Manatee County Government Administrative Center Commission ... · 8/24/2017 · Indigent Health Program Enrollees ~2,400 : Percent at or below 200% FPL . 36.31% : Percent of Population

August 24, 2017 - Work Session Agenda Item #1

Subject 2017/18 Health Care Programs Briefings Briefing Provided Upon Request Contact and/or Presenter Information Cheri Coryea, Director, Neighborhood Services, ext 3468 Joshua Barnett, Healthcare Services Manager, ext 3030 Action Requested Review annual Healthcare Programs for 2017/18 budget Enabling/Regulating Authority Efficiency in Service Background Discussion Annually, the Board of County Commissioners discusses the interest and amount of financial participation for programs to low income persons and special needs individuals. This group of programing which deals with healthcare and behavioral health care includes service providers from not for profit organizations and for profit organizations. Staff will present recommendations for consideration by the Board based on factual data for healthcare needs in Manatee County. By the Budget adoption hearing on September 28, 2017, recommendations suggested by the board will be included in the annual funding budget for healthcare. Upon budget adoption, staff of the department prepare funding agreements and establish results first performance outcomes that are monitored through the year. County Attorney Review Not Reviewed (No apparent legal issues) Explanation of Other Reviewing Attorney N/A Instructions to Board Records None Cost and Funds Source Account Number and Name

Manatee County Government Administrative CenterCommission Chambers, First Floor

9:00 a.m. - August 24, 2017

TBD Amount and Frequency of Recurring Costs TBD

Manatee County Government Administrative CenterCommission Chambers, First Floor

9:00 a.m. - August 24, 2017

Health Care Services 2017-18 Budget Recommendations August 24, 2017

Joshua T. Barnett, MHS, MA, CPRP, ICCDP-Diplomate Health Care Services Manager Community Services Division Department of Neighborhood Services

WORK SESSION AGENDA • Acknowledgements • Vision • Healthcare Advisory Board Recommendations • Staff Recommendations • BOCC Discussion • October 17th Work Session – Service Details

Barnett, J. HSC BOCC Work Session 8-24-17

Health Care Services Community Involvement

• Behavioral Health Consortium/Acute Care Meeting • Central Florida Behavioral Health Network – Board of Directors & QI • Chamber of Commerce: Healthcare Subcommittee • Community Paramedicine Steering Committee • Department of Health’s CHIP & CHA

– Access to Care – Addiction Crisis Taskforce

• Drug Epidemiologic Network – Manatee • Drug Free Manatee – Board of Directors • Health Care Advisory Board - Liaison • Health Care Alliance • Health Council of West Central Florida • Manatee Community Foundation • Medical Society of Manatee County • and Presentations: Center for Local Government Excellence, Lake Eerie

College of Medicine, Probation & Parole, and Faith Based Alliance


Health Care Context History & Present • Acute Care Services

– Emergency Department – In-Patient Services

• Medical • Mental Health

• Physician Services – HIE Requirement – Safety Net Hospital

• Homeless Health – Dental, Screenings, Diabetes

• Eligibility Guidelines

Future Vision • Enhance Diversity of Services • More Services & Patients • Improve Health Status • Accountable to Quality

Standards of Care • Coordinated & Collaborative

Treatment • Reduced Cost Per-Capita


Institute of Health Innovation Triple AIM & Results First


Population Health Management Patient – Centered Approach

• Engage Residents into Health Care Services

• Facilitate How/When/Where Residents Access Care

• Assess Needs & Manage • Follow-Up • Equitable Resources

Systems-Focused Approach • Community & Clinic Based • Accountable to Quality • Performance & Value-based

Contracting • Collaborative Care

– Between Providers – Integration of Services – FQHC

• Reduces Emergency Department (Acute)

Dependency


County Health Statistics - WHO Category Manatee County Statistic

Number of Uninsured below 200% FPL ~25,000

Indigent Health Program Enrollees ~2,400

Percent at or below 200% FPL 36.31%

Percent of Population Uninsured 18.03%

Quality of Life 12th Best in FL

Dissatisfaction Greatest Amongst Women, Hispanics, Blacks, Lower Income, and Younger Age Groups

Patient Dissatisfaction in Health Care Lack of Coordination, High Deductibles, Unmet Health Needs, and ED Delays

