MINUTES Public lic H Healt lth and Me Medic icaid id Ad Advi visor ory G Grou oup Ju July 27 27, 2 201 018, 10: 10:00 00am – 3:00p 00pm Wor orkgr grou oup p Purpos poses (O (Overall P ll Purpo pose): ): In order to increase the effectiveness and efficiency of Kansas Medicaid services, this workgroup is designed to help guide the planning, policy development, and coordination of services of KDHE (Kansas Department of Health & Environment), KALHD (Kansas Association of Local Health Departments), local health departments, and others interested in public health services for the Kansas Medicaid population. Obje bjectiv ctives: s: 1. Welcome, Purpose, Updates from the Group a. In attendance: AAron Davis, Kristina Helmer, Danielle Ast, Ty Kane, Tammy Von Busch, Janet Wertzberger, Kasey Sorell, Edith Matthews, Jason Tiller, Katie Mahuron, Brooke Sisson (KDHE Intern), Michelle Ponce, Teri Caudle b. Updates: i. KDHE Division of Healthcare Finance - Kasey 1. API Modifier – effective November 1 – will have to itemize 2. Rates for adults vaccine will increase – August 1 3. Moving forward with 3 MCOs – United, Sunflower and Aetna starting January 1 4. Tobacco Cessation – covered service for all Medicaid beneficiaries (classes and individual counseling) 5. LHDs can Administer and bill Makenna p17 6. Cover lactation counseling 7. To get bulletins go to KMAP ii. CPHI Updates (from April Advisory Meeting) 1. MCH Program feedback has been incorporated into 4 workgroups 2. Specific areas translating into work include: a. SDoH – conversations will begin in July meeting b. Increasing efficiency of LHDs – conversations will begin in July meeting c. Expanding LHD billable services d. Health Homes – this will start again soon. e. Community Coordination f. Local Public Health Leadership Series starting in August 2018 – cohort 9 g. Partnership and Process in Public Health – concludes in December 2018. Summary will be provided in early 2019 h. CHW Symposium 2. KanCare 2019 Update/Discussion a. New MCO is Aetna b. Group discussed concerns and questions about the new MCO and the new contracts ………………………………………………………………………………………………………………………………… W ICHITA S TATE U NIVERSITY | Community Engagement Institute | 1845 Fairmount Street | Wichita, Kansas 67260-0201 Tele: (316) 978-3843 | toll-free: 1-800-445-0116 | fax: (316) 978-3593 | web: www.communityengagementinstitute.org
3. Addressing Social Determinants in our Medicaid Population a. Identifying SDoH was included in the last round RFPs. b. Every Bureau is working on SDoH at KDHE in some way. Brainstorming Activity 1. What role should LHDs play in addressing SDoH? • Policy development/legislation ** • Tobacco 21 • Zoning/Access to food • Clarifying/Identifying resources who is doing what. • Networking – connectivity • Advocacy** • Involving the consumers/people in the conversation • Leverage combined funding • Communicate with everyone on all levels – consumers and government • Establish a vision/get everyone pulling in the same directions • Consistent • Data • Education • Community Health Strategist • Partnership development – building bridges** • Need to work on relationship building (more that handing out a business card) • Cross-train staff so they can help address multipole needs of clients – team case management approach** 2. What is currently happening in your department or community that is addressing SDoH? • Working on poverty through circles • FC in the FPHS model • Poverty issue as PH focus • K-state Extension • Transportation system • KanCare 2019 • Implementing Medical case manager to connect pts to community resources • Tobacco 21 at county and state level • Community Development planner • Community Health Workers • Becoming a Mother (BAM) • HD Services • Bus passes/taxis • HIAs – Health Impact Assessments • Farmer’s market • Summer picnic program • FQHCs • Coalition building • Low income housing connector to other services (OPIS – Geary County) • Farmworker Program • Available services 3. What would you need move from the current state, to where we should be?
