california children’s services program redesignhealthpolicy.ucla.edu/documents/spotlight/complete...
TRANSCRIPT
Meeting Call-in Number – (888) 921-8686
Meeting ID Number – 103-120-2607
California Children’s Services Program Redesign
Redesign Stakeholder Advisory Board Meeting #2
Focus: Formation of Technical Workgroups
Friday, January 23, 2015
10:00am – 4:00pm
AGENDA California State Lottery – Pavilion 700 North 10th Street, Sacramento, CA 95811
10:00-10:30 Registration, Coffee
10:30-10:50 Welcome and Purpose Statements
Overview of Today’s Meeting Focus Dylan Roby or Jessica Padilla, UCLA
Goals and Considerations for the Redesign Discussions
CCS Data Availability Anastasia Dodson, DHCS Louis Rico, DHCS
10:50-11:10 Vision for the CCS Program, Survey Results, and Technical Workgroup Topics
Dylan Roby, UCLA Jess Schumer, UCLA
11:10-12:10 CCS Program Components that are “ Working Well”
Facilitated discussion about specific aspects of the CCS program that are working well, based on survey results, Stanford data analysis, and RSAB input
Moira Inkelas, UCLA
Wrap-up Dylan Roby, UCLA
12:10-12:40 Lunch Break
12:40-1:40 CCS Program Components that “Can Be Improved”
Facilitated discussion about specific aspects of the CCS program that can be improved based on survey results, Stanford data analysis, and RSAB input.
Dylan Roby, UCLA
Wrap-up Dylan Roby, UCLA
1:40-1:50 Break, Light Refreshments
1:50-2:50 Additional information Needed to Make Decisions
Facilitated discussion about what information is needed to make decisions and what
topics should be addressed by workgroups for the CCS Program
Wrap-up
Dylan Roby, UCLA
2:50-3:15 Reflections about the Goals identified for the CCS Program & CCS Population Jess Schumer, UCLA Louis Rico, DHCS
3:15-3:35 RSAB Members Questions and Comments
Moderator: Dylan Roby, UCLA
3:35-3:55 Public Comments
Moderators: Dylan Roby, UCLA and Louis Rico, DHCS
3:55-4:00 Wrap-Up, Closing and Next Steps
Dylan Roby, UCLA
Louis Rico, DHCS
State of California—Health and Human Services Agency
Department of Health Care Services
TOBY DOUGLAS DIRECTOR
EDMUND G. BROWN JR. GOVERNOR
Systems of Care Division 1515 K Street, Suite 400, Sacramento, CA 95814
P.O. Box 997413, MS 8100 Sacramento, CA 95899-7413 (916) 327-1400
Internet Address: www.dhcs.ca.gov
Department of Health Care Services California Children’s Services (CCS) Redesign Goals
January 20, 2015 Consistent with the DHCS Stakeholder Engagement Initiative, the CCS stakeholder process is designed to openly engage in communication with stakeholders for the purpose of improving health care delivery and quality of care to CCS eligible children. This process is also intended to embrace the core values embodied by the Triple Aim: better health, better health care, and lower costs. The CCS Redesign goals listed below are provided to the CCS Redesign Stakeholder Advisory Board (RSAB), to restate and clarify the goals of the CCS redesign process.
1. Implement Patient and Family Centered Approach: Provide comprehensive
treatment, and focus on the whole-child rather than only their CCS eligible
conditions.
2. Improve Care Coordination through an Organized Delivery System: Provide
enhanced care coordination among primary, specialty, inpatient, outpatient,
mental health, and behavioral health services through an organized delivery
system that improves the care experience of the patient and family.
3. Maintain Quality: Ensure providers and organized delivery systems meet
quality standards and outcome measures specific to the CCS population.
4. Streamline Care Delivery: Improve the efficiency and effectiveness of the CCS
health care delivery system.
5. Build on Lessons Learned: Consider lessons learned from current pilots and
prior reform efforts, as well as delivery system changes for other Medi-Cal
populations.
6. Cost-Effective: Ensure costs are no more than the projected cost that would
otherwise occur for CCS children, including all state-funded delivery systems.
Consider simplification of the funding structure and value-based payments, to
support a coordinated service delivery approach.
