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National Initiative for Asthma Reimbursement Achieving Reimbursement for Environmental Health Services
Please find the webinar recording here.
October 9, 2018
www.ghhi.org | 2©2016 Green & Healthy Homes Initiative. All rights reserved.
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www.ghhi.org©201 Green & Healthy Homes Initiative. All rights reserved.
www.ghhi.org | 2©2017 Green & Healthy Homes Initiative. All rights reserved.
Webinar Logistics
To join:
1. Open the calendar invitation
you received after registering for
the webinar.
2. Click the Join URL when it's
time to start.
3.If using a telephone,* dial in and
enter the Audio Pin provided in
the GoToWebinar control panel.
*We recommend using a phone to
avoid echo problems
If you are experiencing
difficulties in joining the
webinar, please email Kevin
Chan ([email protected])
www.ghhi.org | 3©2016 Green & Healthy Homes Initiative. All rights reserved.
www.ghhi.org | 3©2015 Green & Healthy Homes Initiative. All rights reserved.
www.ghhi.org©201 Green & Healthy Homes Initiative. All rights reserved.
www.ghhi.org | 3©2017 Green & Healthy Homes Initiative. All rights reserved.
Agenda
• Introductions
• Overview of Green & Healthy Homes Initiative
• Overview of EPA Indoor Environments Division
• Overview of the National Initiative for Asthma Reimbursement
o Introduction to Center for Health Care Strategies
• Overview of Business Development Technical Assistance Services
• Overview of Reimbursement Support Technical Assistance Services
• Q&A
www.ghhi.org | 4©2016 Green & Healthy Homes Initiative. All rights reserved.
www.ghhi.org | 4©2015 Green & Healthy Homes Initiative. All rights reserved.
www.ghhi.org©201 Green & Healthy Homes Initiative. All rights reserved.
www.ghhi.org | 4©2017 Green & Healthy Homes Initiative. All rights reserved.
Welcome from Executive Sponsors
Introductions
Ruth Ann Norton
President & CEO
Green & Healthy Homes Initiative
Tracey Mitchell, RRT, AE-C
Environmental Protection Specialist
Environmental Protection Agency
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Overview of GHHI
www.ghhi.org | 6©2016 Green & Healthy Homes Initiative. All rights reserved.
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The GHHI National Initiative for Asthma Reimbursement Team
Introductions
Kevin Chan
Social Innovation Specialist
Kiersten Sweeney
Social Innovation Specialist
Brendan Brown
Senior Associate
Michael McKnight
VP, Policy & Innovation
Andrew Olson
Social Innovation Specialist
Will Klein
Social Innovation Specialist
Elsie Andreyev
Environmental Health Intern
www.ghhi.org | 7©2016 Green & Healthy Homes Initiative. All rights reserved.
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GHHI has a long history of working towards healthy housing for all.
1986 FoundedParents Against Lead became the
Coalition to End Childhood Lead Poisoning
2015 EPA Asthma AwardProud recipient of EPA’s National Environmental
Award in Asthma Management
2015 Social Innovation Fund AwardAward expands to 6 national sites to advance asthma
Pay for Success across private business models
2009 Becomes GHHIExpand scope and scale to break the link between
unhealthy homes and unhealthy families nationally
2016 Robert Wood Johnson FoundationAward expands Pay for Success portfolio to 11 asthma
projects including state governments
2017-20 EPA-supported Technical AssistanceProviding technical assistance to support comprehensive
asthma interventions
2016 National Lead SummitLaunched concept paper on addressing lead-
poisoning through Social Impact Bond
Overview of GHHI
www.ghhi.org | 8©2016 Green & Healthy Homes Initiative. All rights reserved.
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Source(s): GHHI
Breaking the link between unhealthy homes and unhealthy families to
improve health, economic, and social outcomes.
Overview of GHHI
Accomplishments
• 98% reduction of lead
poisoning in Maryland
• 35 pieces of legislation
passed
• 25 GHHI-designated sites
across the country
• Over $300 million raised
• Over 500,000 integrated
healthy homes, lead hazard
reduction, and energy
efficiency units in
partnership with HUD
Philanthropy Government Private-sector
$System
• Single intake system
• Comprehensive
assessment
• Coordinate services
• Integrated
interventions
• Cross-trained workers
• Shared data
Outcomes
• Lead-hazard reduction
• Asthma-trigger control
• Household injury
prevention
• Energy efficiency
• Weatherization
• Housing rehabilitation
www.ghhi.org | 9©2016 Green & Healthy Homes Initiative. All rights reserved.
