SEPTEMBER 2008 ISSUE

Safety Net Working Group reviews progress

At its August 26 meeting, the Safety Net Working Group (SNWG) heard progress reports from its four committees:

• Members of the Access to Care Committee shared information regarding a proposed patient navigation grant application to the Health Care Foundation of Greater Kansas City (HCF). Truman Medical Center wrote a letter of intent to HCF to serve as a placeholder for a possible SNWG application. Members of the SNWG discussed the pros and cons of such a submission and decided that the model for a patient navigation program should be more fully developed. Members also acknowledged that the need for increased evening hours at safety net clinics is emerging as an important priority, and funding resources should be focused in this area.
• Members of the Health Information and Exchange Committee reported on technology initiatives in both Kansas and Missouri. SNWG members felt that the process used in Missouri to assess the information technology capabilities of federally qualified health centers and the resulting assistance in implementing an electronic health record (EHR) would be valuable to explore for all Kansas City safety net providers. The committee also reported on KC CareLink’s recent Request for Information and vendor responses.
• Members of the System Capacity Committee shared information about a group purchasing contract opportunity. An Associated Purchasing Services (APS) contract would allow participating safety net providers to purchase supplies at a discounted rate. A one-year pilot project will be offered at no cost to the safety net providers. At its conclusion, providers will determine whether the program provided value. MARC staff will assist in development of the contract and implementation of the pilot project. The committee also shared capacity maps showing the utilization of the safety net system.
• Members of the Provider Relations Committee requested input on a document developed to share the story of the uninsured and the safety net providers, and presented an accompanying marketing strategy. The SNWG members discussed both items and encouraged the committee to look at a wide variety of new marketing techniques.

In other business, SNWG members revisited a compact developed to clarify the relationship of the safety net providers to each other and to MARC. The group reached consensus that the compact is sufficient to guide the work of the SNWG in the upcoming months, but expressed the need to develop a more formal structure in the future.

SNWG members also heard an overview presentation on the Kansas City behavioral health initiative. They discussed the parallel nature of the two initiatives and the need to work together.

Committee Updates — August 2008

	The Access to Care Committee met on August 19 at the MARC Conference Center. Gregg Lombardi, executive director of Legal Aid of Western Missouri, gave a report on Legal Aid’s role in helping patients obtain or continue Medicaid coverage. Currently, Legal Aid works with Truman Medical Center and Swope Health Services, but would like to expand its services to other safety net clinics in Missouri. (For more information, see below.) Representatives from Truman Medical Center reported their submission of a letter of intent (LOI) to the Health Care Foundation of Greater Kansas City for a grant application to establish a regional patient navigation program, with emphasis on reducing hypertension in medically vulnerable populations. The program would include other interested safety net providers. Members of the committee indicated their support for the LOI and willingness to write letters of support, and agreed to present the information to the Safety Net Working Group. Committee members also discussed possible venues for gaining consumer/patient information about barriers to health care in Kansas City. A representative from Communities Creating Opportunities (CCO) said that CCO recently surveyed area consumers about access to healthcare, and a report may be available as soon as the end of August 2008. Committee members agreed to determine next steps, including possible focus groups, once they review the report.
	The System Capacity Committee met on August 5 at the MARC Conference Center. Bruce Frerking and Lisa Kidd of Associated Purchasing Services (APS) gave an overview of their group purchasing program. APS works with the Kansas Hospital Association, the Missouri Hospital Association, local hospitals and some safety net clinics to provide group-purchasing services at a discount rate. After discussing several options, the committee agreed to join APS as a group for a trial year at no cost to the clinics. MARC staff will work out contractual details with APS and work with the clinics to get the group purchasing pilot project in place. Committee members discussed key strategies to improve clinic capacity. After much discussion the committee members agreed that three main areas that would provide the most assistance include workforce recruitment and retention, joint training programs and establishing multi-year grants focused on sustaining core operating funds. The committee members agreed to discuss plans for these three areas in more depth at its September meeting.
	The Health Information and Technology Committee met on August 20 at the MARC Conference Center. Cathy Harding, executive director of Kansas Association of the Medically Underserved (KAMU), and Angela Herman, clinical director for the Missouri Primary Care Association (MPCA), reported on technology initiatives in Kansas and Missouri. Cathy shared information about current health information technology pilot projects. The projects include a community health record managed by Cerner in Wichita; HealthChoice Network in Emporia; and Electronic Health Systems (EHS), which is in use throughout the state. She also reported on state legislative funding and grants opportunities that support Health Information Technology (HIT) in Kansas, and announced KAMU would update its Web site to include workforce recruitment tools. Angela shared information about HIT projects in Missouri. In 2007, state legislators appropriated $5 million for HIT in federally qualified health centers (FQHCs). MPCA, which is responsible for managing these resources, allocated $175,000 for each FQHC to plan and implement electronic health record (EHR) technology. For clinics that already have EHR, the funds were used for upgrades, sustainability and maintenance. MPCA said its goal is for clinics to all go live with EHR in June 2009. MPCA is also developing a data warehouse with centralized data collection capabilities. Data gathered through the FQHC EHR will be electronically transferred to the data warehouse. At this time, it will only gather data from the FQHCs, but it does have the capability of adding free clinics at a later date. (For more information about MPCA and HIT initiatives see related article.) Linda Davis, executive director of KC CareLink, announced that on August 15, KC CareLink received six responses to its Requests for Information (RFI) on proposals to enhance its health information exchange technology. KC CareLink will submit follow-up questions to the vendors and meet with various groups to seek feedback before selecting a vendor.
	The Provider Relationships and Advocacy Committee did not meet in August. At its next meeting, Sept. 11, the committee will review draft marketing materials designed to tell the safety net story.

