the 2008 legislative session. She also said that she supports a tobacco tax to fund health reform and that the single most effective way to stop kids from smoking is to raise the price of cigarettes through a tobacco tax.

Steven Aldana Ph.D., director of the Lifestyle Research Group, shared data related to obesity and diabetes. He specifically noted the difficulty that children and adults have in negating marketing images from the food industry. He presented statistics from Venkat Narayan (JAMA, 2000) regarding children that were born in 2000. Of the children studied, 49 percent of Hispanics, 43 percent of Blacks and 35 percent of Caucasians will have diabetes by age 50. He pointed out that this is not the result of a change in genetics; rather it is a change in the environment. He said that society is much more sedentary than 20 years ago and people consume much larger quantities of food. Dr. Aldana noted that there are some positive advances in wellness programs sponsored by business and that the state of Indiana has legislated a 50 percent tax credit for companies that implement a wellness program.

A panel of local health care professionals discussed the health dilemma faced by the states of Kansas and Missouri. The panel included Rex Archer M.D., director of health, City of Kansas City, Mo.; Jack Bastable, national practice leader, CBIZ Benefits and Insurance Services, Inc.; Rick Kahle, president, Employee Benefits Division, Lockton Benefit Company; Gregg Laiben, M.D., medical director, Primaris; and James O’Keefe, M.D., dDirector, Preventive Cardiology Program, Mid America Heart Institute.

The summit concluded with an address by Tom Bowser, president and CEO of Blue Cross and Blue Shield of Kansas City. Tom shared a compelling “Did You Know” video that provided sobering health care statistics. Tom also thanked all in attendance and encouraged the members of the audience to take personal responsibility to improve the health of all Kansas City residents.