preparing for transformation · 2016. 4. 5. · h e a lt h c a r e pa r t n e r s h i p / 2 0 1 2...
TRANSCRIPT
-
S A C R A M E N T O R E G I O NH E A L T H C A R E P A R T N E R S H I P / 2 0 1 2
A Market Analysis of the Sacramento Region Primary Care Safety Net
A Sierra Health Foundation initiative
Preparing for Transformation: Rethinking, Revitalizing and Reforming the Sacramento Region’s Health Care System
S A C R A M E N T O R E G I O NH E A L T H C A R E P A R T N E R S H I P / 2 0 1 2
A Strategic Plan for the Sacramento Region
A Sierra Health Foundation initiative
Preparing for Transformation: Rethinking, Revitalizing and Reforming the Sacramento Region’s Health Care System
-
S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P
This strategic plan for the Sacramento Region primary care safety net system was commissioned and funded by Sierra Health Foundation with additional funding from
The California Endowment and Sacramento Region Community Foundation. The strategic planning process was facilitated by The Abaris Group,
Public Health Institute and Hatches Consulting.
Consultant Team
The Abaris Group
Mike Williams, MPA/HSA, Project Lead
Marsha Regenstein, PhD
Alaina Dall
Juliana Boyle, MBA
Mark Zocchi
Chuck Baucom
Public Health Institute
Carmen Nevarez, MD, MPH
Marisel Brown, MPH, MSBA
Art Chen, MD, MPH
Nancy Shemick, MPP
Hatches Consulting
Barrett Hatches, PhD
The Abaris Group, Public Health Institute, Hatches Consulting, Mighty Pen Writing & Editing and Sierra Health Foundation
contributed to the writing and editing of this strategic plan report.
-
S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 1
Table of ContentsAcknowledgements 1
LetterfromtheFunders 4
LetterfromCongresswomanDorisMatsui 5
ExecutiveSummary 6
PreparingforTransformation 12
ProjectOverview 13
ProjectTimelineandProcess 14
SacramentoRegion’sCurrentSafetyNet 15
TheSuccessfulSafetyNet 16
DevelopingaStronger,HealthierRegionalSafetyNet 18
CareCoordination 19
Collaboration 21
CapacityBuilding 22
PrimaryCare/SpecialtyCareIntegration 23
What’sNext 24
Conclusion 26
-
S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 1
AcknowledgementsThank you to the many stakeholders who contributed their time, expertise and involvement with the development of this strategic plan. Sincere apologies to anyone who may have been inadvertently left off this list.
JonathanLehrman,MDAccessElDorado
ChristineSisonAccessElDorado
SandiSnelgroveAnotherChoiceAnotherChance
SeanAthaAnthemBlueCross
KerryBrownAnthemBlueCross
KimWilliamsBuildingHealthyCommunities
JosephHafkenschielCaliforniaAssociationforHealthServicesatHome
ChristineSmithCaliforniaConsortiumforUrbanIndianHealth
RosanaJacksonCaliforniaDepartmentofPublicHealth
LeticiaAlejandrezCaliforniaFamilyResourceAssociation
DorethaWilliams-FlournoyCaliforniaInstituteforMentalHealth
CarolLeeCaliforniaMedicalAssociationFoundation
ElissaMaasCaliforniaMedicalAssociationFoundation
EdMendozaCaliforniaOfficeofStatewideHealthPlanningandDevelopment
RonaldSpingarn CaliforniaOfficeofStatewideHealthPlanningandDevelopment
JonathanTeague CaliforniaOfficeofStatewideHealthPlanningandDevelopment
SandraPerezCaliforniaOfficeofthePatientAdvocate
MarthaTorres-MontoyaCaliforniaOfficeofthePatientAdvocate
KiranGrewalCaliforniaPharmacistAssociation
DeborahOrtizCaliforniaPrimaryCareAssociation
DavidQuackenbushCaliforniaPrimaryCareAssociation
SteveBarrowCaliforniaStateRuralHealthAssociation
AlHernandez-SantanaCalifoniaStateRuralHealthAssociation
MartyKealeCapitolCommunityHealthNetwork
AshelyTolleCapitolCommunityHealthNetwork
JohnAdamsCASAElDorado
DebbieBrussard CenterforAIDSResearch,Education&Services
RobertKamrath CenterforAIDSResearch,Education&Services
JanetParkerCenterforAIDSResearch,Education&Services
WendyPetkoCenterforCommunityHealthandWell-Being,Inc.
KarenShoreCenterforHealthImprovement
TaraDavisCenterForInnovativeCommunitySolutions
SheliaDuruisseau-SidqeCenterForInnovativeCommunitySolutions
AutumnValerioCenterforMulticulturalDevelopment
CathyFreyCentralValleyHealthNetwork
LisaDaviesChapa-DeIndianHealthProgram,Inc.
RobinAffrimeCommuniCareHealthCenters
LeonSchimmel,MDCommuniCareHealthCenters
AlanLangeCommunityLinkCapitalRegion
ArielLovettCommunityRecoveryResources
BrianGraafCommunityResourceProject
KellyBennett-WoffordCovertheKids
JoilXiongCovertheKids
MichaelNegrete,PharmD CPhAandCaliforniaNorthstateUniversity
KaciBaldiDignityHealth
RosemaryYountsDignityHealth
LizDowellDivideReadyby5
JohnBachman,PhDElDoradoCommunityHealthCenter
JamesEllsworth ElDoradoCommunityHealthCenter
-
Respi te Par tnership Col laborat ive | P a g e 6 Respi te Par tnership Col laborat ive | P a g e 7
DeborahPalmer ElDoradoCounty
OliviaByron-Cooper,MPH ElDoradoCountyHealth&HumanServicesAgency
JoanMeisWilsonElDoradoCountyHealth&HumanServicesAgency
MichaelUngeheuer,RN,MN,PHNElDoradoCountyHealth&HumanServicesAgency
ChristyWhiteElDoradoCountyHealth&HumanServicesAgency
ChristineHoyt ElDoradoCountyPublicHealth
AlexBolteElHogarMentalHealthandCommunityServices
EileenSnickerFeministWomen’sHealthCenter
RickAlfordFirst5ElDorado
KathleenWalker First5ElDorado
DebraPayneFirst5Sacramento
JulieGallelo First5Yolo
DebraOto-Kent HealthEducationCouncil
RichardIkeda,MDHealthforAll
EffieRugglesHealthNetofCalifornia
MarthaGeraty HealthNetStateHealthPrograms
ScottSeamonsHospitalCouncilofNorthernandCentralCalifornia
JenniferAblogKaiserPermanente
EllenBrownKaiserPermanente
StephanieLandrum KaiserPermanente
MyrnaRivas KaiserPermanente
PatriciaRodriguez,RN,MPHKaiserPermanente
CarolSerreKaiserPermanente
ChaosarnChao LaoFamilyCommunityDevelopment,Inc.
ElisaHerrera LatinoLeadershipCouncil
BobLong,MD LatinoLeadershipCouncil
BillKennedy LegalServicesofNorthernCalifornia
FrankLemus,PhDLemusConsultingGroup
JenniferDwight-FrostMarshallMedicalCenter
SherryGeurinMarshallMedicalCenter
VernSaharaMarshallMedicalCenter
DennyPowellMercyGeneral
MarciaWells MercyNorwoodFamilyClinic
TonyBrowneMidtownMedicalCenterforChildren&Families
ElizabethCassin MidtownMedicalCenterforChildren&Families
RobertReichMidtownMedicalCenterforChildren&Families
RichardDanaMutualAssistanceNetwork
LeonardRanasinghe,PhD,MDNatomasCrossroadsClinic
BarbaraSayre-Thompson NCADDSacramento
GailCatlinNonprofitResourceCenter
RichardBurton,MD,MPHPlacerCountyHealth&HumanServices
JamesGandley,DDS,MPHPlacerCountyHealth&HumanServices
ElizabethFraley PlannedParenthoodMarMonte
RaquelSimentalPlannedParenthoodMarMonte
JenniferStorkPlannedParenthoodMarMonte
LindaWilliams PlannedParenthoodMarMonte
LorraineRinkerRinkerandAssociates
AliciaRossSacramentoAreaCongregationsTogether
AllisonSwanSacramentoAreaCongregationsTogether
NenickVuSacramentoAreaCongregationsTogether
JoeConcannonSacramentoAreaCouncilofGovernments
GordonGarrySacramentoAreaCouncilofGovernments
MonicaHernándezSacramentoAreaCouncilofGovernments
RebeccaThorntonSloan SacramentoAreaCouncilofGovernments
SharonSprowlsSacramentoAreaCouncilofGovernments
DiAnneBrownSacramentoCityUnifiedSchoolDistrict
JerryBliatoutSacramentoCommunityClinic/HALO
MiguelSuarezSacramentoCommunityClinic/HALO
S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 2 S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 3
-
Respi te Par tnership Col laborat ive | P a g e 6 Respi te Par tnership Col laborat ive | P a g e 7
BradHudsonSacramentoCounty
PaulLakeSacramentoCountyDepartmentofHumanAssistance
SandyDamiano,PhDSacramentoCountyHealthServices
MarciaJo,PhD SacramentoCountyHealthServices
AnnEdwardsSacramentoCounty,CountywideServices
BruceWagstaffSacramentoCountyCountywideServices
KathyHarwellSacramentoCountyHealth&HumanServices
OliviaKasirye,MD,MS SacramentoCountyHealth&HumanServices
GlennahTrochett,MDSacramentoCountyHealth&HumanServices
DyannWolfeSacramentoFamilyMedicalCenter
KendraBridges SacramentoHousingAlliance
LisaBatesSacramentoHousingRedevelopmentAgency
EricEnriquezSacramentoNativeAmericanHealthCenter,Inc.
