SAN FRANCISCO HEALTH REFORM TASK FORCE FINAL REPORT Presentation to the San Francisco Health Commission April 19, 2011 Tangerine Brigham, Deputy Director of Health/Director of Healthy San Francisco, San Francisco Department of Public Health Wade Rose, Vice President, Public Policy and Advocacy, Catholic Healthcare West
Task Force Overview 2 Created in March 2010 at the request of former Mayor Newsom to analyze the impact of Health Reform on San Francisco To plan for a San Francisco health care safety net that thrives Mission under Health Reform and the State’s Section 1115 Medicaid Waiver To develop local, State and federal policy recommendations Purpose for consideration by the Mayor, the Board of Supervisors, and the Health Commission that would better position San Francisco’s health care safety net for implementation of Health Reform ■ Enrollment ■ Economics Key Issue ■ Infrastructure ■ Local Programs Areas ■ Capacity
Work of the Task Force 3 Defined the San Francisco Health Care Safety Net Addressed each of the five key issue areas Due to the link between Economics and Capacity, discussions and recommendations in these issue areas were combined Monitored State and federal HR implementation activities to inform recommendations Developed 37 policy recommendations Local, State and federal level recommendations Recommendations made in each key issue area Not all areas lent themselves to recommendations at all levels of government
San Francisco Health Care Safety Net 4 KEY TASK FORCE FINDING: There will be a continued need for a health care safety net in San Francisco after Health Reform. Rationale for continued health care safety net HR does not expand coverage to all uninsured – several populations will continue to rely on safety net systems after 2014 Eligible but not enrolled in public health insurance Undocumented Incarcerated Individuals with religious objections Individuals with affordability exemptions Persons who elect not to fulfill individual mandate Safety net systems will continue to be relied upon to care for many of the people who will be newly eligible for Medicaid and Health Benefit Exchanges
Definition of San Francisco Safety Net 5 Safety Net Providers Public and private non-profit organizations that provide significant health care services to low-income, uninsured, publicly-insured, and vulnerable populations. Safety Net Population San Franciscans eligible for Medi-Cal, Healthy Families, Healthy Kids, Healthy Workers, and Healthy San Francisco. Patients served by the clinics of the San Francisco Community Clinic Consortium, by the Department of Public Health, and by the Department’s contracted providers, as well as charity care patients seen by San Francisco’s non -profit hospitals and private providers.
Task Force Recommendations 6 Final report to be submitted to the Mayor Recommendations organized by level of government to which policy considerations are targeted Local: For consideration by the Mayor State: For consideration by the Mayor’s State Legislative Committee for inclusion in the City’s state policy platform Federal: To be submitted to the City’s federal lobbyist for inclusion in the City’s federal policy platform Following is a summary of recommendations by key issue area, specifically highlighting local-level policy recommendations
Enrollment Recommendations 7 Summary of Recommendations: Majority of recommendations at State level given primary role that State has in coordinating/interfacing State and All Levels of Government county eligibility and enrollment databases for Medi-Cal and the California Health Benefits Exchange Recommendations acknowledge importance of: Consumer-friendly enrollment Privacy protections for coordinated databases Outreach and retention strategies for enrollment Promote maintaining San Francisco’s current database systems
Local Enrollment Recommendations 8 Local eligibility and enrollment systems should support, 1. Local Recommendations: and as appropriate, interface with the State systems. Local outreach efforts should complement the State’s 2. outreach plan. Enrollment Investment in a new local enrollment system is not advised, 3. though adjustments will likely be needed.
Infrastructure Recommendations 9 Summary of Recommendations: Recommendations are in the area of information technology infrastructure needed to facilitate enrollment All Levels of Government and exchange of information across systems to improve quality of care and better monitoring of health care Recommendations fall into two different categories On the federal level, adequate, accelerated and direct payments to safety net providers (hospitals and Federally- qualified health centers) investing in electronic health records On the local level, support for regional and local health information exchanges (for patient health information)
Local Infrastructure Recommendations 10 San Francisco’s health care community should support the 4. Local Recommendations: efforts of the San Francisco health information exchange. San Francisco’s health care community should support the 5. community fundraising effort of the San Francisco health Infrastructure information exchange. The San Francisco health information exchange should 6. continue to pursue partnerships with other exchanges in the Bay Area. Organizations analyzing citywide health care statistics 7. should work with the San Francisco health information exchange to determine if aggregated data may assist with health care planning.
Economics/Capacity Recommendations 11 Summary of Recommendations: Recommendations focus primarily on opportunities for the State and federal government to build clinical capacity All Levels of Government via increased provider participation or expanded clinical models Streamlining Medi-Cal administrative processes to attract provider participation Enhancing primary care capacity via loan repayment programs, additional nurse practitioner delivery models, Enhancing provider capability and flexibility to serve seniors and persons with disabilities Planning for long-term and community-based care capability
Local Economics/Capacity Recommendations 12 The Health Care Services Master Plan should consider a 8. Local Recommendations: Economics and Capacity range of options implementable at the local level that can build capacity within San Francisco’s health care provider community.
Local Programs Recommendations 13 Summary of Recommendations: Recommendations are primarily focused on potential changes to San Francisco’s health care programs and support the general All Levels of Government principal that encourages movement toward the health insurance options under HR San Francisco should not, at this point, make any changes in the eligibility and enrollment for its local programs (i.e., Healthy San Francisco, Healthy Kids, and Healthy Workers) State and localities should maximize take up in Medi-Cal and Health Benefits Exchange and monitor progress Eligibility, enrollment and/or benefit provisions for local programs and the Health Care Accountability Ordinance should be aligned with HR provisions
Local Program Recommendations 14 The Healthy San Francisco (HSF) eligibility and enrollment 9. Local Recommendations: system should identify applicants eligible for a subsidy under the California Health Benefit Exchange (Exchange) and reflect new Medi-Cal eligibility criteria for 2014. Local Programs Eligibility rules for local programs (i.e., HSF, Healthy Kids, and 10. Healthy Workers) should be refined to ensure full participation in Medi-Cal and subsidized health insurance offered in the Exchange. HSF and San Francisco Health Plan application assistors should 11. route eligible individuals to Medi-Cal or the Exchange. DPH should carefully monitor HSF provider capacity after 12. implementation of Health Reform to ensure appropriate access to care. DPH and the Health Commission should ensure that the Health 13. Care Accountability Ordinance’s minimum standards are in alignment with the minimum standards for plans in the Exchange.
Health Care Security Ordinance 15 Task Force did not consider the Employer Spending Requirement (ESR) of the Health Care Security Ordinance Review by DPH and the City Attorney indicates that the ESR will remain in effect under Health Reform Should any inconsistency arise, can be addressed with either federal or local regulation between now and 2014
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