• Money ** • Infrastructure staff – state and local level *** • Stability funding/money ** • Right people in the room – including PH existing groups • New partners • More formalized/routine way of sharing ideas – what others are doing • Policy development – need legislative support • Advocacy, research, commission support • Innovation and outside the box thinking • Flexible use of money • Stronger partnership • Community support 4. What questions do you still have that need answered? • MCO activities on SDoH • Do we have an overarching goal? – Does everybody know the goals? • What is the cost of doing nothing? • What is the current impact (including money) of PH on SDoH? • What is the consistent message from KS PH on SDoH to our partners (including commissioners)? ** • What are LHDs and others across the staff doing? * • What do clients need? – from their point of view. How do you get their input? • Where do we start? What are greatest needs? • Would it be helpful KS to “adopt” a SDoH model? * FPHS Link • How is KDHE engaging the system about financial opportunities? 4. Building Capacity in Local Health Departments to help improve Medicaid Services a. Who else provides leadership to advance LHD capacity building efforts? • Legislator raised the heat to build capacity around childcare (Wabaunsee) • Community • PHAB – changing LHD culture • Academic institutions – partner with K-State, KWU, KU Salina as a site for MPH/nurses/etc. interns (Saline). b. Identified TA Needs, KDHE ATL Survey (2018) • Community engagement: 48% i. Surprised about community engagement listed so high • Develop public health policies and plans: 43% • Performance management and QI: 27% • Workforce development: 25% • Conduct research and use evidence-based practices: 24% • Conduct and disseminate assessments: 24% • Inform and educate about public health: 22% • Investigate health problems and environmental health hazards: 21% c. Taking the Temperature about the Need for Capacity Building d. What resonates with you about what you’ve heard so far? • Pre-requisites for PHAB are important for all LHDs not just the LHDs going through accreditation
• CHA/CHIP/SP – How did that go? What was the impact? LDHs didn’t sign up. Lessons learned about methods. • Particular topic needs to be important to them and how it can relate to their work? • Who has to sell it to have it viewed important? e. What are “your” greatest capacity building needs? • Staff – reliable and sustainable funding (staff and current funding are barriers) • Tough to get staff out of the office • Develop and execute cross jurisdictional sharing agreement and how to get commissioners to support these ideas • Engaging providers around Key PH issues f. When it comes to you LHDs ability to build capacity, what’s possible now given your current environment? • Some grants require training • Staff turnover and succession planning • Unionized employees • Gaps in key roles during staff transitions • Retirement i. Opens new creativity and new direction. But miss the connection and history (retirements also mean new opportunity) ii. COOP planning is important g. When it comes to your ability to fulfill your vision and mission, what’s getting in the way? (Do you have a vision and mission) • Damage control and misinformation (i.e. community member routinely likes to send information to County Commissioners about how the health department isn’t doing their job. Director has to take time to dispute this information) • Competing priorities that may not be our brand of PH = Department of Health and Human Services Opioid Initiative – not part of their mission/vision. But this is their biggest funder h. Are Kansas LHDs too comfortable with their current level of performance? Are they afraid of change? Why? What’s getting in their way? • Some LHDs want to, but can’t work on C.B efforts • Not just “soft skills” and capabilities; also essential PH functions i. Our current Thinking About “ How” • Online resources of tools and resources • Expert guided peer learning opportunities • Pilot programs (e.g. KARP) • Individualized support for specific sites • Educations webinars • Communities of practice (e.g. ESSC, QI, etc.) • Regional or statewide gatherings j. Brainstorming and Prioritization Activity • Anticipated outcome: A short list of what’s needed (and not needed) for this initiative to be successful • Clarify our purpose statement – In terms of capacity building, what’s needed to help LHDs close the gap between where they are now and where they need to be to accomplish their mission and vision? • Generate a list of ALL “must do” and “must-not-do” ideas (programs, activities, resources, etc.)
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