1. 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

2. 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

3. Why change is on its way Budgetary pressures
IN THE STATES Budget gaps in 20 states in 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

4. 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

5. 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)

6. 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

7. 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

8. 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

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

10. 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)

11. 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)

12. 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?