John Schlitt National Assembly on School-Based Health Care School Health in Era of Health Care Reform

School Health: A Force 74,000 school nurses 14,000 SWers 99,000 counselors 30,000 psychologists 2,200 SBHCs Unknown #s physicians, mental health and substance abuse specialists Source: Lear JG. Health at school: a hidden health care system emerges from the shadows. Health Aff (Millwood) 2007;26:409–19.

School Health: A Force Surveillance data Extensive child development knowledge Cross-disciplinary competencies System infrastructure

Triple Aim Better health care experience Improved outcomes for population Lower cost

Shifts in Health Care OUT IN IN VolumeValue QuantityQuality UnitsOutcomes Carve out/silosIntegration Lone rangersMultidisciplinary teams IndividualPopulation ClinicCommunity

Redesign Experiments in State Medicaid Programs Health Homes Pay for Performance Integrated Care Models

Health Homes Primary care redesign Building block for most reforms Patient-centeredness at the core Care coordination/management Enhanced access (24/7) Electronic linkages to health neighborhood Quality improvement

Pay for Performance (P4P) Provider incentives for tracking quality measures, adopting new roles/behaviors – Enhanced rates/fees – Augmented payments/bonus – Behavioral health????

Integrated Care Models Accountable Care Organizations – “vertical integration” – Provider-driven, not insurance-driven – Emphasis on accountability = performance – Shared savings as incentive to drive down costs, make smarter investments in front end

Realigning Health with Care Product Product : broaden concept to ameliorate effects of nonclinical determinants – Inadequate food, housing, safety Place Place : beyond medical complex  neighborhoods Provider Provider : nontraditional team members – Community outreach workers, heath educators, coaches, resource coordination

Integrated Health Neighborhood Learning Supports Primary Care Behavioral Health Public Health Asthma Depression School failure Substance use Teen pregnancy Obesity

Schools in the Health Neighborhood Point of entry to primary prevention, risk reduction and care management system Inter-disciplinary team : whole child approach that unifies mind and body Screen/address behavioral health needs often undetected and unmet by mainstream PC system Meets young people where they are (literally) in terms of problems, pain, social and developmental challenges Unprecedented opportunity for population health

SBHC Lessons for Reformers Co-location > collaboration > integration Structural issues related to integration - space, data, scheduling – are not insurmountable Breaks down hierarchy; maximizes skill sets Minimizes stigma by normalizing within school setting

New Competencies for School Health Think “ SYSTEMS. ” MEASURE quality. Get WIRED. Get COUNTED (and paid). Know your VALUE. Get to the TABLE. Practice INTER-DISCIPLINARILY.

New Competencies for School Health Think “ SYSTEMS. ” MEASURE quality. Get WIRED. Get COUNTED (and paid). Know your VALUE. Get to the TABLE. Practice INTER-DISCIPLINARILY.

General Reform Resources National Academy of State Health Policy Health Affairs Kaiser Family Health Foundation

SCHOOL-BASED HEALTH ALLIANCE NASBHC =

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