2017 & 2018 –

New Member Employers 2017 2018

• Almon, Inc. • American Metal Technologies • Bemis Manufacturing Company • Inlanta Mortgage, Inc. • Krones, Inc. • Nordco, Inc. • Oldenburg Group, Inc. • Wisconsin Aluminum Foundry

Company

• Associated Banc-Corp. • The Bon-Ton Stores, Inc. • Goodwill Industries of North

Central Wisconsin, Inc. • Goodwill Industries of

Southeastern Wisconsin, Inc. • Kohler Co. • Reinhart Partners, Inc. • Sendik’s Food Markets

And significant growth expected throughout 2018 and for 1/1/19

Today’s Agenda

2:30-2:35 Welcome 2:35-2:40 Mary Ellen Stanek, Baird – Opening Remarks 2:40-3:30 Julie Schuller, M.D., Sixteenth Street Community Health Centers Joy Tapper, Milwaukee Health Care Partnership 3:30-4:10 John Prince, OptumRx 4:10-5:00 Peer-to-Peer Networking

Business Health Care Group

March 21, 2018

Mission

The Milwaukee Health Care Partnership is a

public/private consortium dedicated to improving

health care for low-income, underserved populations

in Milwaukee County, with the aim of improving -

– health, – reducing disparities, – and lowering the total cost of care.

Members 4 Health Systems

• Ascension WI • Aurora Healthcare • Children’s Hospital & Health System • Froedtert Health

5 Federally Qualified Health Centers (FQHCs/Community Health Centers)

• Gerald Ignace Indian Health Center • Milwaukee Health Services, Inc. • Outreach Community Health Centers • Progressive Community Health Centers • Sixteenth Street Community Health Centers

Public Health Agencies

• City of Milwaukee Health Dept. • Milwaukee County Dept. Health & Human Services • WI Dept. of Health Services and Medicaid Office

Academic

• Medical College of Wisconsin Affiliates: Wisconsin Hospital Association, Wisconsin Primary Health Care Association, Medical Society of Milwaukee County, Wisconsin Statewide Health Information Network (WISHIN), Free Community Clinic Collaborative (FC3), Others

Milwaukee County Population Profile

2017County Health Rankings Who is Vulnerable? Milwaukee County’s rank among 72 Counties

Quality of Life 72

Overall Health 71

Health Behaviors 71

Socioeconomic Factors 71

Length of Life 66

Clinical Care 45

Milwaukee County Population 957,735 Nearly 20% of residents live at or

below the federal poverty level

33% are enrolled in a Medicaid program

46% of children are covered by Medicaid

Between ~7% of the population is uninsured at any point in time

Health Disparities

50

55

60

65

70

75

80

2012 2013 2014

Age

in y

ears

Milwaukee County Average Age of Death by Race/Ethnicity

White

Black

Hispanic

American Indian

Asian

Secondary Data Report: Wisconsin Interactive Statistics on Health (WISH) dhs.wisconsin.gov/wish/ mortality

Core Functions

1. Assess & build awareness of community health needs

2. Implement a community wide plan and policy agenda*

3. Secure and align public and private funding and invest in high- impact initiatives

4. Monitor and report outcomes

5. Serve as a clearing house for new initiatives

*Improve efficiency and effectiveness by reducing duplication, fragmentation of efforts and cost

Goals

1. Secure adequate and affordable health insurance coverage for all

2. Increase the availability and accessibility to health care programs and services

3. Enhance care coordination and navigation within and across health and social care delivery systems

4. Address targeted community health issues via cross-sector collaboration

ACTIVITES & ACCOMPLISHMENTS

• +75 Organizations

• >160 Enrollment Assisters and Insurance Navigators

• +20 Outreach and Enrollment Events

• “Crowd Funding” for Community Marketing Campaign

Sources of Insurance in Milwaukee County 2017

Nationally Recognized Enrollment Coalition

Milwaukee Enrollment Network

Uninsured in Milwaukee County

17,769

41,820

22,202

39,422

24,913

15,861

33,802

Quarterly Coverage Report October 2017

55,667

23,768

22,202

11,512

39,442

28,058

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

2013 2016

≥ 2.00 FPL 1.38 to 1.99 FPL < 1.38 FPL

Post - ACA 6.8%

117,311

63,338

46% Reduction in the Uninsured Rate

Pre- ACA 12.6%

13

Primary Care Access Study Highest Poverty Zip Codes accounted for: • 45% of total county population

