News from Community Clinic Voice

The Department of Health and Human Services (HHS) recently proposed new rules to implement the Navigator and consumer assistance programs for the new health insurance Exchanges established by the Affordable Care Act (ACA). The proposed rules outline conflict-of-interest, training and certification, and meaningful access standards for Navigators and non-Navigator assistance personnel for Exchanges, writes Insure the Uninsured Project (ITUP).

Read the full summary. (April 10, 2013)

CMS Opens Applications for $54 Million in Grants for ACA Exchange Navigators

On 4/9/13, CMS opened the grant application process to help fund ACA Exchange navigators, which will provide guidance to individuals enrolling in the federally run and partnership health insurance exchanges under the Affordable Care Act.

The grants are available to self-employed individuals, private companies and public organizations that will serve as navigators in the 33 states with federally run or partnership exchanges; organizations and individuals that receive compensation from health insurers are not eligible...

Matt Ingram of the Metta Fund writes in Health Affairs about an innovative new partnership with UCSF's Center for Excellence in Primary Care and San Francisco Health Plan that uses coaches to work intensively with all twenty-nine safety-net clinics in San Francisco, including San Francisco Community Clinic Consortium sites, Department of Public Health clinics, and UCSF痴 primary care clinics, to bring patient-centered care to 130,000 of the city痴 most underserved patients.

The Metta Fund is supporting the initiative, called Share the Care, with a three-year grant totaling $1 million. While consultants have been used to a growing extent in recent years, particularly around improving patientsexperience at clinics, this is one of the first programs to deploy coaching in such a deep and coordinated way, with so many clinics at once, says Ingram.

The coaches use Tom Bodenheimer痴 Building Blocks of High-Performing Primary Care model to ensure consistency and simplicity, while allowing for individual variation between sites to ensure the best fit.

Share the Care aims to achieve the same primary care transformations for which private health systems are striving, but in a diverse safety-net population in which 90 percent of patients have incomes below 133 percent of the federal poverty level...

Countries around the world have realized some success in achieving the "Triple Aim" of health care: better health and better health care at lower cost. A new series of Commonwealth Fund穆upported articles in the April issue of Health Affairs describes the lessons these successes hold for the U.S. health care system.

Read about: - How Australia instituted a strategy for reviewing and covering new prescription drugs that saved money without compromising quality. - How value-based cost-sharing has reduced prescription drug costs in some countries and brought higher-quality care to patients in others...

Investing strategically in proven, community-based prevention programs could offer a substantial savings over traditional medical treatments for illnesses such as diabetes and cardiovascular disease, lowering health care costs and improving people痴 quality of life.

This brief from Robert Wood Johnson Foundation summarizes the findings and recommendations from four major studies released between 2008 and 2011.

Read more on prevention from RWJF.

The Bilirakis-Pallone Health Center funding support letter deadline has been extended to April 17th due to the release of the President’s FY14 budget on April 10th, NACHC reports.

Nearly 100 U.S. Representatives have already signed on to the Bilirakis-Pallone letter. See the letter, current list of signers, and recommended action from NACHC.

Read more on health center funding the the President's FY17 budget from NACHC.

Ask Emily is a new biweekly column by Emily Bazar of the CHCF Center for Health Reporting, answering your questions about ObamaCare and what it means for you. See: http://vimeo.com/62749872#

This year’s theme, Advance Health Equity Now: Uniting Our Communities to Bring Health Care Coverage to All is a call to action, a charge for all of us to unite towards a common goal of improving the health of our communities and increasing access to quality, affordable health care for everyone. Download tool and resources.

April also marks the second anniversary of the launch of the HHS Action Plan to Reduce Racial and Ethnic Health Disparities and the National Stakeholder Strategy for Achieving Health Equity.

Read more at: http://minorityhealth.hhs.gov/actnow/

Shared savings models—allowing providers to keep a portion of the money they save caring for patients—have been touted as one method for aligning the incentives of providers and payers. Most prominently, shared savings is a central element of the Affordable Care Act's Accountable Care Organizations (ACOs).