BrittaGuerrero SacramentoNativeAmericanHealthCenter,Inc.
AllieShilinSacramentoNativeAmericanHealthCenter,Inc.
PriscillaEnriquezSacramentoRegionCommunityFoundation
JohnChuck,MDSerotoninSurgeCharities
WilliamSandbergSierraSacramentoValleyMedicalSociety
KristineWallachSierraSacramentoValleyMedicalSociety
AileenWetzelSierraSacramentoValleyMedicalSociety
KellyBrenkSutterHealth
TomGagenSutterHealth
HollyHarperSutterHealth
KeriThomasSutterHealth
JoseAlbertoArevalo,MDSutterIndependentPhysicians
MarlonCuellar TheCaliforniaEndowment
ChristineTienTheCaliforniaEndowment
EricFimbresTheEffort,Inc.
J.RodneyKennedyTheEffort,Inc.
BunryPinTheEffort,Inc.
JonathanPorteus,PhDTheEffort,Inc.
TomStanko,MDTheGatheringInnClinic
GraceRubensteinTheSacramentoBee
WarrenBarnesUCBerkeleySoPH/RightCareInitiative
SheltonDuruisseau,PhDUCDavisHealthSystem
LauraNiznikUCDavisHealthSystem
ClairePomeroy,MD,MBAUCDavisHealthSystem
CarolynRamirezUCDavisHealthSystem
RobertWaste,PhDUCDavisHealthSystem
CongresswomanDorisMatsuiU.S.HouseofRepresentatives
NathanDietrich OfficeofCongresswomanDorisMatsui
KariLacostaOfficeofCongresswomanDorisMatsui
DaleAinsworth,PhDValleyVision
CarlHeardWesternCliniciansNetwork
CharlaParkerWesternCliniciansNetwork
CasieParrishWesternCliniciansNetwork
AlexanderGiloffWesternSierraMedicalCenter
SherBarberWindYouthServices
KimSudermanYoloCountyAlcohol,DrugandMentalHealth
JillCook,MS,RN,PHNYoloCountyPublicHealth
TraciLucchesiYoloCountyPublicHealth
TrishaStanionisYoloFamilyServiceAgency
GregBergner,MD
DawnDunlapConsultant
GrantlandJohnsonFormerSecretaryofCaliforniaHealthandHumanServicesAgency
SierraHealthFoundation:
ChetHewitt
DianeLittlefield
RobertPhillips
AbrahamDaniels
SusanKing
KatyPasini
S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 2 S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 3
-
Respi te Par tnership Col laborat ive | P a g e 6 Respi te Par tnership Col laborat ive | P a g e 7S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 4 S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 5
Letter from the Funders
DearColleagues,
In2011,SierraHealthFoundationlaunchedtheSacramentoRegionHealthCarePartnershipwiththegoalof
findingwaystoimproveaccess,carecoordinationandthequalityoftheregion’sprimarycaresystem,witha
specificfocusoncommunityhealthcenters.Partnersinthisinitiativeincludedleadersfromcommunityclinics,
healthsystems,healthplans,associationsandcounties,aswellasphysicians,policymakersandothers.The
timingwasright,astheimplementationoftheAffordableCareActin2014offersanunprecedented
opportunitytoextendhealthinsurancecoveragetothosecurrentlyuninsured.
InordertofullyrealizetheopportunitiesoftheACA,weneedtounderstandboththestrengthsandthe
weaknessesofthecurrentregionalsystemthatservesresidentsofElDorado,Placer,SacramentoandYolo
counties.Accordingly,thePartnershipcommissionedtwostudies:amarketanalysisthatidentifiesthecurrent
servicecapacitywithintheprimarycaresafetynet,andastrategicplantodevelopanintegratedhealthcare
deliverysystemmodelthatefficientlylinkscommunityhealthclinicstoregionalproviders,thusexpanding
accesstohighqualityandculturallysensitiveservicesforlow-incomeadultsandchildreninourregion.The
CaliforniaEndowmentandSacramentoRegionCommunityFoundationwerefundingpartnersforthemarket
analysisandstrategicplanningprocess.
Wearepleasedtosharewithyouthemarketanalysisandthestrategicplan,whichilluminatewhatwecando
asaregiontoprepareforthetransformativeimpactsofhealthcarereform.Thestressesonourregionalsafetynet
aresubstantial;atthesametime,wearegalvanizedbythevisionofacollaborative,accessible,highqualityand
culturallycompetentprimarycarehealthsystemthatisoutcome-basedandsustainable.Thatisavisionwecan
andmustsupport,individuallyandcollectively.
Weofferthesereportstoinspireconversationandactionaboutthewaystocreateahighqualitypatientcare
systemthatwillbeready,willingandabletoserveournewlyinsuredresidents.Thisisatimeoftremendous
challengeandopportunity,andwemusttakewisestepstogetheraswecreateastrongerandwidersafetynet
toeffectivelyserveallofourresidents.
Sincerely,
ChetP.HewittDr.RobertK.Ross RuthBlank
President and CEO President and CEO CEO
Sierra Health Foundation The California Endowment Sacramento Region Community Foundation
-
Respi te Par tnership Col laborat ive | P a g e 6 Respi te Par tnership Col laborat ive | P a g e 7S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 4 S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 5
-
Executive SummaryThe Patient Protection and Affordable Care Act (ACA) offers an unprecedented opportunity to rethink, revitalize and reform Sacramento’s regional health care system.
The primary care safety net of El Dorado, Placer, Sacramento and Yolo counties in Northern California is comprised of a diverse group of organizations, including community health centers, hospitals, health plans, counties and nonprofit agencies. The primary care safety net has been described regionally as strained, inefficient and inadequate to meet the growing needs of the community.
To absorb the anticipated influx of 227,500 newly insured residents under the Affordable Care Act in 2014, the Sacramento Region must address the safety net’s many vulnerabilities and inadequacies while building on its strengths.
We must work together to close the gaps between residents’ needs and the system’s ability to meet them efficiently.
The Sacramento Region Health Care Partnership convened health care and civic leaders to address this challenge. Through this initiative, they identified resources (ACA and other) that the region can apply to bolster safety net functioning to better meet current and looming resident demands.
About the Sacramento Region Health Care Partnership
At the request of several community stakeholders, in 2011 Sierra Health Foundation launched the Sacramento Region Health Care Partnership. The initiative grew out of conversations with policymakers, health systems and community health centers, who approached Sierra Health Foundation to serve as intermediary in preparing the Sacramento Region to implement health reform. The Health Care Partnership creates the region’s first coordinated philanthropic, county agency, nonprofit provider and community health center effort focused solely on regional health care reform preparedness and implementation.
The Health Care Partnership’s Goal
The Sacramento Region Health Care Partnership’s goal is to find ways to improve access, care coordination and quality of the region’s safety net primary care system through community-driven input. The Health Care Partnership’s ultimate vision is to increase and improve primary care access and quality for individuals and families in low-income communities and communities of color in El Dorado, Placer, Sacramento and Yolo counties.
How the Market Analysis Informs this Strategic Plan
The Sacramento Region Health Care Partnership brought together stakeholder groups from the Sacramento Region to prepare for implementation of the Affordable Care Act. The group was supported by a team of expert industry consultants to:• assess the current capacity and forecasted demand for
primary care safety net services, • measure the impact of health reform on the region and
its safety net, • facilitate and develop a strategic plan to help ensure
readiness for health reform, and • improve health access and services for safety net
populations.
The first deliverable for this project was a comprehensive safety net market assessment report, which was concluded in April 2012
1.
The regional strategic plan was developed by the same stakeholder-consulting team between April and May 2012. The market analysis findings informed the development of the strategic plan.
Respi te Par tnership Col laborat ive | P a g e 6 Respi te Par tnership Col laborat ive | P a g e 7S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 6 S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 7
1SacramentoRegionHealthCareSafetyNetMarketAssessmentReport,April2012,TheAbarisGroup,Martinez,CA
-
Sacramento Region’s Current Safety Net
TheSacramentoRegionHealthCarePartnership’smarket
analysisidentified10criticalissuesimpactingsafetynet
performanceandsustainability:
1. RethinkPrimaryCare.Whilethecurrentsafetynet
intheregionhasmanychallenges,theadventofACA
allowsthecommunitytheopportunitytorethinkits
approachtoprimarycareascurrentlyprovidedbythe
safetynet.
2. GrowingDemand.227,500non-elderlyadultsand
childrenwillbeeligibleforhealthcarecoverageunder
ACA.Thesafetynetpopulationisgrowingandwill
continuetogrownaturally.Demandwillaccelerate
withtheadventofACA.
3. SickerCitizens.Communityhealthindicatorspredict
thenewlyinsuredpopulationwillbesickerthanthe
existingpubliclyinsuredpatientpopulationandhave
significantlyhigherlevelsofchronicdiseasesandrisk
factorssuchasasthma,diabetes,highbloodpressure,
obesity,smoking,andpreviouslyunmetneedsfor
healthcareand/ormentalhealth/alcoholordrughelp.
4. MaxedOutCapacity.Theprimarycarecapacityof
communityhealthcentersandemergencydepartments
totreatthesafetynetpopulationhasgrown,but
withoutfurthereffortswilllikelyreachcapacity
priorto2016.
5. RegionalCapacityBelowAverage.Thenumberof
communityhealthcentersintheSacramentoRegion
hasgrown,butfallssignificantlyshortofmanyother
similar-sizedregionsinCalifornia.
6. MoreMedi-CalPayments.Approximately60percent
ofthenewlyinsuredpatientswillbeinsuredby
Medi-Cal,makingitthesecondlargestpayer
sourceintheSacramentoRegion.
7. OveruseofHighCostHospitalandEmergency
DepartmentServices.Currently,thesafetynetisoverly
dependentonexpensivehospitals,andemergency
departments,inparticular,foroutpatientcare.