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20 projects working to develop health care financing to support healthy
homes
Innovation Portfolio
Funders
Feasibility Ongoing• Chattanooga – Erlanger Children’s Hospital
• Philadelphia – St. Christopher’s Hospital
• Worcester - UMass Memorial Hospital
• Oregon - Community Services Consortium
• Indiana - Indiana Joint Asthma Coalition
• Chicago - Presence Health
• Houston - Community Health Choice
• Minneapolis – Minnesota Multifamily Affordable
Housing Energy Network
• CT - Connecticut Green Bank and DSS / State
Medicaid
Post-Feasibility Development• Baltimore – Priority Partners MCO
• Buffalo - YourCare Health Plan and Millenium
• Grand Rapids – Priority Health
• Houston - UnitedHealthcare
• Memphis - Le Bonheur Children’s Hospital
• New York City - Affinity Health Plan
• New York State Energy Research and
Development Authority
• Philadelphia - Health Partners Plans
• Rhode Island - State Medicaid and Integra
• Salt Lake County – University of Utah Health
Plans
• Springfield - Baystate Health and BeHealthy
Partnership ACO
Protecting Public Health and the Environment through
Health Care Collaboration and Reimbursement of Preventive Asthma
Control Strategies
Tracey Mitchell, RRT, AE-C
U.S. Environmental Protection Agency
Indoor Environments Division
10
EPA’s Role in Asthma
Agency Mechanisms
– Regulatory Measures
– Research
– Guidance Development
– Outreach & Education
– Partnerships; Leveraging systems
IED Asthma Program Aim
Get environmental controls into all elements of asthma management.
– Health care
– Housing
– Schools
– Community Systems, with a special focus on EJ
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Environment Plays a Critical Role in
Asthma Control
• Federal asthma guidelines recognize environmental
trigger reduction as a critical component of
comprehensive asthma care.*
• The evidence base demonstrates that in-home
environmental interventions are effective at improving
asthma control in children and adolescents.†
NHLBI. Guidelines for the Diagnosis and Management of Asthma (EPR-3). 2007. https://www.nhlbi.nih.gov/health-pro/guidelines/current/asthma-guidelines
† CDC. The Guide to Community Preventive Services. 2005. https://www.thecommunityguide.org/
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Evolution of IED’s Asthma Program
Sustainable Financing
Science, Policy & Practice in Place
EPA Supports High Value, In-Home
Environmental Interventions
Meeting Communities Where They Are
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Overview of the National Initiative for
Asthma Reimbursement
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Goals of the National Initiative for Asthma Reimbursement
The National Initiative for Asthma Reimbursement has three main goals,
which we will work toward simultaneously.
Increase the number of home visiting programs providing
comprehensive asthma (including environmental
remediation of asthma triggers) interventions.
Increase the number of health plans serving Medicaid
populations and/or state Medicaid programs that
reimburse for these comprehensive services.2
1
Increase the use of standardized environmental
management & health outcomes metrics for evaluation
(EMHOME)3
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Overview of the National Initiative for Asthma Reimbursement
The National Initiative for Asthma Reimbursement seeks to advance
evidence-based comprehensive interventions through three support
services.
Reimbursement technical assistance 2
Business development technical assistance1
Environmental Management & Health Outcomes Metrics
for Evaluation (EMHOME) system3
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There is a strong evidence base for the efficacy and efficiency of
comprehensive asthma interventions that provide environmental health
services.
Providing a Continuum of Healthcare from the Clinic into the Home
Medications
Assessment and monitoring
Patient education
Control of environmental factors
Four components of asthma care• Asthma programs use a community-based
element to reinforce clinical interventions and
also address environmental triggers for the
patient and family.
• Research shows that environmental control
should be performed in a comprehensive
manner using a multi-trigger, multicomponent
approach.
Ex: Mold remediation, ventilation, removal of
carpets and dust sinks for dust mites and
allergens, integrated pest management
Clin
ical
Com
munity
Although the evidence shows that comprehensive interventions can improve asthma outcomes,
the healthcare system does not traditionally pay for these types of services.
Based on a review of the evidence base, the NIH’s National Asthma Education and Prevention
Program recommends four components of effective asthma care.
