A“HealthyNeighborsAssurancePlan”

May18,2017

ORGANIZINGNORTHCAROLINA’SESSENTIALCOMMUNITYPROVIDERSINTOAHEALTHSYSTEM

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NCSafety-NetHealthSystem

663ServiceSitesOfferedviaaNetworkofAffiliations§ NorthCarolinaAssociationofFree&CharitableClinics(NCAFCC)– anassociationof70freeand

charitableclinics– 78membersoperating84sites

§ NorthCarolinaCommunityHealthCenterAssociation(NCCHCA)– anassociationof38FederallyQualifiedHealthCenters– 37healthcenterscomprising216sites

§ NorthCarolinaAssociationofLocalHealthDirectors(NCALHD)– anassociationofprimarycareanddentalclinicsandotherpublichealthservices,suchasfamilyplanning,operatedbylocalPublicHealthUnits– servingall100counties(186sitesin71countiessurveyresponsestodate)

§ RuralHealthCentersandClinics(RHCC)- supportedbystateandfederalfunds,butnotcurrentlyrepresentedbyanassociation– 87sitesandprovidingtechnicalassistancetoall100counties

§ CollaborativeNetworksworkingwithCareShareHealthAlliance(CSHA)– entitiescomprisedofmultiplelocalpartnerswhointegratemedical,preventative,community,social,andeconomicresourcestoachievecollectiveoutcomesthroughacoordinatedsystemofcare– 20collaborativenetworksserving45counties

§ NorthCarolinaSchoolBasedHealthAlliance(NCSBHA)– supportingaccessible,affordable,qualityhealthcareinschool-basedandschool-linkedhealthcentersandprovidingtechnicalassistanceandadvocacyfortheNCschoolhealthcentersatalocal,state,andnationallevel–activein25countiesatover90locations

PriorInvestmentsandOurCollectiveAssetsServeasaFoundation

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QuickLook:GeographicCoverageNCSNHSCoverageMap

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x

x x

xx

xx

(100+Sites)

(216Sites)

(84Sites)

45

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PrimaryCareSafety-NetUninsured43% ofuninsuredNCresidentshavesoughtcareinourclinics

PatientsServed(annually)

PercentUninsured

78,4861 100%all

471,7252 42.2%>two infive

502,4443 36.8%>oneinthree

82,8984 13.3%~one inseven

1,063,709 44.5%473,507

Sub-total

Sources:1. 2015NCAFCCAnnualOutcomesSurvey2. 2015FederalDataReportforNCHealthCenters3. NCLHDStatisticalDataSummaryReportSFY20154. RuralHealthCentersbasedonSFY2017Applications

Doesnotacceptorbillinsurancecompanies

Mustseeallpatientsregardlessoftheirabilitytopay;26%Medicaid

Responsiblefor100countystrategy;providesdirectprimarycarein>70counties

DesignationasaRuralHealthCenterisspecifictoNCstate-supportedmedicalfacilities

43%oftheestimated1.1MuninsuredNCresidentshavesoughtcarewithinourclinics

- Insured

- Uninsured

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Safety-NetClinicsServed473,507oftheState’s1.1MUninsuredGettingFolks‘InsuranceReady’

Peopleareencouragedtoseekcareeither…

throughahospitalemergencydepartmentforanaveragecostof$1,2331 pervisit

inanestablishedprimarycaresettingwithinthesafety-netatacostof$40.133pervisit

or

1 blog.bcbsnc.com/2014/04/5-emergency-room-myths-busted/2 https://www.acep.org/news-media-top-banner/the-uninsured--access-to-medical-care/3Level3EstablishedOfficeVisit(99213)- https://dma.ncdhhs.gov/providers/programs-services/medical/federally-qualified-health-centers

55%ofemergencycaregoesuncompensated2

44.5%ofprimarycarepatientsaccessingthesafety-netareuninsured

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BuildingMomentumProgressingTowardsaSelf-DeterminedSafety-NetHealthSystem

Assessing– Phase2Defining– Phase1

- FaithHealth NCofficiallyjoinsNCSNHS

– EasternHealthStewardspresentation/discussion– StatewideCollaborativeNetworkCommitteeMeetingpresentation/discussion

– ORHpresentationatstatewideHealthNet TransitionandCHGmtg

– Writeandsubmitfirstgrantapplication

SECUREFUNDING

- PresentcaseforsupportatNCALHDCommitteeMeeting- InitialmeetingwithLeonLevineFoundation

REFINEANDSOCIALIZEAPPROACH

PROPOSESOLUTION

JanuarytoFebruary2017- Formalizefinancialandin-kindsupportfromsupportingorganizations

November2016– presentDevelopcollateralanddiscussiondocumentsoutliningtheconceptsofaunitedsafety-nethealthsystem

May2016topresent- Conveneagroupoflikemindedessentialcommunityprovidersdeterminedtodevelopapathtowardsself-determination

- Recommendinitialdatasharingactivitiesbegininearnestandapprovetheformationofaworkingdatagroup(committee)andamarketingandcommunicationscommitteetobereadyforthegrantannouncement

- Proposetheon-goingmonthlySafety-NetLeadersmeetingserveasaneartermgovernancemechanismfortheNCSNHS

Findasustainablepathforward

- InitialmeetingswithAetna,UnitedHealthcareandCentene

– NCAFCCBoardpresentation/discussion

ContinuetoengagenationalthoughtleadersfromForbes,WSJandotherpublicationstoincorporatelatesttrendsandmovementsintheon-goinghealthcarereformlandscape

– Care4Carolinapresentation/discussion– NCMedicalSocietypresentation/discussion

Continuetorespondto,approachandmeetwithindividuals/groupsthatcanhelprefinemessagingandprogramelements

- Evaluateandrecommendnewoperatingmodel,enhancedcapabilities,andpotentialforsharedservices

- Validateeachlocation’sabilitytomeetfutureHIEcompliancedeadlines

- CompletetheeffortsrequiredtoproduceadetailedinventoryoftheNCSNHSnetwork,

- Usefindingstodescribenetworkadequacy,and

- makerecommendationsforresourceallocations

Developadvocatesandbeneficialpartnerships

ProgressToDate

– LockeFoundationpresentationanddiscussion