California Children’s Services
Redesign Stakeholders Advisory Board
David Alexander, MD President & CEO Lucile Packard Foundation for Children’s Health
Maya Altman CEO Health Plan of San Mateo
Nick Anas, MD President Children's Specialty Care Coalition, Pediatrician in Chief, Director Pediatric Intensive Care Unit CHOC Children's Hospital
Dyan Apostolos Assistant Director of Public Health Monterey County Health Department
Edward A. Bloch, MD Medical Director Children’s Medical Services, L! County
Amy Carta Assistant Director Santa Clara Valley Health & Hospital System
Representing: California Association of Public Hospitals and Health Systems
Kris Calvin CEO American Academy of Pediatrics, CA
Athena Chapman Director, Legal and Regulatory Affairs California Association of Health Plans
Richard Chinnock, MD Vice President California Specialty Care Coalition
John Patrick Cleary, MD Vice President / President Elect California Association of Neonatologists
Stuart Cohen, MD Chair, California District American Academy of Pediatrics
Arlene Cullum Director, Women’s !nd Children’s !mbulatory Services Sutter Health
Devon Dabbs Executive Director Children’s Hospice & Palliative Care Coalition of C!
Karen Dahl, MD Vice President of Quality and Safety Valley Children's Hospital
Juno Duenas CMA Representative Family Voices
Chris Dybdahl California Children’s Services Administrator Santa Cruz County
James Gerson, MD Vice President & Senior Medical Director HealthNet
Kelly Hardy Senior Managing Director, Health Policy Children Now
Domonique Hensler Director, Care Redesign Planning for RCHSD & Network Rady Children’s Hospital – San Diego
Jennifer Kent Executive Director Local Health Plans of California
1
California Children’s Services
Redesign Stakeholders Advisory Board
Tom Klitzner, MD Chair, Cardiac Technical Advisory Committee California Children’s Services, UCL!
Ann Kuhns President & CEO California Children’s Hospital Association
Tony Maynard Board Member / Patient Hemophilia Council of California
Susan Mora CMS Program Chief Riverside County Department of Public Health
Tony Pallitto California Children's Services Administrator Kern County Public Health Services Department
Richard Rabens, MD Medical Director, Medi-Cal and State Programs The Permanente Medical Group / Kaiser Permanente Northern California
Judith Reigel Executive Director County Health Executives Association of California
Katie Schlageter California Children’s Services !dministrator Alameda County
Ed Schor, MD Senior Vice President Lucile Packard Foundation for Children’s Health
Laurie Soman Director Children’s Regional Integrated Service System (CRISS)
David Souleles Deputy Agency Director Orange County Health Care Agency
Abbie Totten Director, Government Programs and Strategic Initiatives Health Net, Inc.
Amy Westling Director of Policy Association of Regional Center Agencies
2
For General Inquiries: [email protected]
California Children’s Services
Program Redesign Team Dylan H Roby Principal Investigator Assistant Professor, UCLA Fielding School of Public Health, Department of Health Policy and Management Program Director, UCLA Center for Health Policy Research
[email protected] Jessica Padilla Project Manager UCLA Center for Health Policy Research
[email protected] Michaela Ferrari Research Analyst UCLA Center for Health Policy Research
[email protected] Nathan Moriyama Research Assistant UCLA Center for Health Policy Research
[email protected] Neal Halfon Co-Principal Investigator Director, UCLA Center for Healthier Children, Families & Communities Professor of Pediatrics, UCLA School of Medicine
[email protected] Moira Inkelas Investigator Assistant Director, UCLA Center for Healthier Children, Families, & Communities Assistant Director, Child and Family Health Program Associate Professor, UCLA Fielding School of Public Health, Department of Health Policy and Management
Lee M Sanders Expert Consultant Co-Director, Stanford's Center for Policy, Outcomes, and Prevention (CPOP) Associate Professor of Pediatrics, Stanford University School of Medicine Paul H Wise Expert Consultant Co-Director, Stanford's Center for Policy, Outcomes, and Prevention (CPOP) Richard E. Behrman Professor of Child Health and Society and Professor of Pediatrics and Health Policy, Stanford University School of Medicine
Lisa Chamberlain Expert Consultant Associate Director, Stanford's Center for Policy, Outcomes, and Prevention (CPOP) Associate Professor of Pediatrics, Stanford University School of Medicine
Jess Schumer Research Expert and Consultant Pediatrician and Fellow, Health Resources and Services Administration (HRSA) Maternal and Child Health Training Program
Mimi Choi Research Expert and Consultant Pediatrician and Fellow, Health Resources and Services Administration (HRSA) Maternal and Child Health Training Program
Peter Harbage Expert Consultant President, Harbage Consulting Mia Orr Expert Consultant Principal Consultant, Harbage Consulting
Key Components of a System for Publicly Financed Care of CSHCN in California
Disagreement
with the content
of this document
is anticipated and
encouraged.