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Non-profit policy center dedicated to improving the health of low-income Americans
About the Center for
Health Care Strategies
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Overview of Business Development Technical
Assistance Services
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Overview of the National Initiative for Asthma Reimbursement
Business Development is the first opportunity within the National
Initiative for Asthma Reimbursement
Business Development Technical Assistance
Business Development Technical Assistance Cohort Timeline
Cohort year 2018 2019 2020
TA sites per cohort 4 sites 5 sites 5 sites
Goal: Develop and implement asthma
home visiting programs that provide or
are seeking to provide comprehensive
environmental health service
Timeline: Each cohort (5 sites) will
receive 8 months of technical
assistance. Cohort 2 (2019) will run
from January 15 – September 30, 2019
Key Dates
• Oct 1: RFP released
• Nov 19 : Applications due 8p ET
• Jan 21: Public award announcement
Eligibility criteria:
• 2 partners willing to participate: a
health care entity & a service provider
• Interest in delivering environmental
health services
✓
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GHHI will provide technical assistance to the five selected sites across
eight different areas with specific planned deliverables.
Overview of Business Development Technical Assistance Services
1. Project planning
2. Stakeholder analysis
3. Data management
4. Operations planning
5. Payer engagement
6. Benefit-cost analysis
7. Evaluation design
8. Business plan
Technical assistance areas:
• Operations plan
• Data management plan
• Benefit-cost analysis to determine ROI
• Evaluation plan
• Business plan
Deliverables
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Overview of Business Development Technical Assistance Services
Business Development Timeline
Jan
00 Project selection (5 sites)
01 Project planning
02 Stakeholder analysis
03 Data management
04 Operations planning
05 Payer engagement
06 Benefit-cost analysis
07 Evaluation design
08 Business plan
Site visits
00
01
03
04
05
02
Feb Mar Apr May Jun Jul Aug Sept
Project timeline (Cohort 2, Jan – Sept 2019)
Activities
06
07
08
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2018 Business Development Cohort
Community Services Consortium: Albany, OR
• Community Services Consortium (lead)
• Samaritan Health Services
• Linn County Health Department
Partners
Project status
The Healthy Homes Asthma Program has
completed the development of a business
model that would allow them to utilize targeted
case management funding to provide home
visits while leveraging weatherization funding
for home remediation.
Low-income asthma sufferers in
Linn, Benton, and Lincoln
counties.
Target population
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2018 Business Development Cohort
Energy Coordinating Agency: Philadelphia, PA
• Energy Coordinating Agency (lead)
• St. Christopher’s Hospital for
Children, Center for the Urban Child
Partners
Project status
The team has completed their business plan and is seeking pilot funds to test the
comprehensive model that was developed through their project. ECA and St. Chris
have performed home visit shadowing as a first step to coordinate health and
energy assessment measures.
Children and their families currently
being served by the Asthma Care Clinic
at the Center for the Urban Child, St.
Christopher’s Hospital
Target population
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2018 Business Development Cohort
Indiana Joint Asthma Coalition: Indianapolis, IN
• Indiana Joint Asthma Coalition (lead)
• Improving Kids Environment (IKE)
• Indiana Community Health Workers
(CHWs) Assoc.
• Riley Hospital for Children
• Ball State University
• MDWise
• Marion County Public Health Dept
• Parkview Health
• Indiana State Department of Health
Partners
Project status
The team planned and implemented the first round of
asthma-specific CHW training in two counties, with
plans to replicate the training in other counties in the
Spring. Over 20 CHWs have been trained thus far.
Children in Indiana with
a diagnosis of asthma
whose asthma is not
well controlled.
Target population
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2018 Business Development Cohort
UMass Memorial Medical Center: Worcester, MA
• UMass Memorial Medical Center (lead)
• City of Worcester’s Healthy Homes Office
• Worcester Public Schools
• Community Legal Aid
• Montachusett Opportunity Council
Partners
Project status
GHHI worked with UMMMC and partners to:
• Collect and analyze hospital data to build a cost-benefit analysis
• Improve upon an integrated operations plan for service implementation
• Plan for expansion of services to more rural area north of City of Worcester
Children between 2-18 years
who are at-risk or high-risk of
suffering from asthma in the
Worcester area
Target population
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Overview of Reimbursement Support
Technical Assistance Services
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Reimbursement Support is the second opportunity within the National
Initiative for Asthma Reimbursement
Reimbursement Technical Assistance
Goal: Increase Medicaid
funding for these
comprehensive environmental
health service interventions.
Eligibility criteria:
• Operational program that includes
environmental health services
• Established partnership with healthcare entity
Reimbursement Technical Assistance Cohort Timeline
Cohort year 2018 2019 2020
TA sites per cohort 2 sites 4 sites 4 sites
Projects that successfully complete the business development phase will be encouraged to
apply for the Reimbursement phase in the following year.