8. FinanciallyChallengedCommunityHealthCenters.
Roughlyhalfoftheregion’scommunityhealthcenters
arefinanciallychallenged,withexpensesconsistently
exceedingrevenues.
9. LimitedFederallyQualifiedHealthCenters.The
numberandlocationoffederallyqualifiedhealth
centers(FQHCs)intheregionislowerthanthestate
averageandotherregions.Manycommunityhealth
centersarenotabletotakeadvantageoffinancial
incentivesaffordedtoFQHCs.
10.LackofCoordinatedLeadership.Thecurrenthealth
caresafetynetlacksaleadagency,coordination
andintegration.
The Successful Safety Net
SacramentoRegionstakeholdersrecommendedprinciplesof
asuccessfulsafetynet,whichinclude:2
• Strongcollaboration,coordinationandintegrationofhealthcareservices
• Anaccessible,affordableandequitableclinical,behavioral/mentalhealthsafetynetsystem
• Astrongconsumervoiceandrealconsumerchoice
• Prevention-focusedincentivesandeducation
• Useofevidence-basedandpractice-basedapproaches
• Ageographicfocusthatbalanceslocalandregionalconcerns
• Cost-effectiveandfinanciallysustainableproviders
• Unobstructedconsumeraccesstosafetynetproviders
• Shareddata,trainingandtechnologysystemdesign
Developing a Stronger, Healthier Regional Safety Net
Althoughalloftheidentifiedemergingtopicareasare
importanttotheregion’ssafetynetandalldeservetobe
addressed,theSacramentoRegionhasawindowofonly18
to24monthstoprepareforhealthreformimplementation.
Respi te Par tnership Col laborat ive | P a g e 6 Respi te Par tnership Col laborat ive | P a g e 7S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 6 S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 7
2Oct19,2011SacramentoRegionHealthCarePartnershipnotes
-
Accordingly,thelistwasnarrowedbytheregion’s
stakeholderstothefourmostimmediatelyactionableareas:
1. Bettercarecoordinationforpatients
2. Bettercollaborationamongproviders
3. Capacitybuildingforproviders
4. Betterprimarycare/specialtycareintegration
Individuallyandcollectively,thesefourfocusareasoffer
immediateopportunitiestocreatereal,meaningfuland
measurableimprovementintheregion’ssafetynet.
Respi te Par tnership Col laborat ive | P a g e 6 Respi te Par tnership Col laborat ive | P a g e 7S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 8 S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 9
Regional Strategic Planning Direction
Followingisagraphicdepictionofthefourtopicareasin
theircurrentstateandintheirfuturestate,oncethesafety
netistransformedbycoordinatedandevidenced-based
strategiestoamoresuccessfulversion.Thefutureprimary
caresystemcapitalizesontheopportunitiescreatedbythe
implementationofhealthreform.
Current Primary Care SystemPrior to Strategic Plan Implementation
CareCoordination:Theprovisionofpatientcare(i.e.,primaryandchronicdisease)lackscoordination,reducingthelikelihoodthatservices,careandhealthresourcesareefficientlyusedtocreatethebestoutcomespossible.
Collaboration:Insomepartsoftheregion,thehealthcaresystemisfragmented.Coordinationamongallsitesthatprovidehealthcareislacking,withminimalsharingofpatientcareplans,methodologiesorresources,resultingininconsistentpatientcareaccess(i.e.,primary,chronicdiseaseandspecialtycare)andgapsinservicedelivery.
Capacity:Currentcapacityisnotconsistentacrossproviders.Thesafetynetisvulnerabletorisingdemandandlimitedbyprovidershortagesandalackofbestandpromisingpractices.
PrimaryCare/SpecialtyCareNetwork:Therearelimitedspecialtycareprovidersforthosewithoutapayersource,oftenleadingtounnecessaryemergencydepartmentcare.
Future Primary Care SystemAfter Strategic Plan Implementation (18-24 months beginning September 2012)
CareCoordination:Evidence-basedpracticesforprimarycareandchronicdiseasemanagementwillbecoordinatedandimplementedsothatpatientswillachievethebestoutcomespossible.
Collaboration:Aregionalintegrateddeliverysystemframeworkprovidestheinfrastructureandalignedfundingincentivestoimprovepatientaccessibilityandqualityofcare.Increasedcollaborationincreasescooperationandlimitsinappropriateandinefficientcompetitionamongstakeholders.
Capacity:Capacitybuildingwillbedesignedinastrategicandcoordinatedmannerthatallowsforfullimplementationofcosteffectiveness,bestpractices,technologywhereneededandimprovedaccess.
PrimaryCare/SpecialtyCareNetwork:Safetynetproviderswillreferpatientstotimely,appropriatespecialtycarewithinafinanciallysustainablesystem.
-
1. Care Coordination Successfulcarecoordinationinvolvesthepropersystems,
access,communicationsandcontinuitytoensurethata
patientreceivestheappropriatequalityofcareamong
differentprovidersandsettings.Carecoordinationstandards
willprovidethestructure,processandoutcomemeasures
requiredtoassessprogresstowardcarecoordinationgoals
andtoevaluateaccess,continuity,communicationand
trackingofpatientsacrossprovidersandsettings.3
Care Coordination Goal
By January 1, 2014, safety net providers will meet agreed-upon
quality indicators for mental health, substance abuse, dental
care and chronic disease management through effective care
coordination/care management.
CARE MANAGEMENT – QUALITY
Improvinghealthcareservicequalityinvolvesa
combinationofcaremanagementandevidence-based
practicesfoundinqualityimprovementprograms.“Care
management”isdefinedasprograms[that]applysystems,
science,incentivesandinformationtoimprovemedical
practiceandassistconsumersandtheirsupportsystemto
becomeengagedinacollaborativeprocessdesignedto
managemedical/social/mentalhealthconditions
moreeffectively.4
FiveCareManagement–QualityActionSteps
wereidentified.
PATIENT NAVIGATION
Thereisgrowinginterestinpatientnavigationasavital
resourceforconsumersovercomingbarrierstoaccessing
care.A“patientnavigator”isapersonororganizationwho
assistsunderservedpopulationswithculturallyappropriate
informationandhelpspatientsaccesshealthservicesand
educationregardingoverallhealth.5
ThreePatientNavigationActionStepswereidentified.
Respi te Par tnership Col laborat ive | P a g e 6 Respi te Par tnership Col laborat ive | P a g e 7S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 8 S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 9
PATIENT-CENTERED HEALTH HOME
AhealthhomeasdefinedbySection2703oftheAffordable
CareActisaperson-centeredsystemofhealthcarethat
facilitatesaccesstoandcoordinationofthefullarrayof
primaryandacutephysicalhealthservices,behavioralhealth
careandlong-termcommunity-basedservicesandsupports.6
Themodelaimstoimprovehealthcarequalityandclinical
outcomesandthepatientcareexperience,whilealso
reducingpercapitacoststhroughmorecost-effectivecare.7
ThreePatient-CenteredHealthHomeActionSteps
wereidentified.
2. CollaborationCollaborationandcooperationamongsafetynetprovidersis
criticaltomaximizingresourcesandefficienciesinthehealth
caresysteminunderservedareas.Asprovidersseeknew
opportunitiestocreateaccesstohighquality,coordinated
careformorepatientsundertheAffordableCareAct,
collaborationwillbecomeevenmoreimportant.
Collaboration Goal
By June 2013, safety net providers will have effectively
contracted with or made arrangements with health
plans/managed care organizations and/or hospital systems
to provide seamless patient-centered care. This includes
primary, secondary, tertiary and behavioral health care. These
arrangements will strengthen the quality of care and financial
sustainability of the safety net once the Affordable Care Act is
implemented and funding begins to flow through these
organizations.
SevenCollaborationActionStepswereidentified.
3Oct2010NationalQualityForum:PreferredPracticesandPerformanceMeasuresforMeasuringandReportingCareCoordination42007CenterforHealthCareStrategies,Inc.Care Management Definition and Framework5PLoSMed.2006July;3(7):e193.ReducingDisparitiesintheburdenofcancer:Theroleofpatientnavigators6TheHenryJ.KaiserFamilyFoundation:FocusonHealthReformMedicaid’sNew“HealthHome”Option,Jan.20117TheHenryJ.KaiserFamilyFoundation:FocusonHealthReformMedicaid’sNew“HealthHome”Option,Jan.2011
-
Respi te Par tnership Col laborat ive | P a g e 6 Respi te Par tnership Col laborat ive | P a g e 7S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 1 0 S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 1 1
3. Capacity BuildingServinganadditional227,500consumersseekingcare
asaresultoftheAffordableCareActwillrequire
increasedcapacitythroughouttheregion’ssafetynet.
Thecapacitybuildingactionstepsfocusonworkforce
development,technicalassistanceandtoolstoimprove
thequalityofthepatientexperience.
Capacity Building Goal
By January 2014, the safety net will have sufficient workforce
capacity to meet the needs of existing and newly insured patients
covered under the Affordable Care Act.
SixCapacityBuildingActionStepswereidentified.
4. Primary Care/Specialty Care IntegrationThemodelofapatient-centeredhealthhomeispremisedon
apersonalphysicianwhoworkswiththepatientandtheir
careteamtocoordinateallhealthservices.Successofthis
modelrequiresintegrationofspecialtycareandprimarycare
functionstoprovideintegrated,patient-centeredcare.
Primary Care/Specialty Care Integration Goal
By January 2014, primary care physicians and other providers
will meet safety net patient demand, reduce unnecessary specialty
care referrals, treat conditions at the lowest and most appropriate
level of care, and create a sustainable financing system that will
support patients’ access to specialty care in the Sacramento Region.
ThreeNetworkIntegrationActionStepswereidentified.
