N ORTH C AROLINA H EALTH N ET N ETWORKS : W AKE U P AND S MELL THE C OLLABORATION Anne Braswell HealthNet Program Director NC Office of Rural Health and Community Care NCSCHA 2011 Annual Conference December 6, 2011 Raleigh, NC

2000: HEALTH RESOURCES AND SERVICES ADMINISTRATION ANNOUNCED COMMUNITY ACCESS PROGRAM (CAP) New federal grants program supporting community indigent care initiatives to increase access and quality of care for the uninsured and underserved Expanded access for the uninsured by increasing effectiveness and capacity of the nation’s health care safety net at the community level 2

COMMUNITIES RECEIVING CAP FUNDS EXPECTED TO: Build integrated health care delivery systems and a seamless continuum of care for uninsured and underinsured populations Eliminate unnecessary, duplicative functions in service delivery and administration Increase access to health care for low-income uninsured and underinsured persons 3

FIRST COMMUNITY ACCESS PROGRAM IN NORTH CAROLINA June 2000: Office of Rural Health and Community Care applied for CAP funding on behalf of Community Care Plan of Eastern Carolina for Pitt, Greene, Edgecombe & Bertie Counties September 2000: ORHCC awarded one of only 23 CAP grants in U.S. -- $897,000 for Pitt et al 4

2000: COMMUNITY CARE PLAN OF EASTERN CAROLINA AND ORHCC CREATED “HEALTHASSIST” Built upon administrative infrastructure of Community Care of North Carolina (CCNC) Established 4 Community Resource Centers Co-located services with other community non- profits (e.g. JOY Soup Kitchen; Pactolus Fire/Rescue) Provided health care services, care coordination, wellness and prevention services, adult continuing education, and job skills training for low-income and uninsured residents 5

BEGINNING 2001: HRSA REPLACED CAP WITH HEALTHY COMMUNITIES ACCESS PROGRAM (HCAP) Additional indigent care networks were initiated throughout NC with HCAP funding: Cabarrus, Guilford, Buncombe, Moore, Beaufort, Durham, Henderson, Orange/Chatham Several communities initiated programs, but were not awarded federal funding: Mecklenburg, Wake, Vance/Warren, Wilkes, Wilson, Mitchell/ Yancey, Watauga, New Hanover, and others 6

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IMPACT OF HCAP PROGRAM IN NC Between 2000 and 2005, HCAP helped: Induce physicians and hospitals to provide more free care and services for the uninsured Encourage local governments and philanthropic organizations to provide matching investments of funds and resources Bring about both perceived and measurable improvements in the health and wellness of participants Reduce inappropriate use of hospital EDs and other costly services by participants 10

2005: HCAP NO LONGER FUNDED BY HRSA After 2005, former HCAP sites and other programs in NC struggled to maintain the same level of programs and services with limited resources Early in 2007, the last HCAP “carryover” funding ran out In the summer of 2007, The Duke Endowment provided 4 months of emergency funds 11

A KEY LESSON LEARNED FROM HCAP: There must be sustaining funds to support the administrative infrastructure needed to effectively operate these indigent care programs and develop an integrated health care delivery system for the uninsured. 12

2007: “NC HEALTHNET” INITIATIVE In SFY , NC General Assembly made a one-time appropriation to ORHCC of $2.88 million to implement HealthNet to support North Carolina’s safety net primary care provider networks and develop community- based systems of care serving the uninsured. 13

NC HEALTHNET: Links local safety net organizations and indigent care programs providing free and low-cost health care services with the infrastructure of Community Care of North Carolina and CCNC’s networks of physicians and services. 14

HEALTHNET NETWORKS INCLUDE: Physicians Hospitals Public Health Free Clinics Rural Health Centers Community Health Centers School Based Health Centers Departments of Social Services Behavioral Health Law Enforcement Other Community-Based Safety Net Organizations 15

HEALTHNET TARGET POPULATION: Uninsured adults, years old, whose family income is at or below 200% of FPL 16

HEALTHNET ENROLLEES: Provided a Primary Care Medical Home and access to: Specialty Care Wellness Education Prevention Services Prescriptions Medications Care Coordination for Chronic Medical Conditions Other Needed Services 17

HEALTHNET NETWORKS: Receive technical assistance and grant funding from ORHCC to support the community’s ongoing efforts to: Increase access and quality of care through a coordinated delivery system Share and conserve limited resources through collaborative partnerships 18

SFY : HEALTHNET IN YEAR 1 Funded 16 HealthNet Networks providing services for the uninsured in 27 counties 40,000+ individuals were provided a medical home 25,000+ individuals had access to needed prescription medications 19

SFY : HEALTHNET IN YEAR 2 In SFY , ORHCC received $2.8 million in recurring appropriations to sustain existing HealthNet Networks plus $950,000 in non- recurring funds to develop new collaborative networks. 20

SFY : HEALTHNET IN YEAR 2 Funded 21 HealthNet Networks that provide services for the uninsured in 39 counties 50,000+ individuals were provided a medical home 38,000+ individuals had access to needed prescription medications 21

SFY : HEALTHNET IN YEAR 3 In SFY , ORHCC received $4.8 million in recurring appropriations to sustain existing HealthNet Networks and develop new collaborative networks. 22

SFY : HEALTHNET IN YEAR 3 Funded 31 HealthNet Networks that provide services for the uninsured in 63 counties 61,000+ individuals had access to a medical home 42,000+ individuals had access to needed prescription medications 23