Kansas Sen. Bob Dole to tackle health care reform

At the Dole Institute of Politics in Lawrence, Kan., on August 4, Bob Dole — former U.S. senator from Kansas and past presidential nominee — joined other key stakeholders to tackle the issue of health care.

Sen. Dole is working with three other former Senate leaders — Howard Baker, Tom Daschle and George Mitchell — to launch the Bipartisan Policy Center’s Leaders Project on the State of American Health Care. The Leaders Project is an effort to produce a politically viable set of policy recommendations that address the delivery, cost, coverage and financing challenges facing the nation’s health care system.

Sen. Dole came to Lawrence as a part of a Leaders Project Policy Forum to hear what other key stakeholders in Kansas have to say about a health care system that is leaving over 47 million Americans without health coverage. Sen. Dole said that he thinks health care is the hidden issue in this election year.

In opening comments, Sen. Dole said reform shouldn’t be just about the government spending more on health care, but also about personal responsibility. He said that of the 47 million Americans without health insurance, “about 10 million are young people from 24 to 34 who don’t want to buy insurance.” He also noted the importance of Americans taking an active role in their own health care.

Following Sen. Dole’s remarks, three panels of key Kansas health care stakeholders discussed critical health care topics:

• Empowering patients to access and effectively use high-value care
• Engaging consumers on preventive and wellness care to encourage healthier lifestyles
• Health care reform: meeting the needs of rural communities

KC CareLink issues Request for Information (RFI)

KC CareLink is a regional nonprofit collaborative whose mission is, through the use of information technology and the secure exchange of health information, to ensure that providers across health care safety net organizations better coordinate and deliver health care to patients that they jointly serve.

Seven years ago, when KC CareLink was first started in Kansas City, there was very little patient information shared between safety net providers. However, over the last few years health information exchanges have become more common across the nation and the technology used has changed dramatically.

In order to address the changing technology needs of Kansas City safety net providers, the board of directors of KC CareLink developed and issued a Request for Information in July 2008. The RFI seeks assistance with upgrading and expanding the capabilities of KC CareLink, with a focus on current KC CareLink functionality and additional products or solutions that could be incorporated.

In the RFI, vendors were asked to specifically focus upon the following:

• solutions for patient intake that eliminate or minimize the need for duplicative data entry
• a patient referral process that includes all of the KC CareLink functionality
• inclusion of comprehensive patient clinical information
• connectivity
• security
• a robust reporting capability

Six vendors responded to the RFI, with wide variations in costs. KC CareLink staff and board members continue to review the proposals and request clarification and additional information from some vendors. For more information, contact Ken Ortbals.