What’s Next
Implementationisanessentialpartofthestrategicplanning
process.Allthosewhoarecommittedtoimproving
healthgenerally,aswellaspolicymakersateverylevelof
government,areneededtomakesafetynettransformation
atoppriority.TheSacramentoRegioncanseizethe
opportunityoffederalhealthcarereformtofundamentally
strengthenhealthcarequalityandaccess.Itwilltakea
sustained,concertedefforttofullyrealizetheopportunities
oftheAffordableCareActandthisstrategicplan.
The decisions made today will set the direction for health
care delivery in the Sacramento Region for generations
to come.
Therearefourimmediatestepsthatshouldbeundertaken
tostartbuildingaregionalframework:
Step 1 — Preparation
ThisisanambitiousworkplanfortheSacramentoRegion.
Beforewecanproceed,weneedtoknow:
• Isthereakeychampion,orchampions,whowillleadthiseffortinourregionandbringotherleaderstothetable?
• Arethereresources(staff,funding,etc.)thatwillsupporttheseleaders?
• Aretherightorganizationssignedonaspartners?
• Willthepoliticalandfiscalenvironmentsupportthiseffortinboththeshortandlongterm?
• Dotheregion’sleadersagreeonwhattheywanttoaccomplish?
• Istherearealappreciationofwhatitwilltaketogettheseeffortsupandrunning?
• Dowehavethefundingandotherresourcestocarry
outtheplanningandprogramdevelopment?
The Sacramento Region Health Care Partnership must
affirmatively answer these questions and establish a
functioning, funded planning coalition to make an
informed decision to proceed with the projects outlined
in this plan.
-
Respi te Par tnership Col laborat ive | P a g e 6 Respi te Par tnership Col laborat ive | P a g e 7S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 1 0 S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 1 1
Step 2 — Analysis and Design
Decisionsregardingtheformtheregion’scollectiveeffort
willtakemustbebasedonaclearunderstandingofneed,
existingservices,thepoliticalenvironment,costestimates
andfinancingoptions.
The Sacramento Region Health Care Partnership should
generate: 1) a design document that describes the target
population(s), the financing models to be used, the program
requirements, and the planned structure for governance and
administration; and 2) a cost estimate for the proposed program
designs relative to the funds expected to be available.
Step 3 — Implementation Vision
Wemusthaveastrategicvisionof“howtochange”inorder
toachievethevisionof“whattochange.”Asharedvision
letseveryoneknowwhattheendresultshouldbeandwhy
itisimportant.Thisstepinvolvesclarifyingexactlyhowthe
elementsofthestrategicplanimplementationwillwork.
The Sacramento Region Health Care Partnership should
generate a business plan for the strategic plan that includes all
financial, operational and implementation details for the plan’s
program components.
Step 4 — Implementation Team
Animplementationteamcomposedofstakeholderswho
understandtheplan’spurposeandimplementationprocess
willbeneededtoshepherdthisplanfromconcepttoreality.
Asmallgroupsupportedby,andreportingto,asteering
committeethatcanencourageprogressandfieldquestions
oraddressproblemsastheyarisewouldservethispurpose.
The Sacramento Region Health Care Partnership should
develop a small team that has senior leadership, strong
financial skills and experience, and professional support to
implement the strategic plan recommendations.
Conclusion
WelaunchedtheSacramentoRegionHealthCare
Partnershipin2011withthegoaloffindingwaysto
improveaccess,carecoordinationandthequalityofthe
region’sprimarycaresystem,focusingspecificallyon
thesafteynet.Thecompletionofthemarketanalysisand
strategicplannowoffersusaroadmaptoachievethatgoal
ofcreatingastrongersafetynettoserveallresidentsof
ElDorado,Placer,SacramentoandYolocounties.
Certainly,thechallengesfacingourregionaretremendous,
butthetransformativeopportunitiessparkedbythe
AffordableCareActareequallygreat.Thisstrategicplan
spellsoutthestepswemusttake,individuallyand
collectively,toachievethevisionofhealthcarereform.
Wewillneedtoworktogetherandseizethisunprecedented
opportunitytocreateacollaborative,accessible,highquality
andculturallycompetentprimarycarehealthsystem.
Regionalsuccessiswithinreach,ifwereachforittogether.
Thepotentialrewardsareimmeasurable:ahealthierand
brighterfutureforall.
-
Respi te Par tnership Col laborat ive | P a g e 6 Respi te Par tnership Col laborat ive | P a g e 7S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 1 2 S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 1 3
Preparing for TransformationBy rethinking, revitalizing and reforming the health
care safety net in the four counties of the Sacramento
Region, together we will create a coordinated and
integrated 21st-century patient care system for the
medically underserved.
ThePatientProtectionandAffordableCareAct(ACA)
offersanunprecedentedopportunitytorethink,revitalize
andreformtheSacramentoRegion’shealthcaresystem.The
primarycaresafetynetofElDorado,Placer,Sacramento
andYolocountiesinNorthernCaliforniaiscomprisedofa
diversegroupoforganizations,includingcommunityhealth
centers,hospitals,healthplans,countiesandnonprofit
agencies.Ithasbeendescribedasstrained,inefficientand
inadequate.Toabsorbtheanticipatedinfluxof227,500
newlyinsuredresidentsundertheAffordableCareActin
2014,theSacramentoRegionmustaddressitssafetynet’s
manyvulnerabilitiesandinadequacies,whilebuildingonits
strengths.Wemustworktogethertoclosethegaps
betweenresidents’needsandthesystem’sabilityto
meetthemefficiently.
TheSacramentoRegionHealthCarePartnershipconvened
healthcareandcivicleaderstoaddressthischallenge.
Throughthisinitiative,theSacramentoRegionHealthCare
Partnershiphasidentifiedresourcestheregioncanapplyto
bolstersafetynetfunctioningtobettermeetcurrentand
loomingresidentdemands.
Byplanningandtakingaction,asinformedbythe
SacramentoRegion’sMarketAnalysis,wecanbettermeet
theSacramentoRegion’shealthcareneedstoday,while
preparingourselvesforvastlyincreaseddemandunder
healthreform.
Health Reform Brings Opportunities for Improvement
IntheSacramentoRegion–ElDorado,Placer,Sacramento
andYolocounties–aprojected227,500non-elderlyadults
andchildrenwillbeeligibleforhealthcoveragethrough
expandedMedi-Calbenefitsorsubsidizedprivateinsurance
(healthcareexchanges).Withoutaction,manyofthese
newlyinsuredresidentswillenteranoverwhelmedand
alreadyfragmentedsafetynetsystem.
The Affordable Care Act (ACA) permanently authorizes
and expands Community Health Centers and the
National Health Services Corps. It provides a total of
$1.5 billion in new funding through 2015 to train more
primary care providers via scholarships and loan
repayment assistance.
ACA investments will double community health center
capacity. Through federal programs and grants to states,
the health reform law will help expand the nation’s
health workforce – physicians, nurses and public
health professionals – through scholarships and local
repayment assistance.
The ACA also aims to improve the diversity of the health
care workforce to assure care that is appropriate for the
entire population.
In short, the ACA provides many opportunities to
strengthen the safety net, but also poses real challenges.
Meeting the vastly increased demand for health care
services is no small task.
Withthisstrategicplan,weidentifyandquantifyaction
stepstoprepareourregion’sprimarycaresafetynetfor
successfulimplementationoftheAffordableCareAct.
About the Sacramento Region Health Care Partnership
Attherequestofseveralcommunitystakeholders,in
2011SierraHealthFoundationlaunchedtheSacramento
RegionHealthCarePartnership.Theinitiativegrewout
ofconversationswithpolicymakers,healthsystemsand
communityhealthcenters,whoapproachedSierraHealth
Foundationtoserveasintermediaryinpreparingthe
SacramentoRegiontoimplementhealthreform.The
SacramentoRegionHealthCarePartnershipcreatesthe
region’sfirstcoordinatedphilanthropic,countyagency,
-
Respi te Par tnership Col laborat ive | P a g e 6 Respi te Par tnership Col laborat ive | P a g e 7S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 1 2 S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 1 3
nonprofitproviderandcommunityhealthcentereffort
focusedsolelyonregionalhealthcarereformpreparedness
andimplementation.
TheSacramentoRegionHealthCarePartnershipincludesa
broadrangeofhealthcarepartnersandleadersthroughout
theSacramentoRegionfromcommunityhealthcenters,
healthsystems,healthplans,associationsandcounties,as
wellasphysicians,policymakersandothernonprofitsthat
workwithinthesafetynet.SierraHealthFoundation,
TheCaliforniaEndowmentandSacramentoRegion
CommunityFoundationarefundingpartnersofthe
marketanalysisandregionalstrategicplan.
The Health Care Partnership’s Goal
TheSacramentoRegionHealthCarePartnership’sgoalis
tofindwaystoimproveaccess,carecoordinationand
qualityoftheregion’ssafetynetprimarycaresystem
throughcommunity-driveninput.TheHealthCare
Partnership’sultimatevisionistoincreaseandimprove
primarycareaccessandqualityforindividualsandfamilies
inlow-incomecommunitiesandcommunitiesofcolorin
ElDorado,Placer,SacramentoandYolocounties.
Betteraccesstoprimarycarewilllowerthecostofhealth
careoverall,moreeffectivelyallocatehealthcareresources
(e.g.,reduceexpensive,unnecessaryacutecareresponsesto
preventablechronicdisease)andimprovepublichealthin
theSacramentoRegion.
Project Overview Identifying and pursuing opportunities to optimize the region’s safety net system
Strategic Plan Goal
Developaregionalstrategicplanforanintegratedhealth
caredeliverysystemthatefficientlylinkscommunityhealth
centerstoregionalhealthsystemstoexpandaccesstohigh
qualityservicesforlow-incomeadultsandchildreninthe
SacramentoRegion.