Issue Brief September 2014 KEY COMPONENTS OF A SYSTEM FOR PUBLICLY FINANCED
CARE OF CSHCN1 IN CALIFORNIA by Edward Schor, MD, Lucile Packard Foundation for Children’s Health
The future of the state’s CCS program has spawned numerous but often unfocused discussions. In order
to help organize and focus forthcoming discussions, this paper, a System for Publicly Financed Care of
CSHCN in California, is provided as a proposal to which stakeholders can react.
The paper attempts to present a coherent plan for a system for CSHCN while
identifying the key issues and decisions that might arise as the system is
developed. Some of the items represent current approaches, while others suggest
alternative ones. Some are more easily implemented than others. Disagreement
with the content of this document is anticipated and encouraged, as its purpose is to foster productive
discussion. Discussion should begin with the proposed Principles and Goals, because without clarity and
agreement on those it will be difficult to discuss subsequent items. Once the remaining components have
been agreed upon, responsibilities for processes will need to be determined.
PRINCIPLES AND GOALS
A single health care financing system that promotes integration of services to meet all the child’s
healthcare needs
A statewide, regionalized system of comprehensive care services
Equity of eligibility, access and benefits regardless of child’s residence
Family-centered system with medical homes for all children
Easy to access services and supports
Continuity of care with health care providers
Culturally competent care
Common, transparent performance metrics across the system
Health plans and providers held accountable to meet quality and performance standards
Constantly improve quality of care by all service providers
Begin system change by focusing on coordinating care and services
1 The definition of children with special health care needs (CSHCN) used here is that recommended by the federal Maternal
and Child Health Bureau but may exclude the “at risk” population included in that definition.
Key Components of a System for Publicly Financed Care of CSHCN in California
www.lpfch-cshcn.org
SYSTEM STRUCTURE
An organized delivery system capable of meeting all of the medical care needs of a child for
whom it has assumed responsibility
A clearly articulated governance model incorporating participating providers and meaningful
consumer participation
Regionalized services
Maximized integration of services and functions
Statewide registry for eligible CSHCN including those receiving care from Regional Centers
Designated special care centers and quaternary centers of excellence
Required inclusion of children’s and university hospitals as part of health plan provider panels
Complex primary care clinics eligible to qualify as special care centers
Uninsured children covered by counties buying Medi-Cal equivalent coverage from managed
care organizations
ADMINISTRATION
Client Eligibility
- Standardized screening for eligibility for enhanced services
- Eligibility process includes consideration of both diagnoses and functional assessment of
acuity and complexity
- Time-limited conditions excluded
- Procedures designed to maximize inclusion of children who would benefit
- Extend eligibility until age 26 years to align with ACA policy
- Neonatal services covered by Medi-Cal except when CCS eligible condition present
- Standardized determination across public programs
Provider Eligibility
- Certification/empanelment authority
Management: State DHCS Responsibilities
- Centralized, standardized eligibility determination, service authorization and utilization
review
- Maintain statewide patient registry
- State and regional systems coordination: Use memoranda of understanding among health
plans, public health, CHDP, Early Start, Regional Centers, Mental Health clinics, Medi-
Cal, home health care and social services
- Collaborate with Medi-Cal Managed Care office to ensure that contracts with health
plans assure the availability of services needed by CSHCN
- Liaison with health plans, professional associations and other statewide service
organizations and agencies serving CSHCN
- Regularly convene provider and consumer advisory committees
- Regularly updated health care needs assessment of the populations to be served
3
Key Components of a System for Publicly Financed Care of CSHCN in California
Lucile Packard Foundation for Children’s Health
- Proactive state leadership to improve system performance including access, quality and
value
- Standardize care processes, e.g., referral, care planning, discharge procedures, and
transition planning and processes
- Assure provision of technical assistance to counties and provider practices serving
CSHCN
- Monitor performance, measure quality, and issue regular public reports
- Monitor population health of CSHCN
- Site visitation and certification of providers
- Maintain up-to-date registries of providers and of their capacities to accept new patients
and of community services frequently used by CSHCN
- Offer ombudsman/consumer relations services
- Streamline reimbursement process
- Offer billing assistance to providers
- Medical therapy units operated by counties or regionalized
Management: Regional or County Public Health Department Responsibilities
- Monitor access to care
- Need-based care coordination, case management and navigation assistance
- Provide technical assistance to provider practices
- Certification review
- Medical Therapy Unit operation