• 71% of the county’s Medicaid

and uninsured population

• 27% of total primary care physicians

• 60% of primary care treatable ER visits

Primary Care Access

FQHC Growth Plan Build the capacity and

capabilities of Milwaukee’s Community Health Centers

Invest in New Access Points

Support operational improvements, efficiencies, collaboration and shared services

Access Organized and Supported Other Safety-Net Clinics

+25 Free Medical Clinics; 38 other Safety Net Clinics reported 510,472 patient visits in 2016.

Specialty Access for Uninsured Program

ACCESS Behavioral Health • Advancing MKE County BHD Redesign • Investments and Expansion in

Outpatient Care • Expansion to Psychiatric

Teleconsultation Services Expansion

Oral Health • Embed Hygienists in Primary Care

Settings • Expand Seal-A-Smile program in high risk

schools • Improve access for Special-Needs

Dentistry

Goal: Decrease avoidable ED visits and connect to Primary Care and other health resources.

Care Coordination Emergency Department Care Coordination

ED to Health Home Program • +55,000 referrals since

2009; ~500 patients per month

• 45% show rate; 55% stick rate

• 44% decrease in ED visits once connected

Collaborative Community Health Improvement Priorities

Leveraging Investments

Shared Community Investment Fund (SCIF) Health Systems’ Strategic Funding Pool

Total Investments: $26.6 million

MHCP/ United Way Health Improvement Fund (HIF) “Challenge Grant” Total Investments: $2 million

Other Extramural Funding Total Raised: $5.9 million

More than $32 million in aligned funding to improve access, reduce disparities and slow the rate of increase in the cost of care in Milwaukee.

Greater Milwaukee Business Foundation on Health Medication Access • $185,832 in GMBFH grant funding over 7 yrs. to support prescription assistance program:

Served 5,717 unique patients

Filled 30,943 prescriptions

Provided medications at an average wholesale value of $37,285,106

ROI = $201 in Rx cost savings for every $1 contributed Health Information Exchange • $164,000 grant enabling the connection of 8 largest safety-net clinics to WISHIN Coverage • $300,000 commitment from 2018 – 2020 to strengthen and sustain insurance enrollment assistance

Impact on Payers and Employers Supporting enrollment, ensuring timely access to the “right” care and improving overall population health benefits payers and employers Securing Coverage and Access to Care for Working Poor

– Estimate > 50% uninsured are employed – 78% of Medicaid beneficiaries live in a family with at least one working family

member; 60% of adult Medicaid enrollees are employed full or part time

Reducing Cost-Shifting – Reducing charity pass- through – Reducing Medicaid uncompensated care – “Hidden Tax” – Medicaid Tax-Payer Value

Building a Safer, More Productive, and Prosperous Community – Preventing and addressing illness, chronic disease and disabilities – Supporting the development of a healthier workforce

Sixteenth Street Community Health Centers Over 45 years of quality, patient-centered, family- based

healthcare and supportive services

What is a Community Health Center (CHC)?

For over 50 years, HRSA-supported community health centers have provided comprehensive primary and preventative health care services – which means • Medical • Dental • Behavioral health • Substance use care • Connections to social services

Community Health Center Requirements

• Have a 51% patient-majority board of directors

• Be located in/serve a medically underserved area or population

• Apply for and receive competitive HRSA grants for continuation

• Comply with HRSA 19 program requirements • Demonstrate compliance through routine

HRSA operational site visits

To improve the health and well-being of Milwaukee and surrounding communities by providing quality, family-based health care, health education and social services, free from linguistic, cultural and economic barriers.