Strategic Plan Vision
To create a collaborative, accessible, high quality and culturally competent primary care health system in the Sacramento Region of El Dorado, Placer, Sacramento and Yolo counties that is outcome-based and sustainable.
How the Market Analysis Informs this Strategic Plan
TheSacramentoRegionHealthCarePartnershipbrought
togetherstakeholdergroupsfromtheSacramentoRegionto
prepareforimplementationoftheAffordableCareAct.
Thegroupwassupportedbyateamofexpertindustry
consultantsto:
• assessthecurrentcapacityandforecasteddemandforprimarycaresafetynetservices,
• measuretheimpactofhealthreformontheregionanditssafetynet,
• facilitateanddevelopastrategicplantohelpensurereadinessforhealthreform,and
• improvehealthaccessandservicesforsafetynetpopulations.
Themarketanalysisfocusedoncommunityhealthcenters,
healthsystems,healthcareprovidersandnonprofitsthatare
partoftheentireenginethatservestheSacramentoRegion’s
safetynet.Thepurposeoftheanalysiswastobenchmarkthe
currentandforecastedcapacityoftheprimarycaresafetynet
topreparetheSacramentoRegionforAffordableCareAct
implementation.
Thisstrategicplanwascreatedbasedoninputfrom
stakeholdersrepresentingacross-sectionofsafetynetsystem
leaders,healthsystems,countiesandcommunityphysicians
andconsumersofcommunityhealthcentersservicesinthe
SacramentoRegion.
-
Respi te Par tnership Col laborat ive | P a g e 6S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 1 4
Sacramento Region Health Care Partnership Phase I Process and Deliverables
ResearchontheSacramentoRegion’ssafetynetbeganin
October2011,withaconveningofsystemstakeholdersand
thoughtleaders.Participantsinthisandsubsequentmeetings
includedhealthcareproviders,healthsystemrepresentatives,
governmentofficials,electedgovernmentmembersand
variousnonprofits–allwithadesiretoseeimprovementin
thecurrentprimarycaresafetynetservicedeliverysystem
forthefour-countyregion.
Thefirstdeliverableforthisprojectwasacomprehensive
safetynetmarketassessmentreport,whichwasconcludedin
April20128.Thepublishedmarketanalysisisacompanion
documenttothisstrategicplan.Thesereportsareposted
onlineatwww.sierrahealth.org/healthcarepartnership.
Theregionalstrategicplanwasdevelopedbythesame
stakeholder-consultantteambetweenAprilandMay2012.
Themarketanalysisfindingsinformedthedevelopmentof
thestrategicplan.
Project Timeline and ProcessThechartbelowshowsthedevelopmentprocessand
timelinefortheSacramentoRegionsafetynetmarket
analysisandstrategicplan.
Respi te Par tnership Col laborat ive | P a g e 7S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 1 5
R E G I O N A L M E E T I N G S
APRIL 16TH SESSION• Rollout of Detailed Market Analysis
• Present Feedback Top �ve (5) areas for focus by the region Bene�ts/Challenges
• Respond to Top Areas Where are the gaps? What are the bene�ts/challenges? What are the risks/threats? What are the success factors needed to implement?
APRIL 30TH SESSION• Present SWOT Analysis by Opportunity• Complete SWOT Analysis• Design SMART Goals for each opportunity via group process• Group consensus on Goal Statement• Develop action necessary to achieve• Notify participants re: online survey purpose & deadline
VALIDATE DRAFT WITHADVISORY GROUP
DRAFTSTRATEGIC PLAN
INPUT FROM THECOMMUNITY, WRITTEN BY THE
CONSULTANT TEAM
SURVEY
MAY 7TH• Present online survey results• Priority items de�ned via group process• is is the reality check session where the facilitators discuss what factors are needed for success & resources available• SMART Goal concept developed
MAY 21ST• Present DRAFT Strategic Planning Document• Implementation Development• Strategic plan leadership• Timeline
ROLLOUTSTRATEGIC PLAN
Community-wide MeetingCongresswoman Matsui
and Key Policymakers
8SacramentoRegionHealthCareSafetyNetMarketAssessmentReport,April2012,TheAbarisGroup,Martinez,CA
-
Respi te Par tnership Col laborat ive | P a g e 6S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 1 4 Respi te Par tnership Col laborat ive | P a g e 7S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 1 5
Sacramento Region’s Current Safety NetThe safety net is characterized by a fragmented group of small and financially fragile health centers that together offer limited outpatient capacity.9
Previousstudieshaveidentifiedspecificchallengesfacing
theSacramentoRegion’ssafetynet:
• Underdevelopedadministrativeandservicedeliverycapacity
• Limitedaccesstomedicalspecialistsanddentalcare
• Insufficientlinguisticandculturalresources
• Transportationbarriersforresidents
• Budgetreductionsthathaveledtoclosureofmanyprimarycareclinics
In2010,ajointventurebyfourlocalhospitalsystems
conductedaCommunityNeedsAssessmentoftheGreater
SacramentoRegion.Thereporthighlightedchallengesand
needswithintheunderservedpopulations,identifyingthese
majorobstaclesthathinderedorpreventedaccesstohealth
careamongtheunderservedpopulation:10
• affordabilityofhealthcareservices,especiallyhealthinsurance,
• locatingphysicians,specialists,dentists,mental/behavioralhealthandotherproviderswhoacceptMedi-Caland/orworkatreducedrates,
• navigatingacomplexandinefficientsafetynetandrelatedsocialservicessystem,and
• culturalbarriers,includinglanguageandsocialcustoms.
10 Stressors and Strengths Driving Regional Safety Net Performance
TheSacramentoRegionHealthCarePartnership’smarket
analysisidentified10criticalissuesimpactingsafetynet
performanceandsustainability:
1. RethinkPrimaryCare.Whilethecurrentsafetynet
intheregionhasmanychallenges,theadventofACA
allowsthecommunitytheopportunitytorethinkits
approachtoprimarycareascurrentlyprovidedbythe
safetynet.
2. GrowingDemand.227,500non-elderlyadultsand
childrenwillbeeligibleforhealthcarecoverageunder
ACA.Thesafetynetpopulationisgrowingandwill
continuetogrownaturally.Demandwillacceleratewith
theadventofACA.
3. SickerCitizens.Communityhealthindicatorspredict
thenewlyinsuredpopulationwillbesickerthanthe
existingpubliclyinsuredpatientpopulationandhave
significantlyhigherlevelsofchronicdiseasesandrisk
factorssuchasasthma,diabetes,highbloodpressure,
obesity,smoking,andpreviouslyunmetneedsforhealth
careand/ormentalhealth/alcoholordrughelp.
4. MaxedOutCapacity.Theprimarycarecapacityof
communityhealthcentersandemergencydepartmentsto
treatthesafetynetpopulationhasgrown,butwithout
furthereffortswilllikelyreachcapacitypriorto2016.
5. RegionalCapacityBelowAverage.Thenumberof
communityhealthcentersintheSacramentoRegion
hasgrown,butfallssignificantlyshortofmanyother
similar-sizedregionsinCalifornia.
6. MoreMedi-CalPayments.Approximately60percent
ofthenewlyinsuredpatientswillbeinsuredby
Medi-Cal,makingitthesecondlargestpayersourcein
theSacramentoRegion.
7. OveruseofHighCostHospitalandEmergency
DepartmentServices.Currently,thesafetynetisoverly
dependentonexpensivehospitals,andemergency
departments,inparticular,foroutpatientcare.
8. FinanciallyChallengedCommunityHealthCenters.
Roughlyhalfoftheregion’scommunityhealthcenters
arefinanciallychallenged,withexpensesconsistently
exceedingrevenues.
9CaliforniaHealthCareFoundation,SacramentoPowerfulHealthSystemsDominateaStableMarket.http://www.chcf.org/publications/2009/07/sacramento-powerful-hospital-systems-dominate-a-stable-market#ixzz1t5kNz6tN(Lastaccess4-25-12)10AinsworthD,DiazH,SchmidtleinM:2010CommunityNeedsAssessmentFortheGreaterSacramentoRegionhttp://www.healthylivingmap.com/CNA%20Report%202010.pdf
-
Respi te Par tnership Col laborat ive | P a g e 6S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 1 6
9. LimitedFederallyQualifiedHealthCenters.The
numberandlocationoffederallyqualifiedhealthcenters
(FQHCs)intheregionislowerthanthestateaverage
andotherregions.Manycommunityhealthcentersare
notabletotakeadvantageoffinancialincentives
affordedtoFQHCs.
10.LackofCoordinatedLeadership.Thecurrenthealth
caresafetynetlacksaleadagency,coordinationand
integration.
The Successful Safety NetSacramentoRegionstakeholdersrecommendedprinciplesof
asuccessfulsafetynet,whichinclude:11
• Strongcollaboration,coordinationandintegrationofhealthcareservices
• Anaccessible,affordableandequitableclinical,behavioral/mentalhealthsafetynetsystem
• Astrongconsumervoiceandrealconsumerchoice
• Prevention-focusedincentivesandeducation
• Useofevidence-basedandpractice-basedapproaches
• Ageographicfocusthatbalanceslocalandregionalconcerns
• Cost-effectiveandfinanciallysustainableproviders
• Unobstructedconsumeraccesstosafetynetproviders
• Shareddata,trainingandtechnologysystemdesign
Strategic Planning: Focusing Needs, Marshaling Resources
Withthissuccessfulmodelinmind,theSacramentoRegion
HealthCarePartnershipstakeholdersprioritizedthemost
criticalneedsidentifiedinthemarketanalysisintothe
strategicplanningprocess.Thestrategicplanisbasedonthe
followingkeycharacteristicsoftheregion’scurrentsafetynet
anditsproviders:
• Capacity(bothphysicalandprovider)isacontinuingchallengetothesafetynet.