Financing
- Payment adjusted for risk and need
- Promotes team care and shared management
Policy
- Legislative liaison
- Policy development in collaboration with Medi-Cal Managed Care office
- A single health care financing system that promotes integration of services to meet all the
child’s healthcare needs
PROVIDERS
Networks of providers, including primary and pediatric subspecialty care, oral and mental health
professionals, hospitals and centers of excellence adequate to meet the needs of children in a
timely, efficient and effective manner
Medical home designation based on established criteria whether primary or subspecialty care
provider
Meaningful use qualified electronic health record capability
Provider compensation and performance management systems to reward providers for improved
quality of care
Key Components of a System for Publicly Financed Care of CSHCN in California
www.lpfch-cshcn.org
BENEFITS AND SERVICES
EPSDT benefits with special attention to:
- Chronic care management
- Wrap-around service
- Habilitative services
- Primary, secondary and tertiary preventive care
- Durable medical equipment
- Self-management support
- Physical and occupational therapy
- Oral health
- Translation services
- Transportation
- Mental health and behavioral health service parity with physical health services
Enrollment and annual needs assessment for care planning
Care plans for all children
Benefits tied to needs assessment and some provided in a tiered fashion
Neonatal high-risk follow-up based on needs/risk assessment
All children have a medical home
Care coordination as a tiered service provided at the practice and plan levels
Parent-to-parent navigation assistance
Co-management between primary care and specialty care providers
Provider-to-provider consultation
Family support related to care of CSHCN
Coordinated transition planning and services
Home visits as part of care coordination
Health care in homes, child care facilities and schools
Step-down services after hospital discharge
Home and community services
Respite care
Long term care
Palliative care
Coordinate with in-home health services and long-term care services and other service providers
Access to special care centers and centers of excellence
Electronic care management: e-mail, telephone consultation, telehealth
Out-of-plan provider access
QUALITY ASSURANCE
Maintain and expand criteria for empaneled providers and special care centers
Standard performance measures for systems and providers across counties and the state
5
Key Components of a System for Publicly Financed Care of CSHCN in California
Lucile Packard Foundation for Children’s Health
Application of evidence-based, quality measures specific to children with chronic health
problems
Monitor equity and performance related to access to care, health care utilization, quality of care,
satisfaction and experience with care, health care expenditures, health outcomes and impact on
families
Requirement of ongoing quality improvement activities by health plans and providers including
special care clinics
Assessment of cultural sensitivity of care
Family involvement in program and policy activities related to quality of care
Health plans responsible for enrollee population health measures and quality
INCENTIVES
Provide technical assistance to support practice transformation and quality improvement
Tiered incentive for medical homes depending on capabilities or quality
Financial incentives and technical assistance for EMR adoption
Financial incentives for co-location of medical and behavioral health care services
Financial incentives to licensed providers in health professional shortage areas
ADDENDUM
The plan described above is intended to offer improved care to children with special health care needs,
but it falls short in two important ways. First, it does not directly address the health care of CSHCN who
are privately insured. Second, it does not come close to offering a plan for a unified system to promote
the health and well-being of children. The fragmentation of services, most notably the independent
operation of medical, mental, dental and especially developmental services is highly frustrating for
families. It interferes with the provision of comprehensive, coordinated, high-quality care for special
needs children and hampers opportunities to hold agencies and service providers accountable. The
separate financing inherent in this fragmentation no doubt duplicates administrative costs and some
services and raises the costs underwritten by the state’s taxpayers. It should be an aim of state
government and advocates to work toward the creation of the integration of services for children.
Edward Schor, MD, is senior vice president at the Lucile Packard Foundation for Children’s Health.
ABOUT THE FOUNDATION: The Lucile Packard Foundation for Children’s Health works in alignment with Lucile Packard
Children’s Hospital and the child health programs of Stanford University. The mission of the Foundation is to elevate the priority
of children’s health care through leadership and direct investment. The Foundation is a public charity, founded in 1997. To learn
about the Foundation’s work to improve the system of care for Children with Special Health Care Needs, go to www.lpfch-
cshcn.org. To see data about CSHCN in California, visit http://www.kidsdata.org/topic/14/demographics-of-children-with-
special-needs/summary
CONTACT: 400 Hamilton Avenue, Suite 340, Palo Alto, CA 94301, [email protected], (650) 497-8365