But will it work? Ultimately, finding the "just right" solution will require some compromise between financial risks and rewards for providers and for payers, writes Brendan Saloner, in the a href="http://www.rwjf.org/en/blogs/human-capital-blog/2013/03/a_goldilocks_theor.html?cid=xtw_humancap"first in a series of essays, reprinted from the Leonard Davis Institute of Health Economics’ eMagazine, in which scholars who attended the 2013 AcademyHealth National Health Policy Conference on "New Models to Pay for Health Care," reflect on the experience. Read more.

California has made improvements in key public health measures, such as rates of chronic health conditions, according to the 20th anniversary edition of County Health Status Profiles from the California Department of Public Health.

The report found a statewide decrease in the rate of most illnesses from 2006 to 2011, including: all types of cancer; diabetes; heart disease; and stroke. The number of AIDS and gonorrhea cases also decreased statewide during that time.

In addition, state mortality rates also decreased for: homicides; motor vehicle crashes; and unintentional causes, such as drug overdoses. However, the report found that more Californians died from Alzheimer's disease during that time period...

California Healthline asked legislators, stakeholders and consumer advocates to weigh in on a bill before the state Legislature calling for the state to establish a minimum amount of charity care for private, tax-exempt not-for-profit hospitals.

AB 975 -- by Assembly members Rob Bonta (D-Oakland) and Bob Wieckowski (D-Fremont) -- would more tightly define charitable care and stipulate that private not-for-profit hospitals may not have operating revenue exceeding 10% of operating expenses, which includes charity care, community benefits and all other normal business expenses. State law currently requires not-for-profit hospitals to provide charity care, but because definitions of charity care are not specifically spelled out, minimum requirements are not clearly defined. This bill hopes to remedy that.

Read responses at: http://www.californiahealthline.org/think-tank/2013/should-calif-set-charity-minimum-for-not-for-profit-hospitals.aspx

The UCLA International Medical Graduate Program aims to help immigrant doctors obtain their U.S. licenses in return for their pledge to practice primary care medicine in underserved areas of California, Kaiser Health News reports.

The program offers stipends, mentorships and other resources. Program enrollees must agree to work in an underserved area of the state for two or three years after they receive their license.

The program specializes in helping Latino immigrants or individuals from other Spanish-speaking countries who are seeking a medical license, while helping to address the shortage of primary care doctors in the state.

About a quarter of physicians practicing in the U.S...

The latest CPCA Weekly Update of 4/4/13 reports on:

• Covered California 3/21 Board Meeting Highlights

• Weekly Advocacy Call Wednesday, April 10 & every Wednesday at 11 am - Updates on Federal and State Budget & Legislation Call-in Number: 1-866-469-3239 / Participant Code: 56814021 See summary of the April 3rd call

• FQHC/RHC Retro Rate Adjustment EPC Implemented 3/28/13- This EPC included rate increases / decreases from April – August 2012; resulting in over $21.7 million to health centers!

• Update from Medi-Cal - HIPAA 5010 Extension of End Date to April 30, 2013

• Important Deadline Information for HRSA FY12 Quality Improvement Supplemental Funding Recipients - June 30, 2013 deadline to apply for PCMH

Plus other news, trainings, funding notices and much more.

Find the CPCA Update and several topic-specific Newsletters at: http://www.cpca.org/index.cfm/newsletters/

Shawn McIntosh, a project manager for APHA’s Community Transformation Grant work in the Center for Public Health Policy, writes on the impact of Community Transformation Grant (CTG) investments across the country and shares how they are bringing unprecedented systemic changes to community health through transportation improvements, disease prevention programs, healthy food initiatives and more.

In September 2011, the CTG Program, which is funded by the U.S. Department of Health and Human Services and administered by the Centers for Disease Control and Prevention, awarded $103 million to 61 entities in 36 states, including state and local health departments, tribes and territories and nonprofit organizations. In 2012, an additional $70 million was award to 40 communities with fewer than 500,000 people to prevent chronic disease and promote health. In 2013, CTG programs are beginning to realize their potential to create a culture of health...