Our Mission

Our History • Since 1969, Sixteenth Street Community Health

Centers has been a community leader in primary health services for our city’s most vulnerable residents

• Our reputation for compassion, innovation and quality is both locally and nationally recognized

• An independent non-profit agency, Sixteenth Street now operates at six locations, including three full-service medical clinics and a Women, Infants & Children (WIC) nutrition program

• Since 1969, Sixteenth Street Community Health Centers has been a community leader in primary health services for our city’s most vulnerable residents

• Our reputation for compassion, innovation and quality is both locally and nationally recognized

• An independent non-profit agency, Sixteenth Street now operates at six locations, including three full-service medical clinics and a Women, Infants & Children (WIC) nutrition program

Our Board of Directors Rick Walters Board Chairman Wells Fargo Advisors LLC

Lauren Lopez Milwaukee Public Schools

Laura Arnow, CPA Treasurer Arnow & Associates

Teresa C. Mercado Mexican Fiesta/WHSF

José Avila, MSN, FNP Ellen K. Murphy, J.D. UWM School of Nursing

Thomas M. Gazzana Vice President

Juan Ruiz Secretary United Community Center

Wayne F. Heidenreich, MD Northwestern Mutual

Suzanne Sanicola, CPA Ascension Wisconsin

Kathryn Hein Les Aspin Center for Government

Levi Sosa

Steven K. Kulick, MD ProHealth Care, Inc.

Rick Walters Board Chairman Sixteenth Street Patient

8 of our 13 members are patients

Our Practice Sites Milwaukee

• Chavez (full service clinic) • Parkway (full service clinic) • Layton (full service clinic – focus on

behavioral health and AODA) • United Community Center – Senior

Center (geriatric care) • St. Anthony in-school clinics • St. Augustine Prep in-school clinic • Greenfield Building (WIC location among

other services)

Waukesha

• Sixteenth Street – Waukesha (full service clinic)

Our Patients

Our patient population is extremely diverse, representing many cultures, ethnicities and economic backgrounds.

Our Patients

85%

24% 13% 8%

5% 4%

65%

12%

3%

71%

29%

Our Impact In 2016 Sixteenth Street served nearly 38,000 people,

in more than 160,000 individual visits.

Our Impact

Our Quality Story • Sixteenth Street has been accredited by the Joint Commission

since 2010, and passed our last two unannounced Joint Commission audits in 2012 and 2015

• In 2013 we received recognition as a Level 3 Patient Centered Medical Home (PCMH) by the National Committee on Quality Assurance

• In 2016 we were accredited as a Joint Commission Primary Care Medical Home

• We are part of the Wisconsin Collaborative for Healthcare Quality, an organization that aggregates and publishes health care quality information

Key Quality of Care Indicators

Trimester of Entry into Prenatal Care 74% of patients entered prenatal care in the first trimester Childhood Immunizations 92% of children under age two were up-to-date with immunizations Cervical Cancer Screening 71% of women were screened for cervical cancer

Hypertension under Control 74% of patients had their hypertension under control

Diabetes under Control 74% of patients with diabetes had A1c levels under 9

Low Birth Weight 93% of babies delivered by Sixteenth Street providers were at or above normal birth weight

Operations | Coordinated Care for the Whole Person

• We operate within a fully integrated model of primary care, behavioral healthcare, social services and supplemental services all on-site.

• Every added service requires an in depth discussion about cost and sustainability.

• We have to be very disciplined about what is and isn’t within our cost model.

Primary Care | Team-Based Care On site collaboration between providers, case managers, outreach workers, social workers, support staff, within and across medical and behavioral health departments. Staff of all levels work to the top of their license creating cost efficiencies.

Primary Care | Medical and Behavioral Health Services Medical Services • Pediatrics • Family Medicine • Internal Medicine • Midwifery • Women’s Wellness (Prenatal and

Pediatric Nurse Case Management) • Chronic Care Education

Outpatient Behavioral Health Services • Psychology • Psychiatry • Psychotherapy • Marriage & Family Therapy • AODA (Waukesha and Layton only) • MAT (Waukesha and Layton only) • Child and Adolescent Day Treatment (Layton

Only) • ADHD Testing (Waukesha only)

Primary Care | Pediatrics

We offer the highest quality care and treatment of infants, children, and adolescents. With 49% of our patients being under the age of 18, we care for over 18,000 pediatric patients per year.

Primary Care | Internal Medicine

We provide long-term, comprehensive care managing both common and complex diseases.

Primary Care | Family Practice

We offer continuing and comprehensive health care for individuals and families of all ages.

Primary Care | Midwifery & Women’s Wellness

We provide a personalized focus on women’s health issues including disease prevention, reproductive health, birth and delivery services, support groups, case management, parenting classes and child enrichment activities.