Households Below Poverty Level 43%

Satisfaction in Health Care 39%

County Health Ranking 20th Best in FL

Health Outcomes 23rd Best in FL


County Health Statistics - WHAT Manatee County-specific Health Needs (not ranked) 1. Diabetes Management 2. High Blood Pressure/Cardiovascular 3. Cervical and Breast Cancer Screening 4. Late Entry Prenatal Care 5. Tobacco Cessation 6. Suicide and Drug Overdose 7. Oral Health 8. STI/HIV/Hep C Transmission 9. Birth to Teen Mothers 10. Unintentional Injuries (falls)


County Health Statistics - WHERE

Zip Codes • 34207 • 34205 • 34208 & 34203 • 34221

Cities • West Samoset • South Bradenton • Samoset • Memphis • Bayshore Gardens • Palmetto


Resources Asset Limited, Income Constrained, Employed (ALICE) Report – 2017 Update for Florida. United Way. www.uwof.org. Community Health Assessment. Manatee Health Care Alliance. Department of Health in Manatee County. December, 2015. www.manatee.floridahealth.gov Health Needs Assessment Manatee County. Health Council of West Central Florida. March, 2009. www.hcwcfl.org Higgins, S. et al. Medical homes and cost and utilization among high-risk patients. American Journal of Managed Care. 2014, March. 1;20(3):e61-71. Manatee County Health Care Plan for Low-Income Uninsured Adults. Health Management Associates. August, 2016. Simonet, D. Cost Reduction Strategies for Emergency Services: Insurance Role, Practice Changes and Patients Accountability. Health Care Anal (2009) 17:1-19 Xu, T., et al. Variation in Emergency Departments vs Internal Medicine Excess Charges in the United States. Journal of the American Medical Association. 2017. Accessed June 12, 2017.


http://www.manatee.floridahealth.gov/

http://www.hcwcfl.org/

Budget Discussion Thank you

Joshua T. Barnett Health Care Services Manager Division of Community Services Department of Neighborhood Services E-Mail: [email protected]


8/24/2017 www.mymanatee.org/published/August 24, 2017 - Work Session on Thursday, August 24, 2017/6084EEF9-F457 -4561-961 D-02031 D6E9769-0 ...

www.mymanatee.org Manatee County Government Administrative Center Commission

Chambers, First Floor 9:00a.m. -August 24, 2017 August 24, 2017- Work Session

Agenda Item # 1

Sub~ect 201 /18 Health Care Programs

Briefings Briefing Provided Upon Request

Contact and/or Presenter Information Cheri Coryea, Director, Neighborhood Services, ext 3468 Joshua Barnett, Healthcare Services Manager, ext 3030

Action Requested Review annual Healthcare Programs for 2017/18 budget

Enabling/Regulating Authority Efficiency in Service

Background Discussion Annually, the Board of County Commissioners discusses the interest and amount of financial participation for programs to low income persons and special needs individuals.

This group of programing wh ich deals with healthcare and behavioral health care includes service providers from not for profit organizations and for profit organizations.

Staff will present recommendations for consideration by the Board based on factual data for healthcare needs in Manatee County.

By the Budget adoption hearing on September 28, 2017, recommendations suggested by the board will be included in the annual funding budget for healthcare.

Upon budget adoption, staff of the department prepare funding agreements and establish results first performance outcomes that are monitored through the year.

County Attorney Review Not Reviewed (No apparent legal issues)

Explanation of Other

Reviewing Attorney N/A

Instructions to Board Records None

Cost and Funds Source Account Number and Name TBD

Amount and Frequency of Recurring Costs TBD

http://www. mymanatee .org/published/August%2024, %2020 17%20-%20Work%20Session%20on%20Thursday, %20August%2024, %2020 17/6D84EEF... 1/2

Health Care Service.., 2017-18 Budget Recommendation.., \ui.!.U'-1 .!4, 2017

Joshua T. Bamell, M f/S, MA , CPR P, /CCDP-Diplomate Health Care Services Manager Community Services Division Department of Neighborhood Services

WORK SESSION AGENDA

• Acknowledgements

• Vision

• Healthcare Advisory Board Recommendations

• Staff Recommendations

• BOCC Discussion

• October 17'" Work Session- Service Details

Health Care Serviceo., Community Involvement

Behavioral Health Consortium/A cure Care Meeting Central Florida Behavioral Health Network- Board of Director!i & QI Chamber of Commerce: Healtlrcare Subcommittee Community Paramedicine Sreering Commillee Department of Health S CHIP & CHA - Ara ss to Cart' - Addirt ion (ri~·i.f Taskforrf!