SFY : HEALTHNET IN YEAR 4 In SFY , ORHCC again received $4.8 million in recurring appropriations to sustain existing HealthNet Networks and develop new collaborative networks. 24

SFY : HEALTHNET IN YEAR 4 Funding 35 HealthNet Networks that provide services for the uninsured in 70 counties 86,000+ individuals have a medical home 49,000+ individuals have access to needed prescription medications 25

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ORHCC TECHNICAL ASSISTANCE North Carolina Office of Rural Health and Community Care staff provides: Community Needs & Gap Analysis Strategic & Business Planning Network Development Medical, Dental, and Psychiatric Provider Recruitment for Underserved Areas & Educational Loan Repayment Architectural Design Support for Capital Projects 27

ORHCC TECHNICAL ASSISTANCE (CONTINUED) Coordination with: Community Care of North Carolina (CCNC) and Medicaid Critical Access Hospital Program Farm Worker Health Program Medical Access Plan Medication Assistance Program Community Health Grants Program Regional trainings and webinars Bimonthly statewide HealthNet Networks Meetings 28

ORHCC TECHNICAL ASSISTANCE (CONTINUED) Free software applications for determining eligibility, enrollment, resource commitments, referrals, care and disease management, tracking encounter claims data (CMIS) and accessing 150+ pharmaceutical manufacturers’ free prescription drug programs and drugs (MARP- Medication Access & Review Program) More information at:

HEALTHNET AND CCNC-UP ORHCC AND HEALTHNET PARTNERING WITH: the OFFICE of GOVERNOR BEVERLY PERDUE the NC DIVISION OF MEDICAL ASSISTANCE (MEDICAID) NORTH CAROLINA COMMUNITY CARE, INC. (N3CN) the NORTH CAROLINA FOUNDATION FOR ADVANCED HEALTH PROGRAMS the NC INSTITUTE OF MEDICINE the UNC CECIL G. SHEPS CENTER FOR HEALTH SERVICES RESEARCH ACCESSEAST and FOUR COUNTY COMMUNITY CARE PARTNERS to develop Community Care of North Carolina for Uninsured Parents (CCNC-UP), a limited benefit plan that is being piloted in Warren, Pitt and Greene Counties and providing low-income, uninsured parents with access to basic health care coverage. 30

HEALTHNET AND CCNC-UP ORHCC administering North Carolina’s State Health Access Program (SHAP) grant, $4.5 million over 3 years, from the US DHHS Health Resources and Services Administration (HRSA) to develop CCNC-UP. Like HealthNet : CCNC-UP built upon CCNC’s primary care medical home model and administrative infrastructure. CCNC-UP provides enrollees (low-income, uninsured parents) with a primary care medical home and emphasizes prevention and chronic disease management. 31

HEALTHNET AND CCNC-UP In August 2011, ORHCC authorized to reallocate $2.8 million in SHAP funds to undertake 10 new projects providing health care for thousands of uninsured North Carolinians and help prepare the state for implementing the Affordable Care Act: $400K to maintain “Healthy & Ready to Learn” CHIPRA Outreach and Enrollment Program for pre-school and elementary school children. $375K emergency fund to cover co-pays for 5000 uninsured patients. $700K to support NC’s “Medical Access Plan” and provide an additional 10,000 office visits for uninsured patients at rural health centers. 32

HEALTHNET AND CCNC-UP $100K to create “Dental Access Plan” Pilot for the uninsured in partnership with ECU School of Dental Medicine. $180K to create “Behavioral Health Access Plan ” Pilot for the uninsured. $25K for “Health Matters in the Community,” a new OPEN/net television series to inform the public about community health issues, health reform, and the concerns of uninsured / underserved individuals and safety net organizations. More information at: 33

HEALTHNET PARTNERING WITH NC FARM BUREAU: “H EALTHY L IVING F OR A L IFETIME ” I NITIATIVE Mission: To provide Rural North Carolinians with the benefits of living a healthier lifestyle by providing free professional health screenings, educational materials and resources designed to encourage a commitment to healthy living. 34

HEALTHNET PARTNERING WITH NC FARM BUREAU: “H EALTHY L IVING F OR A L IFETIME ” I NITIATIVE Mobile Health Screening Unit 25 screening events per year will be conducted using a 50-foot custom built mobile health screening unit Self-contained, eco-friendly screening facility provides four screening stations, a specialty room for vascular ultrasound and a 1,000 sq. ft. fully enclosable awning Health screenings offered at each event customized for local needs: Blood Pressure, Total Cholesterol, Glucose, Bone Density, Body Mass Index, Vascular Ultrasound More information at: 35

“Rural Hope” Initiative ORHCC AND HEALTHNET PARTNERING WITH: NC RURAL ECONOMIC DEVELOPMENT CENTER THE GOLDEN LEAF FOUNDATION KATE B REYNOLDS CHARITABLE TRUST APPALACHIAN REGIONAL COMMISSION USDA RURAL DEVELOPMENT More information at: 36

HEALTHNET PARTNERING WITH CARE SHARE HEALTH ALLIANCE ORHCC participates as a board member of the Care Share Health Alliance, a statewide organization whose mission is to improve the health of low-income, uninsured North Carolinians by supporting local collaborative networks of care. 37

Q UESTIONS A BOUT H EALTH N ET ? A NNE B RASWELL H EALTH N ET P ROGRAM D IRECTOR NC O FFICE OF R URAL H EALTH & C OMMUNITY C ARE A NNE.B DHHS. NC. GOV A NNE.B DHHS. NC. GOV 38