• Currentservicesarefragmented,fragileandfinanciallyunsustainable.
• Stakeholdersacknowledgethatcollaborationandleadershiparethelargestmissingcomponents.
• Thereisastrongwillingnesstobeginaprocesstosolvethesekeyissues.
All Health Care is Local
Whendevelopinganyregionalcommunityhealthcare
system,itiswisetokeepinmindthatallhealthcareislocal.
WithintheSacramentoRegion,eachcommunityisunique.
However,therearecommonthemesofchallengesand
opportunities,which,whenaddressedcollectivelyasa
region,willimprovethequalityofservicesforconsumers.
Removing Patient Obstacles
Conventionalwisdomholdsthatgoodhealthrequires
personalresponsibilityandasocietalcommitmentto
removingobstaclesthatpreventpeoplefromleading
healthylives.Improvingcommunityhealthrequiresa
combinationofpreventionandaccesstohealthcarefor
residentsononeside,andawell-developedand
evidence-basedhealthdeliverysystemontheother.
Therecommendationsinthisplanaddressthekeyobstacles
withsmallbutactionablestepstomoveforward,allowing
projectstoleverageexistingfundingsources,developnew
opportunitiesandfostercollaborationtoaddresstheneeds
ofthecommunity.
Leadership Enhances Coordination, Collaboration
ThemarketanalysisoftheSacramentoRegionidentified
alackofcoordinatedleadership,whichrepresentsa
significantchallenge.Nosinglestakeholder,entityorgroup
canaddressalloftheseneedseffectivelyorefficientlyalone.
TheSacramentoRegionhasanabundanceofexcellent
healthcareorganizationsandotherkeygroupsthatare
willingtoworktogethertosupportthiseffort.Stakeholder
cooperationandcollaborationisthecornerstoneofthis
strategicplan.
Respi te Par tnership Col laborat ive | P a g e 7S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 1 7
11Oct.19,2011SacramentoRegionHealthCarePartnershipnotes
-
Respi te Par tnership Col laborat ive | P a g e 6S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 1 6 Respi te Par tnership Col laborat ive | P a g e 7S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 1 7
How the Consultant Team Set Strategic Plan Goals
Aftersignificantinputanddiscussionregardingthemarket
analysisdatainElDorado,Placer,SacramentoandYolo
counties,eachcountyidentifiedtopicstoworkonregionally
inpreparationforhealthreform.TheSacramentoRegion
HealthCarePartnershipstakeholdersprioritizedthelistof
10keyfocusareasfromtheregionalmeetingstofourtopic
areastobeaddressedinthestrategicplan.
Althoughalloftheseemergingregionaltopicareasare
importanttotheregion’ssafetynet,andalldeserveto
beaddressed,theSacramentoRegionhasawindowof
only18to24monthstoprepareforhealthreform
implementation.Accordingly,thelistwasnarrowedto
thefourmostimmediatelyactionableareas:
• Bettercarecoordinationforpatients
• Bettercollaborationamongproviders
• Capacitybuildingforproviders
• Betterprimarycare/specialtycareintegration
Individuallyandcollectively,thesefourfocusareasoffer
immediateopportunitiestocreatereal,meaningfuland
measurableimprovementintheregion’ssafetynet.
Emerging Regional Topic Areas
1. Collaboration
2. Funding
3. Workforceexpansion,retention,training
4. Capacitybuilding
5. Carecoordination
6. Primarycare/specialtycareintegration
7. IT-communicationintegration
8. Reduceunnecessaryemergencydepartmentvisits
9. Partnershipsbetweenhospitalsandcommunityhealthcenters
10. Culturallyappropriatepatienteducationonconsumerchoices
Regional Topic Areas Addressedin Strategic Plan 1. Carecoordination
2. Collaboration
3. Capacitybuilding
4. Primarycare/specialtycareintegration
SMART GoalsTheconceptofSMARTGoalswasintroducedduringthestrategicplanningprocesstoprovidestructureindevelopingwell-focusedandachievablegoals:
Specific:Goalsmustbeclearandunambiguous
Measurable:Cleardatapointthatispre-andpost-measureable
Attainable:Goalsmustberealistic(highleverageandhighyield)andattainable(within18to24months)
RelevantorRealistic:Goalsmustbeanimportanttoolinreachingthestrategicplan
Time-bound:Goalsmusthavestartingpoints,endingpointsandfixeddurations
Withthesegoal-settingdefinitionsinmind,thecommunitydevelopedSMARTGoalsforthefourkeytopicareasendorsedbythestakeholders.
-
S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 1 8
Developing a Stronger, Healthier Regional Safety Net
Regional Strategic Planning Direction
Belowisabefore-and-aftersnapshotoftheSacramento
Region’sprimarycaresafetynet.
Thechartprovidesanoverviewofthefourtopicareasin
theircurrentstateandintheirfuturestate,oncethesafety
netistransformedbycoordinatedandevidenced-based
strategiestoamoresuccessfulversion.Thecurrentstateis
basedonthefindingsofthemarketanalysis.Thefuturestate
istheSacramentoRegion’svisionofimprovedcaredelivery
thatwillresultfromstrategicplanimplementation.The
futureprimarycaresystemcapitalizesontheopportunities
createdbytheimplementationofhealthreform.
S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 1 9
Current Primary Care SystemPrior to Strategic Plan Implementation
CareCoordination:Theprovisionofpatientcare(i.e.,primaryandchronicdisease)lackscoordination,reducingthelikelihoodthatservices,careandhealthresourcesareefficientlyusedtocreatethebestoutcomespossible.
Collaboration:Insomepartsoftheregion,thehealthcaresystemisfragmented.Coordinationamongallsitesthatprovidehealthcareislacking,withminimalsharingofpatientcareplans,methodologiesorresources,resultingininconsistentpatientcareaccess(i.e.,primary,chronicdiseaseandspecialtycare)andgapsinservicedelivery.
Capacity:Currentcapacityisnotconsistentacrossproviders.Thesafetynetisvulnerabletorisingdemandandlimitedbyprovidershortagesandalackofbestandpromisingpractices.
PrimaryCare/SpecialtyCareNetwork:Therearelimitedspecialtycareprovidersforthosewithoutapayersource,oftenleadingtounnecessaryemergencydepartmentcare.
Future Primary Care SystemAfter Strategic Plan Implementation (18-24 months beginning September 2012)
CareCoordination:Evidence-basedpracticesforprimarycareandchronicdiseasemanagementwillbecoordinatedandimplementedsothatpatientswillachievethebestoutcomespossible.
Collaboration:Aregionalintegrateddeliverysystemframeworkprovidestheinfrastructureandalignedfundingincentivestoimprovepatientaccessibilityandqualityofcare.Increasedcollaborationincreasescooperationandlimitsinappropriateandinefficientcompetitionamongstakeholders.
Capacity:Capacitybuildingwillbedesignedinastrategicandcoordinatedmannerthatallowsforfullimplementationofcosteffectiveness,bestpractices,technologywhereneededandimprovedaccess.
PrimaryCare/SpecialtyCareNetwork:Safetynetproviderswillreferpatientstotimely,appropriatespecialtycarewithinafinanciallysustainablesystem.
-
S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 1 8 S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 1 9
ThefollowingsectionsdescribetheSacramentoRegion
HealthCarePartnership’sproposedgoals,tasksand
timeframesforaddressingthefourcoreimprovementareas.
Care CoordinationAdopting a systemic approach to seamlessly delivered patient care
Successfulcarecoordinationinvolvesthepropersystems,
access,communicationsandcontinuitytoensurethata
patientreceivestheappropriatequalityofcareamong
differentprovidersandsettings.Whencareispoorly
coordinated—withinaccuratetransmissionofinformation,
inadequatecommunicationandinappropriatefollow-up
care—patientswhoseemultiplephysiciansand
careproviderscanfacemedicationerrors,hospital
re-admissionsandavoidableemergencydepartmentvisits.12
TheNationalQualityForumdefinedcarecoordinationas
a“functionthathelpsensurethatthepatient’sneedsand
preferencesforhealthservicesandinformationsharing
acrosspeople,functionsandsitesaremetovertime.”13
Carecoordinationstandardswillprovidethestructure,
processandoutcomemeasuresrequiredtoassessprogress
towardcarecoordinationgoalsandtoevaluateaccess,
continuity,communicationandtrackingofpatientsacross
providersandsettings.14
Care Coordination Goal
By January 1, 2014, safety net providers will meet
agreed-upon quality indicators for mental health, substance
abuse, dental care and chronic disease management through
effective care coordination/care management.
CARE MANAGEMENT – QUALITY
Improvinghealthcareservicequalityinvolvesacombination
ofcaremanagementandevidence-basedpracticesfoundin
qualityimprovementprograms.“Caremanagement”is
definedasprograms[that]applysystems,science,
incentivesandinformationtoimprovemedicalpracticeand
assistconsumersandtheirsupportsystemtobecomeengaged
inacollaborativeprocessdesignedtomanagemedical/social/
mentalhealthconditionsmoreeffectively.15
Action Steps:
Identifycommongoalsamongpartnersspecifictocare
managementtargets.Identifybestpractices,suchastheTriple
AIMprogram.16
Reachagreementfortheselectedpractices.
Commongoalsincludeimprovingthepatientexperienceof
care(includingqualityandsatisfaction),improvingthehealth
ofspecificpopulationsandreducingthepercapitacostof
healthcare.
1. Identifyevidence-basedtoolsforproviderstomore
easilycommunicateandcollaborate,thussupporting
providerstogivepatientsthebestcarepossible.
2. Supportsafetynetprovidersthroughtrainingon
qualityimprovementandprocessimprovementsothat
theycanimplementthecaremanagementmodels.
3. Adoptappropriateclinicalcaredeliverypathwaysto
preventivechroniccaremanagementandpatient
empowerment.