Dmg Epidemiologic: Network- Manatee Drug Free Manatee- Board of Directo rs Heal tit Care Afh•isory Board - Liaison Health Care A /Iiana Health Council of West Cenrral Florida

Medical Society ofJ~1anatee County _.!.> ~1.:.~~~~ Manatee Communi()• Foundation ~

and Presentations: Center for Local Cow!rnment Excellence, t:.a , College of Medicine, Probation & Parole, and Faith Based Alliance

8/24/2017

1

Health Care Context History & Present

Acute Care Services - EmugenC.:)' Departmelll - lfi ·Pmiem Sen ·h:ef

• Mnbnd • Ml'ntafi/Mith

Physician Sen;ices - HI£ Requirement

- Scifety Net Hospital

Homeless Health - D enftll. Screeni11gs. Diabetef

Eligibility Guidelines

Future Vision

• Enhance Diversity of Services

• More Services & Patients

• Improve Health Stallls

• Accountable to Quality Standards of Care

• Coordinated & Collaborative Treatment

• Reduced cost Pe~rta -. t!· nt

Institute of Health Innovation Triple All\tl & Results First

• ['upu l01tiun f!,·.dth

• ' t l'.1lit>n + I ~·r l .1p11.1

1·\j.'l'rit"n.;.· ("os!s

Population Health Management Patient- Centered Approach

• Engage Residents into Health Care Services

• Facilitate How/When/ Where Resident.\· Access Care

• Assess Needs & Manage

• Follow-Up

• Equitable Resources

Systems-Focused Approach

Communiry & Clinic Based

Accountable to Quality Peifonnance & Value-based Contracting

Collaborative Care - Ben\·een Prm•iderJ - lmegrmion of Sen ·ices

- FQHC

Reduces Emergency Department (Acute) Depend en c)~

8/24/2017

2

County Health Statistics- WHO Category Manatee County Statistic

Number of Uninsured below 200% FPL -2s,ooo Indigent Health Program Enrollees ... 2,400

Percent at or below 200, FPL 36.31%

Percent of Population Uninsured 18.03%

Quality of Ufe 12th Best in Fl

Oisutisfiilction Greatest Amongst Women, Hispanics, Blacks, lower Income, and Younger Age Groups

Patient Dissatisfaction in Health Care lack of Coordination, High Deductibles, Unmet Health Needs, and ED Delays

Households Below Poverty level 43%

Satisfaction in Health Care 39%

County Health Ranking 20m Best in Fl

Health Outcomes 23rd Best in Fl --

County Health Statistics - WHAT

Manatee County-specific Health Needs (••'"'"•') I. Diabetes Man agement 2. High Blood Pressure/Cardiovascular 3. Cervical and Breast Cancer Screening 4. u1te Entry Prenatal Care 5. Tobacco Cessation 6. Suicide and Drug Overdose 7. Oral Health 8. STIIHIV/ Hep C Transmission 9. Binh to Teen Mothers 10. Uninten tional Injuries (jails)

County Health Statistics - WHERE

Zip Codes Cities

• 34207 • West Samoset

• 34205 • Sowh Brademon

• 34208 & 34203 • Samoset

• 3422 1 • Memphis

• Bayshore Gardem

• Palmetto

8/24/2017

3

Resources Anrt Llmltl-d . lncom" ConsH11111<--d. Empkly<.'!J (ALICE) Report - 2017llpdah~ for J~>nda. Un1k...l Wa) wwwuwoforg

CommUni!) llcslt h :~<:ssmcnt M:mata: l kallh Care: All1anu: IJcpaltm.:nt of llo:alth Ill ~laMicc COI.Int)' lkumbn. :WI~ - '4 maMkf 0.....-..bhs:allh .:<l>-

llcalth Nc:ab scssmcnt Man:ata:Counly llcallh Cutmcll ofWo:st (_'cnlr.d Flood:t Mar~h 2CMI9