Behavioral Health

Psychiatrists, psychologists and family therapists provide individual and group therapy sessions and medical management for adults and children. They also help clients better manage stress, chronic illness and pain, abuse, neglect issues and depression.

Integration of Medical and BH Services • Collocation of behavioral health providers on the same floor • Behavioral Health providers able to immediately address mental health concerns

during primary care visit • Short sessions focus on intervention and relief • Reach patients early Collaboration and immediate care is key for preventing behavioral health

issues and giving our patients the coordinated care needed to put them in control of their health.

Primary Care | Supplemental Services • WIC (Women, Infants & Children

Program) • Social Services • Parenting Resource Center • Environmental Health Department • HIV Services • Healthy Choices (obesity prevention

program) • Women’s Wellness (prenatal and pediatric

case management, Obstetric Medical Home Initiative)

Support Services| WIC (Women, Infant & Children) Nutrition Program

We ensure the health and wellbeing of children and families by providing nutrition education, health screenings, breast feeding counseling, food vouchers and other support services.

Support Services| Healthy Choices

Through family education and community advocacy, Healthy Choices strives to improve the home and neighborhood environment for adults and children in Milwaukee’s Southside, so they can enjoy a healthier life.

Support Services| HIV

Sixteenth Street’s HIV program provides a comprehensive approach, including medical care and treatment, supportive case management and prevention education for Milwaukee’s Latino population.

Support Services| Parenting Resource Center

We offer proper car seat usage classes, parenting classes, the child enrichment program and the Stork’s Nest (Wisconsin Chapter of the March of Dimes) to our Sixteenth Street parents.

Support Services| Social Services

Our Social Services department provides crisis intervention, counseling, advocacy, education, health insurance enrollment assistance, referral to community resources and case management services to our patients, their families and the community at large.

Support Services| Environmental Health

The Department of Environmental Health promotes education, community activities and advocacy for neighborhood development and sustainability, in addition to comprehensive lead outreach and testing. It helps families live safe from lead poisoning, contaminated waters and other hazards.

Support Services| Chronic Condition Health Education

We provide prevention, intervention and support for patients managing asthma, diabetes and hypertension. Offering individual and group education, support groups and outcome- based care management.

Outreach Many departments within Sixteenth Street are actively out in the community to connect with and educate residents around prevention and maintenance to care.

• HIV outreach, education and prevention efforts

• Chronic Conditions (Diabetes and Asthma) outreach, education and prevention efforts

• Healthy Choices outreach, community advocacy, obesity education and prevention efforts and maintenance

• Prenatal and pediatric case management

• HIV case management

Enrollment Eligibility and Enrollment Into Coverage • Every patient is evaluated for eligibility

• Specialists help determine if a client may be eligible and assist with enrollment into Badger Care Plus including coverage for children, families, childless adults and express enrollment for qualifying pregnant and child cases

• Sixteenth Street submits applications to the state and the state makes determinations on the case

CHCs| Community Value

Large financial contribution to the health care system as a whole Cost effective care – saving the health care system millions Stimulate local economy

In 2016, the five CHCs in Milwaukee received $13.3 million in federal grants to care for un- or under-insured patients and wraparound services

CHCs| Financial Contribution

Source: Wisconsin Primary Health Association

CHCs| ED and Cost Effective Care ED and UC Visits • Keep people out of ED and UC for non-acute issues

– Nationally, 69% of ED visits among the general population are primary care sensitive in nature and therefore preventable

– Average expense for an ED visit= $978 – Average expense for a health center visit = $150 – Average TOTAL ANNUAL EXPENSE for a health center patient = $687

Cost effective care • Health centers’ average cost runs a dollar less per patient per day compared to all physician

settings (while typically serving more complex patients that are more likely to have chronic conditions)

• Health centers save over $24 billion for the healthcare system annually

CHCs| Stimulate Local Economy

FTEs at health centers in Milwaukee Operating expenditures directly into local economies

* 2015 UDS

707

$75 MILLION

Community health centers are economic engines. • Create jobs • Increase business for surrounding

companies • Take an active part in improving

their surrounding environment

Sixteenth Street Community Health Centers Over 45 years of quality, patient-centered, family- based

healthcare and supportive services