Key Dates:
• Oct 1: RFP re-released
• Proposals accepted on rolling basis
Timeline: Each cohort will
receive up to 12 months of
technical assistance
Overview of the National Initiative for Asthma Reimbursement
✓
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GHHI will provide technical assistance to the selected sites across four
main areas. Specific activities will depend on the needs of each site.
Overview of Reimbursement Support Technical Assistance
• Creation and execution of
appropriate agreements
• Assistance with Institutional Review
Board (IRB) applications
Data support
• Analysis of political and regulatory
issues
• Support navigating and removing
potential barriers
Policy analysis
• Cost-benefit analysis
• Economic modeling
• Budget analysis & recommendations
• Risk analysis & mitigation
recommendations
Economic analysis
• Analysis & selection of best method
for reimbursement
• Payer engagement & support
• Support contracting & finalizing
terms with payer(s)
Payment model support
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2018 Reimbursement Cohort
Integra Community Care Network: Rhode Island
• Integra Community Care Network, LLC
• State of Rhode Island Department of
Health Home Asthma Response Program
(HARP)
• Rhode Island Housing
Partners
Project Status
Corporation for National Community Services Awardee for the 2018-19 Pay For Success
Technical Assistance grant. Together with a collaborative group of community partners, the
initiative involves home visit treatment, case management, and clinical site services which have
contributed to a reduction in emergency room visits and reduced costs for asthma related
cases.
Children between 2-18 years
who are at-risk or high-risk of
suffering from asthma in the
Worcester area
Target population
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2018 Reimbursement Cohort
Healthy Homes Des Moines: Des Moines, IA
• Healthy Homes Iowa
• Des Moines Public Schools
• Visiting Nurse Services of Iowa
• Polk County Health Department
• Child and Family Policy Center
• Polk County Housing Trust Fund
• Polk County Public Works
• Rebuilding Together Greater Des Moines
• Mid-Iowa Health Foundation
• Telligen Community Initiatives
• UnityPoint Health
• Mercy Medical Center
• Broadlawns Medical Center
Partners
Project status
The team is engaging state Medicaid and managed care organizations to begin exploring
payment mechanisms and potential data sources to inform an economic analysis of potential
cost savings for asthma. Within Polk County there is a robust existing capacity for service
delivery, and this project will confirm service provider roles, process flow design, and scaling
considerations for state-wide implementation.
Children between 2-18 years
who are at-risk or high-risk of
suffering from asthma
Target population
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To apply for technical assistance, the applicant must meet a set of
eligibility criteria and requirements.
• Use requested support for a project that delivers home visiting asthma self-
management education, environmental assessment, & environmental control
practices aimed at reducing exposures
• Have two partners willing to participate as project leaders: one from a health
care entity partner and one from a service provider partner
Business Development Eligibility Criteria
Same as above, plus:
• Have an existing asthma program providing environmental health services
• Have existing partnership with a health care entity willing to sign letter of
support to explore reimbursement for program services
Reimbursement Eligibility Criteria
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To apply for technical assistance, the applicant must meet a set of
eligibility criteria and requirements.
• Enter into a Memorandum of Understanding with GHHI for technical
assistance services
• Participate in knowledge-sharing activities and make publicly available all
non-confidential documents and tools developed during the agreement period
Contribute in-kind hours, estimated
at 240-360 hours from each
partner, to support TA GHHI will
provide
Contribute in-kind hours, estimated
at 20-30 hours per month from
each partner, to support the TA
GHHI will provide
General Requirements
Business Development In-Kind Reimbursement In-Kind
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The RFP documents outline all necessary application materials,
submission guidelines, and selection criteria.
• Cover sheet
• Proposal narrative
• Most recent A-133 audit, if applicable
• Most recent financial statement
• Letters of commitment from partner organizations’ leadership
(Reimbursement – required; Business Development – optional, but
recommended)
• Additional project-related documents, such as program evaluation report
(optional, but recommended)
GHHI will provide each applicant the opportunity to have a telephone call of no
more than 30 minutes with GHHI staff to answer questions about the opportunity.
Application materials
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Overview of Business Development Technical Assistance Services
Important dates and links
• October 1, 2018: RFP released
• View application materials here:
https://www.greenandhealthyhomes.org/services/n
ational-initiative-for-asthma-reimbursement/
• October 9, 2018, 4pm ET: Informational webinar
for prospective applicants
• November 19, 2018: Business development
applications due at 8p ET
• Reimbursement Support applications: Proposals
accepted on rolling basis
• January 21, 2019: Public announcement of awards
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Q&A
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Ruth Ann Norton
President & CEO
Brendan Brown
Project Lead