~

U1qms. S L1 aJ ~kJ•u.l h~ and cmt and utth1...Jt)Ofl among h•s h·nsi: paucnu Amcnuan Journal of Mana!edCarc: 201.-. MarLh 1.20(3J,.o(} l -71

Manata: Counly l!o:ahh Can: Pbn fOI' J..o.,. ·IIIC()fM Untn~u r .. -d r\Juks llcahh Manago:mcnl w ualcl ,\u!u~t 2016

s.mon<..1. () Cost llcliULllOn StnalC!M.., for Emcr!!CilC) Scr11L'C$ lnsurunco: Ruk P111LI1\4' Chull_ -~ a .J l':!ollcnu Al.:countabthty Jk.:~hh Car« Ana.! 120091 17 1-19

.-. Xu. T . d al Vanahon m EmcrJCII..:) Dcpanmo:nu \ 'S lnh:mal ~kd)l.."'n<' Elccu C'halJU tn th · Jourru~J of the Amcm:an McJ.cal ,\sMJo;tJ.hon 2017 . A..ccu .. -d June 12. 2017

Budget Discussion

Thank you

Joshua T Barnett Health Care Services Manager

Divil·ion of Community Sen·ices

Deplmment of Neighborhood Sen•ices

£ -Mail: Joshua.Bamen @mymanatee.org

8/24/2017

4

BRIEF STRATEGY RECOMMENDATIONS

POPULATION HEALTH MANAGEMENT FOR UNINSURED RESIDENTS OF MANATEE COUNTY

PRESENTED BY:

HEALTHCARE ADVISORY BOARD

PRESENTED TO:

BOARD OF COUNTY COMMISSIONERS

MANATEE COUNTY

AUGUST 24, 2017 9:00AM

DRAFT PROVIDED BY:

JOSHUA T. BARNETT, MHS, MA, CPRP, ICCDP-DIPLOMATE

HEALTH CARE SERVICES MANAGER

LIAISON TO THE HEALTHCARE ADVISORY BOARD

DEPARTMENT OF NEIGHBORHOOD SERVICES

MANATEE COUNTY GOVERNMENT

Page 1 of 4

The Healthcare Advisory Board (HCAB) initially met in December of 2015, beginning with

an orientation to the County's health resources and contracted programs. To date, the HCAB

has received various presentations and research, providing the thoughtful discussion for the

management of health needs for Manatee County's uninsured population . Following monthly

meetings and additional subcommittee discussions, the time dedicated has provided the ability

for the HCAB to present the following funding recommendations to the Manatee County Board

of Commissioners.

1. Population Health Management Strategies

Proactive methodologies to engage residents in positive health seeking behavior, actively

directing and managing health care resources at both individual and systems levels. By

managing the access of preventative, primary and specialty health care services, avoiding

unnecessary high cost, acute care treatment services such as emergency departments for

primary care or central receiving facilities for psychiatric care, is reduced. Identify the at

risk populations and individuals who most frequently use acute care services for primary

care and non-emergent health issues. Redirect these groups to the appropriate health

settings, avoiding unnecessary costs and educating on how to access health resources for

preventative, primary, and specialty health needs. Support treatment follow-up and address

causal factors of multi-morbid social and health needs.

a. Establish Presumptive Eligibility Procedures which allow patients access to care but also substantiate their eligibility and enrollment into County funded health program with individualized resource allocation . b. Centralize an Eligibility Unit to conduct eligibility analysis and assessment of needs for those currently enrolled in county funded health program . c. Monitored utilization of health communication systems used to exchange health information amongst providers to enhance quality in care and reduce unnecessary costs.

2. Priority Funding of Community Based Healthcare

A significant proportion of health funding in Manatee County is focused on hospital

based, acute care. Accessible primary, preventative and specialty health resources outside

of emergency departments are more affordable. In order to improve health for the

individual and financial health for both the hospitals and the county, early and affordable

health resources within non-hospital settings are recommended to reduce expensive and

unnecessary emergency department dependence. The county may consider contracting for

various health services that direct the patient to appropriate levels of care, sooner, to

prevent deterioration of health and exacerbation of needs as opposed to seeking care in

emergency room settings for primary and specialty care services.

