Health Care Reform & School-Based Health Centers: Three Perspectives NASBHC Annual Conference, Los Angeles, CA June 26, 2008 Donna Behrens, RN, MPH, Associate Director, Center for Health and Health Care in Schools (CHHCS) Julia Lear, Director, CHHCS John Schlitt, Executive Director, NASBHC

School-Based Health Centers and Health Care Reform The context: why some kind of change is on its way and what features of health care will be addressed The major challenges Some lessons from Maryland’s experience SBHCs and health care reform: Views from NASBHC

Why change is on its way Budgetary pressures IN THE STATES Budget gaps in 20 states in 2009. Solutions: draw down reserves, cut spending, raise taxes FEDERAL GOVERNMENT also confronts budgetary pressures -- escalating health care costs and increased Medicare enrollment Weakened opposition to fundamental change Support for expanding/deepening coverage; promoting high-value care State-based health reform -- MA, CA; Legislative & governor-sponsored health care reform commissions

What Will Reform Look Like What Will Reform Look Like? Big Fish Eat the Littler Fish, Littler Fish Eat the Littlest Fish Tightened requirements for insurance-paid care. Payments made to medical home only; carve-outs unlikely Fewer dollars for public health and prevention services

Alternate Roles for SBHCs in Health Care Reform Plans SBHCs function as adjuncts to formal system of care, providing public health services or focusing on specific issues such as child development or mental health (Challenge: hard to secure payments from medical home) SBHCs serve as essential providers, offering medical services associated with a medical home (Challenge: providing 24-7 care, comprehensive services)

Donna Behrens: Top 10 Keys to Keeping SBHCs & School Health in the Health Reform Debate Lessons from the Maryland experience To be taken seriously, SBHCs need to look and feel like other parts of the health care system Maintain and protect that which makes SBHCS AND school health unique and essential and therefore a value added part of the health care system. 3. Don’t be caught playing catch up. Anticipate and PARTICIPATE in all the health care discussions related to children and youth

Maryland Lessons continued Don’t let others in the health care arena define who you are Anticipate the changes that are coming - follow the trends, follow changes in Medicaid, community health centers, reimbursement rates 6. Have research and data that backs what you do

Maryland Lessons concluded 7. Your SBHC advocacy organization is essential Seize any and all opportunities to be a part of health care discussions (federal, state, legislative) 9. Get to know the leaders in your state (school, health department, political) 10. Step boldly up to the health care reform table

John Schlitt: SBHCs Role in Health Care Reform Intervening Catching Early Preventing ROLE FOR SCHOOLS IN CHILD HEALTH DEVELOPMENT SYSTEM

WHAT SBHCS CAN TEACH REFORM EFFORTS Continuity of place/provider matters Ecology matters Inter-professionals teams School setting optimizes population-based approach Prevention/Early Intervention One size does not fit all (annual 15 min office visit) Efficiency Cultural Humility (distinctive from cultural competence)

NEW SYSTEM NEEDS  Population-based payment methodology (redistribution of funds across sectors to create incentives and capacity for prevention) Tiered reimbursement levels based on risk factors IT system to create connectivity across vertical/horizontal systems (medical, public health, civic)

In a Universal Access System… What roles will SBHCs arguably best be able to fill? How is a SBHC role financed? How do we bridge the electronic chasm to promote information exchange?