CONTROLLING JUNK FOOD and the Bottom Line, a report from the Illinois Public Health Institute, says that implementing strong nutrition standards in schools is an important component of comprehensive school health reform. Changes to nutrition standards are often challenging to adopt due to concerns about negative impacts on school profits and fundraising. Yet, as is shown by this study, some districts across the country have implemented stronger nutrition standards without a significant negative financial impact.

This report highlights case studies from middle schools and high schools in eight diverse districts across the country that illustrate it is possible for schools and districts to improve nutrition standards without experiencing significant financial losses. This study focused on policies and practices in middle and high schools (rather than elementary or early childcare settings) because competitive foods are most widely available in the secondary school levels...

Health Disparities are still “Alive & Well” in America, write California Health Advocates.

An Infographic with data from the 2012 National Health Interview Survey, the Centers for Disease Control and Prevention and the National Center for Health Care Statistics highlight some of these the health inequalities, especially those of African Americans: Only 55.9% of African Americans expected to live in good health as opposed to 69.4% of non-Hispanic Whites. See more.

How Will We Know If Health Care Reform Is Working? Using OSPHD Data to Track the Impact of the ACA on Population Health

The California Office of Statewide Health Planning and Development (OSHPD), in collaboration with Dialogue4Health, the Center for Health Improvement, and the California HealthCare Foundation, has initiated this four-part Web Forum series in response to a report by the University of Minnesota’s State Health Access Data Assistance Center. This report identified 51 metrics that California could use to measure the impact of the Affordable Care Act (ACA) on health insurance coverage, affordability and comprehensiveness of coverage, and access to care – including metrics that can be derived from the data collected by OSHPD.

While the University of Minnesota report did not suggest any specific population metrics in its recommendations, the ACA calls for the National Quality Strategy to “improve the delivery of health care services, patient health outcomes, and population health,” and recent activity in California, in particular the Let’s Get Healthy California Task Force report, have highlighted the need to focus on population health metrics in order to achieve the triple aim of better health, better care, and lower cost. As such, the OSHPD dataset that will be featured in this Web Forum are California indicators that have been developed in collaboration with the federal Agency for Healthcare Research and Quality...

An article from i2i Systems founder Janice Nicholson examines three top challenges they have experienced in helping organizations realize the benefit of health IT adoption:

- Limitations Within EHRs that Yield Roadblocks; - Health IT Capabilities are Behind the Times; and - Lack of Incentives.

She also sees various opportunities. First, Health IT vendors must provide clinics open access to their data, and remove barriers to standardization and interoperability.

Second, we need to face the reality of what EHRs currently deliver and help providers understand the intelligence tools they need.

Third, we need to increase the percentage of revenue directly related to pay-for-performance...

Patient-centered end-of-life care, ensuring that a dying person's wishes are known and followed, results in happier, less depressed patients who are in less pain and survive longer, according to research from UCLA. By eliminating aggressive measures that patients might not want, this type of care also helps to keep costs down for those with advanced cancers and other diseases that can't be effectively treated.

Medical care during the final stages of life is often poorly coordinated and fails to take into account a patient's preferences, the UCLA researchers say. It also consumes the lion's share of health care dollars. A 2004 study found that 30 percent of Medicare resources are expended on the 5 percent of beneficiaries who die each year, and one-third of the costs in a patient's last year of life are amassed during the final month...

Epocrates point-of-care mobile software, MedStartr, a healthcare innovation crowdfunding platform, and Voxiva, which delivers interactive mobile health services like Text4Baby, made the list. See the infographic from Health Care Communication News.

The Prevention Institute highlights neighborhood-level changes to the built environment that can have a positive influence on the health of community residents, especially in low-income communities. The profiles demonstrate how health practitioners, community members and many others can work together to improve community well-being by making changes to the built environment.

And see more profiles of Communities Taking Action on Health Equity from PI.