Page 2 of 4

a. Community Health Workers/ Advisors: An evidence-based approach to navigating

the healthcare continuum in a patient-centered approach to engage primary care,

preventative care, dental services, specialty care, and follow-up in a cost-effective

way that yields significant health improvement than infrequent or delayed acute

care.

b. Community Care Clinics: In partnership with community health providers, establish

"health homes" for high need, high utilizers of acute care services for their complex

health needs. Establish outcomes-based funding with a cost-effective clinic to

improve patient understanding and treatment of multiple health conditions and

prevent unnecessary use of acute care.

a. Examples: Residency Clinics, Continuity of Care Clinics, and Integrated Care

Clinics

c. Emergency Room Diversion: Engage in partnerships that support Manatee

Memorial Hospital's ability to divert unnecessary emergency room use, promote

reduction of its use through outcome-based reimbursement, and redirects patients

to the correct place of care.

a. Example: The Community Para-Medicine Program currently serves as the

County's most effective emergency diversion service and primary linkage

resource throughout the county. It is recommended for its continuation due

to its efficacy locally and effectiveness as a national model.

3. Patient-Centered & Collaborative Treatment

It is recommended that members of the County's health program be provided equitable resources to address their various health needs whereby members receive individualized support, specific to their needs, and participate within the health planning process :

a. Needs Assessment & Enrollment 1. Referrals Triaged by Community Para-medicine serving as Gatekeeper

b. Individualized Treatment Placement i.e. Community Care Clinics, Community Para-medicine, Community Health

Advisor, Dental Services, Behavioral Health, or Federally Qualified Health Centers

c. Accountability, Active Participation, and Health Incentives 1. Promote health seeking behavior 2. Establish patient buy-in and funding limits 3. Patient Health Incentives/Rewards such as : dental, education, or nutritional 4. Managed Treatment with Utilization Review and Reimbursement Rates

Page 3 of 4

d. Coordinated and Collaborative Care 1. Expected exchange and of shared-patient health information 2. Facilitated and proactive preventative treatment 3. Quality-based and Outcome-based reimbursement 4. Incentives for movement toward integrated substance use and mental health treatment

Although concise, this document refers to a significant change in the methodology for which health care is funded and delivered. Accountability, community-based services, active engagement, and patient health management are concepts adopted nationally for the ir evidence and are recommended for Manatee County.

This concept is informed by various resources including, but not limited to : Institute of Healthcare Improvement's {I HI) Triple Aim of Increased Population Health, Improved Qual ity, and Reduced Per Capita Cost; Health Management Associates {HMA) report in 2016; University of South Florida {USF) Healthcare Findings and Analysis to Manatee Chamber in 2008; Department of Health {DOH) in Manatee Community Health Assessment {CHA) and Community Health Improvement Plan {CHIP); the Health Council of West Central Florida statistics report; and, the Health Information Exchange {HIE) data reports.

These resources shall each inform continued funding under the advisement of this Healthcare Advisory Board and by the management of the County' s Health Care Services Manager as changes to healthcare are ongoing and anticipated, locally and nationally.

Respectfully submitted,

Steve Hall, CEBS, CHRP, CSFS Healthcare Advisory Board, Chair

Page 4 of 4

DRAFT- 08/ 11/2017

Expenses:

Hospital Payments - Indigent

Doctor Payments - Indigent

FOHC Clinics - Indigent

Homeless Health/Clinic-General Health

Administrative/Third Party Billings

Community Paramedicine

Strategic Initiatives

Emergent Health Fund

Total

Revenues:

Healthcare Corpus

General Fund

Recurring

Additional Recurring Funding in FY18



Non-Recurring

Total

HEALTH CARE BUDGET SUMMARY

4,700,000 4,150,000 4,150,000 3,021 ,586

540,000 1,250,000 1,250,000 1,250,000

270,000 270,000 430,500

1,220,000 208,500 400,000

253,000 150,000 78,740

357,119 357,119

924,979 765,860 925,000

22,950 27,566

7,005,950 6,953,479 6,953,479 6,060,011

7,005,950 679,859

2,908,632 2,908,632

1,000,000

6,273,620 4,044,847 2,151 ,379

7,005,950 6,953,479 6,953,479 6,060,011

Strategic Initiatives: Clinic-based Outpatient Surgery Center(s) Community Health Advocates Opioid Peer Coach Project LECOM Dental for Adults Claims Utilization Management