4. Throughtechnologyandcollaborativemeasures,
developandimplement“load-leveling”modelsacross
thecommunityhealthcentersforpeakpatientintake.
12Oct2010NationalQualityForum:PreferredPracticesandPerformanceMeasuresforMeasuringandReportingCareCoordination13Oct2010NationalQualityForum:PreferredPracticesandPerformanceMeasuresforMeasuringandReportingCareCoordination14Oct2010NationalQualityForum:PreferredPracticesandPerformanceMeasuresforMeasuringandReportingCareCoordination152007CenterforHealthCareStrategies,Inc.CareManagementDefinitionandFramework.16TheInstituteforHealthcareImprovementdevelopedaframeworktooptimizehealthsystemperformance.ThedesignconsistsofthreedimensionscalledtheTripleAim:1)Improvethepatientexperienceofcare,2)Improvethehealthofpopulations,and3)Reducethepercapitacostofhealthcare.
-
S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 2 0
PATIENT NAVIGATION
Thereisgrowinginterestinpatientnavigationasavital
resourceforconsumersovercomingbarrierstoaccessing
care.Apatientnavigatorisapersonororganizationwho
assistsunderservedpopulationswithculturallyappropriate
informationandhelpspatientsaccesshealthservicesand
educationregardingoverallhealth.17
Action Steps:
1. Determineafinanciallysustainableregionalmodelthat
supportspatientnavigators,“promotores”andcare
managerstolinkpatientstoappropriatecareand
promotecommunity-basedhealtheducationand
preventioninamannerthatisculturallyand
linguisticallyappropriate.
2. Takeaninventoryofcurrentbestpracticesspecificto
eachcountyorhealthsystem’spopulationneedsand
usepeoplewhocaneducate,connectwithandsupport
patientstoreduceinappropriateemergencydepartment
use,repeathospitalizations,ambulatorycare-sensitive
admissions,etc.
3. Agreeonaweb-basedsystemthatcanbeusedby
multiplepartnerstosupporthealthliteracy.This
technologymaybeavailablethroughpatientportals.
PATIENT-CENTERED HEALTH HOME
AhealthhomeasdefinedbySection2703oftheAffordable
CareActisaperson-centeredsystemofhealthcarethat
facilitatesaccesstoandcoordinationofthefullarrayof
primaryandacutephysicalhealthservices,behavioral
healthcare,andlong-termcommunity-basedservicesand
supports.18
Thepatient-centeredhealthhome(PCHH)
modelofservicedeliveryexpandsonthetraditionalmedical
homemodelsthatmanystateshavedevelopedintheir
Medicaidprograms,buildingadditionallinkagesand
enhancingcoordinationandintegrationofmedicaland
behavioralhealthcaretobettermeettheneedsofpeople
withmultiplechronicillnesses.19
Themodelaimsto
improvehealthcarequalityandclinicaloutcomesandthe
patientcareexperience,whilereducingpercapitacosts
throughmorecost-effectivecare.20
Action Steps:
1. Identifysafetynetprovidersthathavethepotential
tobecertifiedasapatient-centeredhealthhome
(PCHH).
2. Identifyexistingtrainingprogramsthatsupport
PCHHcertification,sothatinterestedcommunity
healthcentersmayparticipate.
3. Identifyfinancingstrategiestomitigatelossofrevenue
duetoproviderunavailabilityforpatientcareduring
PCHHcertificationtrainingsessions.
17PLoSMed.2006July;3(7):e193.ReducingDisparitiesintheburdenofcancer:Theroleofpatientnavigators18TheHenryJ.KaiserFamilyFoundation:FocusonHealthReformMedicaid’sNew“HealthHome”Option,Jan.201119TheHenryJ.KaiserFamilyFoundation:FocusonHealthReformMedicaid’sNew“HealthHome”Option,Jan.201120TheHenryJ.KaiserFamilyFoundation:FocusonHealthReformMedicaid’sNew“HealthHome”Option,Jan.2011
S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 2 1
-
S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 2 0 S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 2 1
CollaborationHealth centers surveyed seek decreased competition, increased collaboration.
Collaborationandcooperationamongsafetynetproviders
iscriticaltomaximizingresourcesandefficienciesinthe
healthcaresysteminunderservedareas.Asproviders
seeknewopportunitiestocreateaccesstohighquality,
coordinatedcareformorepatientsunderACA,
collaborationwillbecomeevenmoreimportant.
Collaborationandcarecoordinationcanbeespecially
criticalinruralareas,whichfaceuniquechallengesin
providinganintegratedsystemofcareduetoanumber
offactors.Challengesincludeattractingcliniciansand
difficultyachievingeconomiesofscaleinservicedelivery.
Collaborationhelpsreducegeographicandotheraccess
barriersbetweenprovidersandpatients.Inadditionto
fillingcaregaps,contractingwithexistingprovidersmay
alsohelpavoidduplicationofinfrastructureandservices.
Collaboration Goal
By June 2013, safety net providers will have effectively
contracted with or made arrangements with health plans/
managed care organizations and/or hospital systems to provide
seamless patient-centered care. This includes primary,
secondary, tertiary and behavioral health care. These
arrangements will strengthen the quality care and financial
sustainability of the safety net once ACA is implemented and
funding begins to flow through these organizations.
Action Steps:
1. Identifytechnicalassistanceneedsandremoveobstacles
forsafetynetproviderssotheycannegotiatecontracts
withhealthplans/managedcareorganizationsand/or
hospitalsystems.
2. Toreduceadministrativecosts,developa(orcoordi-
natewithanexisting)primarycare“innovationcenter”
toprovidetechnicalassistanceandgrouppurchasing
(e.g.,financial,humanresource,legal,payroll,supplies
acquisition,federaldesignations,etc.)tocommunity
healthcenters.
3. CoordinatethisstrategicplanwiththeSacramento
Medi-CalManagedCareStakeholderAdvisory
Committee’seffortstostudy,defineoptionsand
improvetheexistingGeographicManagedCare
(GMC)model.
4. CoordinatethisstrategicplanwithLowIncomeHealth
Program(LIHP)effortsinSacramentoandPlacer
counties,aswellaswiththeCountyMedicalServices
Program(CMSP)representingYoloandElDorado
countiestoestablishenrollmentandcare
pathwaymodels.
5. ThroughLocalExtensionCenters(LECs),safetynet
providerswilluseacommonregionalinformation
technologytoexchangehealthinformationtomore
effectivelycollaborateamonginstitutionstorepatriate
patientstotheirhealthhome.
6. Createaforumorjointoperationsteamforsafetynet
providerstomeetwithpartnerproviderseverymonth.
Theseforumswillidentifyfundingopportunities;
discusscollaborativemodelstoimproveoperational,
financialandutilizationmanagementissues;andcome
upwithsolutions.
7. Createorexpandinventoryofresourcesforthehealth
caresafetynetpatientsandhealthprovidersondelivery
optionsandotherkeyareas.
-
S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 2 2
Capacity BuildingStaffing up to meet increased demand under ACA
Servinganadditional227,500consumersseekingcareasa
resultoftheAffordableCareActwillrequireincreasedcapacity
throughouttheregion’ssafetynet.Conversationswithsafety
netleadersandphysiciansshowedthattheyarealready
thinkingabouthowbesttomeetincreasingdemand,and
manyaretakingstepstopreparefortheAffordableCareAct
byincreasingstaffandphysicalinfrastructureandpursuing
financialresources.Thecapacitybuildingactionstepsfocus
onworkforcedevelopment,technicalassistanceandtoolsto
improvethequalityofthepatientexperience.
Capacity Building Goal
By January 2014, the safety net will have sufficient workforce
capacity to meet the needs of existing and newly insured patients
covered under the Affordable Care Act.
Action Steps:
1. Providetechnicalassistanceandcoachingforsafetynet
providerstostrengthenaccessandimproveclinic
throughput.
2. Providetechnicalassistancetoensurethattheprimary
careworkforceismaximized(throughoperational
improvementsandleveragingadiversegroupofnurse
practitionersandcommunityhealthworkers)tomeet
futuredemandprojections.
3. Createpartnershipswitheducationalandtraining
institutionstosupportaworkforcedevelopmentplanfor
safetynetproviders.Thisincludesdevelopingrecruitment
strategiesandprovidingmentoringandon-siteinternship/
fieldpracticumopportunitiesatsafetynetsites.
4. Maketechnicalassistanceavailabletosafetynet
providerssothattheyhavethetoolstoimprovethe
patientexperience,makingthemprovidersofchoice.
5. Increaseinformationandlinkagestotransportation
resourcesintheSacramentoRegion.Evaluatepolicy
opportunitiesanddefineoperationalstrategiesto
planforthefuturetransportationneedsofsafety
netconsumers.
6. Createalternativepathwaysusinginformation
technologytoconnectconsumerswithsafety
netproviders.
S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 2 3
-
S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 2 2 S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 2 3
Primary Care/Specialty Care IntegrationHealth information exchange facilitates cross-organizational patient data sharing.
Themodelofapatient-centeredhealthhomeispremised
onapersonalphysicianwhoworkswithpatientsand
theircareteamstocoordinateallhealthservices.Success
ofthismodelrequiresintegrationofspecialtycare
andprimarycarefunctionstoprovideintegrated,
patient-centeredcare.TheSacramentoRegion’seffortsin
thisareafocusoninnovationstobetterlinkprimarycare
andspecialtycareproviders(especiallytechnology-based
informationsharing)tohelpimprovecontinuityofcare
andinformationtransfer,whilereducingspecialtycare
referralsforconditionsthatcouldbetreatedbyaprimary
careclinician.Atthesametime,integrationeffortsseek
tofacilitatepatientaccesstoappropriatespecialtycare,
whichhasbeenlackingintheSacramentoRegion.