Missouri Primary Care Association discusses technology initiatives

Representatives from the Missouri Primary Care Association (MPCA) presented an update to the Health Information and Exchange Committee on August 20. Angela Herman from MPCA led the discussion and shared the organization’s health information and technology vision for the community health centers in Missouri. The primary components of the vision include:

1. All community health centers (CHCs) should have electronic health record (EHR) systems.
2. The EHR must have the ability to integrate with state and local systems.
3. CHCs must have robust data-reporting capabilities that do not require duplicate data entry.
4. CHC data must electronically feed into a data warehouse.
5. CHCs must have IT support and build their IT capacity.
6. Missouri must have the ability to support a Health Information Exchange.

In order to accomplish these goals, MPCA provided each Community Health Center that did not have an EHR with $175,000 to assess IT infrastructure and purchase C-CHIT approved EHR software. For those CHCs that already have EHRs, funds were used to upgrade systems — by adding dental or behavioral health components, for example. All CHCs have identified their software needs, and all should go live with their EHRs by June 2009.

At the same time that the MPCA is supporting CHCs, it is also in the process of building a data warehouse. The data warehouse will allow the MPCA to report data aggregated across all of the CHCs and provide an alternative location for CHCs to create customized data reports. It will also provide a centralized location to examine benchmarks and examine best practices.

MPCA has developed a series of 11 required performance measures that all CHCs must report. The measures focus on quality/risk management, health outcomes/disparities and financial viability/costs.

Patient navigation and care coordination programs in Greater Kansas City

Patient navigation programs are traditionally defined as the recruitment and training of persons from underserved communities to assist in navigating patients through standard cancer diagnosis and treatment services. This model has been very successful in Kansas City and across the nation. Consequently, interest in applying this model to other chronic diseases has developed.

In June, members of the Access to Care Committee developed and submitted a federal grant application focused upon reducing hypertension in underserved populations using patient navigators.

As a part of this effort, committee members wanted to identify “best practices” for patient navigation in Kansas City. They developed a set of questions for MARC staff to use while interviewing a wide variety of clinical and social service providers. (See program matrix.)

Key findings include the following:

1. Generally, the programs are focused on care coordination and the process of assisting patients with their medical needs within a defined health care environment.
2. Generally, the programs hire professional staff with supervisors reflecting a bias toward bachelor-level nurses and social workers.
3. Programs strive to hire culturally appropriate staff members from underserved populations, but due to high educational requirements they have limited success in achieving this goal.
4. Several programs include formal training components; however, most indicate on-the-job training is the norm.
5. Several programs have formal outcome collection systems that address both clinical and process outcomes.
6. None of the programs are financially self-sustaining. Most of the programs depend on grant funds or hospital funds.

For more information on patient navigation please contact Laura McCrary.

Legal Aid of Western Missouri helps disabled patients who have been denied coverage

Legal Aid of Missouri is expanding its Medicaid Appeals project. The project helps low-income patients who are disabled and have been denied Medicaid coverage or have had coverage terminated. Legal Aid has a staff of six attorneys and one paralegal who litigate Medicaid appeals. The services are provided free of charge to patients of safety net providers.

In the past, Legal Aid has worked primarily with Truman Medical Center on this project. The staff at Truman refers patients who have been denied benefits to Legal Aid, whose staff members investigate the facts of each patient’s case. If an appeal is warranted, Legal Aid represents the patient in the administrative appeal of the Medicaid claim. Legal Aid attorneys gather all of the patient’s applicable medical records and obtain letters of support from health care providers. They also conduct research on legal issues involved in the appeal, prepare witnesses and represent the patient in the administrative hearing.

Legal Aid attorneys have won the vast majority of the cases they have handled so far. In 2007, the program obtained Medicaid coverage for close to 200 patients at Truman Medical Center. By winning the appeals, the program generated more than $1.4 million in net revenue for Truman. More importantly, the program greatly improved the health of Truman’s patients.

Missouri safety net providers who are interested in participating in the program should contact Gregg Lombardi.

Western Missouri Mental Health Center discusses privatization

In August, two meetings were held to discuss the possible privatization of the Western Missouri Mental Health Center. The first was held at the Mid-America Regional Council on August 7, and the second was at the Waldo Library on August 20. Dr. Keith Schafer, director of the Missouri Department of Mental Health (DMH), and Dr. Joseph Parks, DMH’s director of comprehensive psychiatric services, attended the Aug. 7 meeting to provide an overview of the process.

Dr. Schafer shared a paper that outlines why DMH is considering the initiative. He noted that privatization is a means to improve the quality of inpatient psychiatric services and expand community-based mental health options in Northwest Missouri through a redirection of funds. Dr. Schafer pointed out that if initiatives such as this are not pursued, the state will continue to face an erosion of its acute and long-term psychiatric hospital services.