3,021 ,586 3,021 ,586

1,250,000 1,250,000

400,000 400,000

80,920 80,920

357,119 357,119

925,000 925,000

25,386 25,386

6,060,011 6,060,011

2,908,632 2,908,632

1,000,000 1,000,000

1,000,000 1,000,000

1,151 ,379

1,151 ,379

6,060,011 6,060,011

HEALTH CARE SERVICES- MANDATED SERVICES Agency Program FY13/14 FY14/15 FYlS/16 FY16/17 FY17/18

Armor Correctional Health Jail Medical FS 901.35 & 951.032 s 5,152,367.00 s 4,735,103 .00 s 5,327,477.00 s 5,694,484.00 s 6,119,503.00

Centerstone of Florida Mental Health Transport s 93,970.00 s 93,970.00 s 93,970.00 s 93,970.00 s 93,970.00

Health Care Responsibil ity Act HCRA FS 154.301 s 118,670.00 s 47,915 .00 s - s 2,834.00 s 150,000.00

Medicaid Match Medicaid Match FS 409.915 s 4,769, 773.00 $4,778,212.00 s 4, 796,486.00 s 4,911,908.00 s 4,349,527.06

Department of Health in Manatee Services s 929,962.00 s 929,962 .00 s 929,962.00 s 929,962 .00 s 929,962.00

Department of Health in Manatee Facil ity s 143,960.00 s 146,155.00 s 132,334.00 s 121,256.00 s 152,499.00

Department of Health in Manatee Minority Aids Social Service s 7,172.00 s - s - s - s -

TOTALS $ 11,215,874.00 $ 10,731,317.00 $ 11,280,229 .00 $ 11,754,414.00 $ 11,795,461.06

HEALTH CARE SERVICES- COUNTY ADMINISTERED PROGRAMS FOR LOW INCOME PERSONS

Agency Program FY13/14 FY14/15 FYlS/16 FY16/17 FY17/18

Prescriptions 0.00 s 103,663.00 $220,763.00 s (52,170.00} s 200,000.00 s 200,000.00

General Fund Cost Allocation 0.00 s 100,000.00 s 100,000.00 s 100,000.00 s - s -

HIE Heplth Information Exchange Health Information Exchange $- $- $- s 3,750.00 s 4,750.00

Hospital Audits Hospital Audit Services $660.00 $- $75,750.00 s - s 105,039.00

IHS Indigent Health Solutions Billing Software $43,415 .00 $23,648 .00 $31,924.00 s 59,235 .00 s 73,666.00

TOTALS $247,738.00 $344,411 .00 $ 155,504.00 $ 262,985.00 $383,455 .00

HEALTH CARE SERVICES- FOR PROFIT FUNDING

Agency Program FY13/14 FY14/15 FYlS/16 FY16/17 FY17/18

Blake Medical Center Indigent Health Care $ 1,121,488.00 $ 1,225,262 .00 $ 523,155.00 $ - PENDING LIP

Clinics Indigent Health Care $ 839,645 .00 $ 724,850.00 $ 564,476.00 $ - PENDING LIP Low Income Pool (LIP) AHCA $ - $- $ - $ 505,000.00 $ 3,021,586.00

Manatee Memorial Hospital Indigent Health Care $ 5,996,520.00 $5,406,707 .00 $ 3,526,586.00 $ 3,021,586.00 PENDING LIP

Physician Payments Indigent Health Care $ 1,000,000.00 $538,238.00 $ 657,266.00 $ 1,250,000.00 $ 1,250,000.00

Speciality Care Indigent Health Care $ 58,286.00 $54,186.00 $ 56,975.00 $ 56,975 .00 PENDING LIP TOTALS $ 9,015,939.00 $ 7,949,243.00 $ 5,328,458.00 $4,833,561.00 $ 4,271,586.00

Pending decision of LIP fund in ool

MMH request in 17/18 the same amount as received in FY 15/16

Consideration for new programs

HEALTH CARE SERVICES • NOT FOR PROFIT

Baker Act Adult

Pharmaceutical Program

Pilot - Community Health Home

Case Mgmnt

Documents

Manatee County Government Administrative Center Commission ... · 8/24/2017 · Indigent Health Program Enrollees ~2,400 : Percent at or below 200% FPL . 36.31% : Percent of Population