Network Integration Goal
By January 2014, primary care physicians and other
providers will meet safety net patient demand, reduce
unnecessary specialty care referrals, treat conditions at the
lowest and most appropriate level of care, and create a
sustainable financing system that will support patients’
access to specialty care in the Sacramento Region.
Action Steps:
1. Createaspecialtyregionalcarenetworkthatincludes
specialistsandcommunityhealthcenterphysicians.
2. Identifybestpracticesfromthosehospitalssystems
thathavereduceddemandforspecialtycarereferrals.
Considerideassuchas:
i. Telemedicineforprimary,dentalandmental
healthservicesaswellasspecialtycare.
ii. Developamapshowinglocationsofspecialists
intheregionbyspecialty.
iii. Shareinformationandconnectpatient
navigatorsandconsumerswithnetworksof
specialtyprovidersintheregion.
3. Identifyandaddressotherbarriersimpactingpatients’
accesstocare,suchastransportation.
-
S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 2 4
What’s NextTheurgencytopreparetheSacramentoRegionsafetynet
torespondtoneedsofthenewlyeligibleconsumersis
reflectedinthisstrategicplan.Astrategicplanisoflittle
usewithoutameansofputtingitintoaction.Infact,an
implementationplanincludingaprocessandatimelineis
anessentialpartofthestrategicplanningprocess.Wehave
ashorttimeframetotakeadvantageofwhattheAffordable
CareActoffers(someofwhichisalreadyinprocess)and
addressimmediatequestionsposedbyourregion’sstrained
healthcaredynamics.
Right nowwehavetheopportunitytomakemeaningful
changesinourregioninawaythatwill:
• transformpeople’slivesthroughbetterhealthcare,and
• providethepeaceofmindthatcomeswithgoodhealthandwell-being.
Thedecisionsmadetodaywillsetthedirectionforhealth
caredeliveryintheSacramentoRegionforgenerations
tocome.However,giventheSacramentoRegion’s
challengingenvironment,realizingthisopportunitywill
notbeeasy.Tobesuccessful,theregionalcommunitywill
needtocometogetherandworktogethertoexpand
publicawarenessandsupport,transformpublicagencies,
andcreatenewandinnovativepublicpolicies.
Meeting These Regional Health Care Challenges – Together
WhatmustbedonetohelptheSacramentoRegionseize
thisunprecedentedopportunityandmeetitschallenges?
Allthosewhoarecommittedtoimprovinghealth
generally,aswellaspolicymakersateverylevelof
government,areneededtomakesafetynettransformation
atoppriority.TheSacramentoRegionhasademonstrated
historyoftacklingtoughpolicyissuesandcreating
modelsthatnotonlyworkhere,butareadoptedbyothers
nationally.Tocontinuebeingtrendsettersinthehealthcare
arena,healthcarestakeholdersintheSacramentoRegion
mustrecommittoleadership.Healthcarestakeholders
mustpropeltheSacramentoRegiontoseizethe
opportunityoftheAffordableCareActtofundamentally
strengthenhealthcarequalityandaccess,whileaddressing
thelong-standingissuesthathavepreventedthisreality.The
transformativechangesneededintheregionandafforded
byACAimplementationwillimprovethelivesofchildren,
familiesandtheregion’scommunities.
Inpracticalterms,itwilltakeasustained,concertedeffortfor
theSacramentoRegiontofullyrealizetheopportunitiesof
theAffordableCareActandthisstrategicplan.
Herearefourimmediatestepsthatshouldbeundertakento
startbuildingaregionalframework:
Step 1—Preparation
ThisisanambitiousworkplanfortheSacramentoRegion.
Allwhohavecontributedtodevelopingthisplanrecognize
themagnitudeofchangerequiredtoachievethesegoals.
Improvingprovidercoordination,increasingconsumeraccess
toqualityservices,andimplementinginformationexchanges
withinandacrossestablishedsystemsofcaretopromote
wellnessisaconsiderableundertaking.Addtothisthe
complexityofasafetynetsystemthatoperatesunderrigid
paymentrulesunconnectedtoqualityandlargelyrelianton
informalreferralrelationships,andsystemicchangebecomes
anevenmoreformidablechallenge.
Suchmonumentalhealthsystemschangesaremorelikely
tosucceediftheplanmeetscertaincriteriafromtheoutset.
Beforewecanproceed,weneedtoknow:
• Isthereakeychampion,orchampions,whowillleadthiseffortinourregionandbringotherleaderstothetable?
• Arethereresources(staff,funding,etc.)thatwillsupporttheeffortsoftheseleaders?
• Aretherightorganizationssignedonaspartners?
• Willthepoliticalandfiscalenvironmentsupportthiseffortinboththeshortandlongterm?
• Dotheregion’sleadersagreeonwhattheywanttoaccomplish?
• Istherearealappreciationforwhatitwilltaketogettheseeffortsupandrunning?
S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 2 5
-
S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 2 4 S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 2 5
• Dowehavethefundingandotherresourcestocarry
outtheplanningandprogramdevelopment?
The Sacramento Region Health Care Partnership must
affirmatively answer these questions and establish a
functioning, funded planning coalition to make an informed
decision to proceed with the projects outlined in this plan.
Step 2 — Analysis and Design
Decisionsregardingtheformtheregion’scollectiveeffort
willtakemustbebasedonaclearunderstandingofneed,
existingservices,thepoliticalenvironment,costestimates
andfinancingoptions.Wemust:
• Understandandagreeonwhatthestrategicplanis(andisnot).
• Highlightanyplanelementsthatmightbeespeciallychallenging.
• Identifyanyelementsthatmightbeunrealisticorexcessiveincost(timeand/ormoney).
• Keepotheralternativeideasinmind,incasetheoriginalapproachprovesunsuccessful.
TheSacramentoRegionHealthCarePartnershipmust
soberlyfacedecisionsonhowtoproceed.Howdoesthe
SacramentoRegionHealthCarePartnershipcollectively
thinkitsstrategicdesign,includingthefinancingplan,can
bestsucceed?Isthereenoughseniorleadershipinvestment
andcommunitysupportforitsproposal?Doesitneedto
revisititsdesign,andperhapsevenitsprogramobjectives?
The Sacramento Region Health Care Partnership should
generate: 1) a design document that describes the target
population(s), the financing models to be used, the program
requirements, and the planned structure for governance and
administration; and 2) a cost estimate for the proposed
program designs relative to the funds expected to be available.
Step 3—Implementation Vision
Thestrategicplanvisionistheoverarchingguidestarfor
theSacramentoRegionHealthCarePartnership’sefforts.
Theremustbeastatementofgoalsandastep-by-step
outlineofresponsibilitiesandtasks.Inshort,theSacramento
RegionHealthCarePartnershipmusthaveatactical
visionof“howtochange”inordertoachieveitsvisionof
“whattochange.”TheprogramdesigncreatedinStep2,
forexample,willdescribeidentifiedtargets.InStep3,the
SacramentoRegionHealthCarePartnershipstakeholders
willdeterminethestepsneededtogetitstargetedeffortsup
andrunning.
HavinganimplementationvisionallowstheSacramento
RegionHealthCarePartnershiptocollectivelybecertain
aboutitsstrategysostakeholderscancommunicateit
consistently.Asharedvisionletseveryoneknowwhatthe
endresultshouldbeandwhyitisimportant.Itprovidesa
clearimageofwhatthestrategicplanisintendedto
accomplish.Thisstepinvolvesclarifyingexactlyhowthe
elementsofthestrategicplanimplementationwillwork.
The Sacramento Region Health Care Partnership should generate
a business plan for the strategic plan’s components that includes
all financial, operational and implementation details for the
plan’s program components.
Step 4—Implementation Team
Inordertoactuallybeginworkonanyelementofthisplan,
therewillneedtobewillingparticipants.TheSacramento
RegionHealthCarePartnershipwillneedtoassemblean
implementationteamtoimplementthestrategicplan’s
components.Thisteamshouldbecomposedofstakeholders
whounderstandtheplan’spurposeandimplementationprocess.
Theywillneedtobringtogethertherightskills,experiencesand
intereststomatchidentifiedcontentareas.Toensureanefficient
andeffectiveprocess,asmallgroupsupportedby,andreporting
to,asteeringcommitteethatcanencourageprogressandfield
questionsoraddressproblemsastheyarisewouldbethe
bestapproach.
The Sacramento Region Health Care Partnership should develop
a small team that has senior leadership, strong financial skills
and experience, and professional support to implement the
strategic plan recommendations.
-
S A C R A M E N T O R E G I O N H E A L T H C A R E P A R T N E R S H I P | P a g e 2 6
SierraHealthFoundation
1321GardenHighway
Sacramento,CA95833
www.sierrahealth.org
ConclusionWelaunchedtheSacramentoRegionHealthCarePartnership
in2011withthegoaloffindingwaystoimproveaccess,care
coordinationandthequalityoftheregion’sprimarycare
system,focusingspecificallyonthesafetynet.Thecompletion
ofthemarketanalysisandstrategicplannowoffersusaroad
maptoachievethatgoalofcreatingastrongersafetynetto
serveallresidentsofElDorado,Placer,Sacramentoand
Yolocounties.
Certainly,thechallengesfacingourregionaretremendous,but
thetransformativeopportunitiessparkedbytheAffordableCare
Actareequallygreat.Thisstrategicplanspellsoutthestepswe
musttake,individuallyandcollectively,toachievethevisionof
healthcarereform.
Wewillneedtoworktogetherandseizethisunprecedented
opportunitytocreateacollaborative,accessible,highquality
andculturallycompetentprimarycarehealthsystem.
Regionalsuccessiswithinreach,ifwereachforittogether.
Thepotentialrewardsareimmeasurable:ahealthierand
brighterfutureforall.
-
www.sierrahealth.org