Dr. Schafer noted critical reasons for exploring the initiative, including:

• Difficulty in recruiting, filling and retaining key clinical positions due to low state salaries. Vacancies in key positions have recently forced the temporary closure of beds.
• Inability to generate Medicaid funding for Medicaid-eligible individuals ages 22 to 64 due to federal regulations that prohibit payment if the state-owned psychiatric facility has more than 16 beds.
• Greater community ownership and responsibility for acute psychiatric inpatient services.
• Reducing the length of stay for patients. Currently 45 percent of the adult beds are filled with patients who have stayed more than two months due to the lack of safe and stable housing in the community.
• Redirection of resources toward community-based services and treatment.

Dr. Schafer said that the proposed solution of transferring acute psychiatric inpatient services to Truman Medical Center would result in two important outcomes:

• Higher inpatient reimbursement rates could allow adequate salaries for key clinical staff.
• A significant amount of funds (approximately $15 million) could be redirected back to Kansas City to establish needed community-based services.

Samuel U. Rodgers Health Center ceremonial groundbreaking held on July 14

On July 14, Hilda Fuentes, chief executive officer of Samuel U. Rodgers Health Center, spoke to a group of 250 invited guests who attended the celebratory groundbreaking of a new location.

“Today we are here to celebrate a new beginning for our future that is rooted in the past and committed to Dr. Rodgers’ legacy,” Hilda said as she began the ceremony.

The program included an invocation by Rev. Sam Mann; statements from Brent Kahler, representing Missouri Gov. Matt Blunt; U.S. Sen. Kit Bond; U.S. Rep. Emanuel Cleaver II; and remarks by Jackson County city and county executives. The architect’s rendering of the new center was unveiled and construction will begin in February 2009.

The downtown Samuel U. Rodgers Health Center has provided health care to residents of Kansas City for 40 years, and the new facility will help the center better achieve its mission — to provide high quality, compassionate health care for all, regardless of ability to pay. Samuel U. Rodgers is a federally qualified health center (FQHC) that receives federal funding to provide comprehensive health care to the uninsured and medically vulnerable members of the community.

Samuel U. Rodgers has six locations, with two full-service primary and preventive health care facilities serving both urban and rural populations. The downtown campus is located in the historic Northeast district at 825 Euclid. The rural campus is located in Lexington, Missouri. In addition, Samuel U. Rodgers has a foster care facility, a methadone treatment program and two dental clinics, one in Independence and one inside McCoy Elementary School in Kansas City, Mo.

Samuel Rodgers is unique in that it provides health care to a very diverse base of patients. In 2007, 37 percent of the patients at Samuel Rodgers were immigrants who spoke little or no English. To meet the needs of patients, interpreters are available upon request in 12 different languages. For more information regarding Samuel Rodgers, please contact Hilda Fuentes at hfuentes@rodgershealth.org.

Upcoming health-related events in the Kansas City area

(If you would like to list an event in future newsletters, please contact Laura McCrary.)

Kansas

Health Care in America: How Can We Make it More Affordable?

Participate in a national conversation on health care at the Johnson County Library on Sept. 18. This community discussion will explore different approaches to improving a system that touches the lives of all Americans in a vital and personal way. Conversations like this are happening all over the country, and the results of the discussion in Johnson County will be shared with those from other communities. Help create a coast-to-coast portrait of American opinions on health care.

When: Thursday, Sept. 18, 6:15–8:30 p.m.
Where: Central Resource Library, 9875 W. 87th Street, Overland Park, Kan.
RSVP: Those who register will receive discussion guides in advance. Register online or call (913) 495-2497 to register by phone. Space is limited.
For more information, contact Lisa Louis at 913-495-2421   

Missouri

Policy Options to Provide all Missourians with Quality and Affordable Health Coverage

Hosted by the Missouri Foundation for Health

When: Tuesday, Sept. 9, 3–4:30 p.m. or Wednesday, Sept.10, 8:30–10 a.m.
Where: MARC Conference Center, Westview Room, 600 Broadway, Suite 200, Kansas City, MO 64105
RSVP: Moira Cahan, 314/345-5578. (Please clarify which meeting you would like to attend. Space is limited to 20 per session, so RSVPs are essential.)