HVIP SUSTAINABILITY STRATEGIES. NNHVIP Annual Conference 2013 Philadelphia, PA Jonathan Purtle Healing Hurt People, Drexel University

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1 HVIP SUSTAINABILITY STRATEGIES NNHVIP Annual Conference 2013 Philadelphia, PA Jonathan Purtle Healing Hurt People, Drexel University

2 SUSTAINABILITY: Existing Programs -Staff - Capacity New Programs

3 SUSTAINABILITY: Existing Programs -Staff - Capacity New Programs

4 OVERVIEW: Mechanisms for Sustainability Hospital Funding Medicaid Reimbursement Victims of Crime Assistance Professionalization Community Health Worker Model Standardization Training

5 HOSPITAL FUNDING: Funding Mechanism HVIP Outcome Funding Rationale

6 HOSPITAL FUNDING: Funding Mechanism HVIP Outcome Funding Rationale Prevent re-injury Reduces Uncompensated Care Trauma centers receive about 30% of charges for treating violent injuries Hospital directly funds program

Uncompensated Care Trauma centers receive about 30% of

7 HOSPITAL FUNDING: Funding Mechanism HVIP Outcome Funding Rationale Hospital directly funds program Prevent re-injury Coordination of follow-up care, prevent re-admissions Reduces Uncompensated Care Trauma centers receive about 30% of charges for treating violent injuries Community Benefit Requirement Under ACA, non-profit hospitals must annually conduct community needs assessment/ development implementation strategy

Trauma centers receive about 30% of charges for treating violent injuries Community Benefit Requirement

8 HOSPITAL FUNDING: Funding Mechanism HVIP Outcome Funding Rationale Hospital directly funds program Prevent re-injury Coordination of follow-up care, prevent re-admissions Enroll clients in Medicaid/VOCA (i.e., get hospitals paid) Reduces Uncompensated Care Trauma centers receive about 30% of charges for treating violent injuries Community Benefit Requirement Under ACA, non-profit hospitals must annually conduct community needs assessment/ develop implementation strategy Facilitates Hospital Reimbursement HVIP staff lighten workload of hospital billing staff and are successful with high risk pop.

charges for treating violent injuries Community Benefit Requirement Under ACA, non-profit hospitals must annually conduct community needs assessment/

9 MEDICAID REIMBURSEMENT: All U.S. citizens below 133% FPL will be Medicaid eligible under ACA (in states that accept expansion) Newly Eligible Violently Injured

10 MEDICAID REIMBURSEMENT: Funding Mechanism HVIP Outcome Funding Rationale Bill Under: I. Services already covered (e.g., case management) II. Services possibly covered (e.g., CHW) III. New service ( violence intervention specialist ) Prevent re-injury Coordination of follow-up care, prevent re-admissions Reduces Medicaid Spending 5 year violent re-injury rates as high as 45% Improves patient outcomes

New service ( violence intervention specialist ) Prevent re-injury Coordination of follow-up care,

11 VICTIMS OF CRIME ASSISTANCE: Funding Mechanism HVIP Outcome Funding Rationale HVIP workers paid as victims of crime advocates HVIPs reimbursed by VOCA for services provided Enroll clients in VOCA Facilitate participation in criminal proceedings VOCA Works as Intended Increases in VOCA enrollment Only 8% of victims of aggravated assault receive VOCA services (unchanged ) Reduction in VOCA disparities Proportion twice as high among women than men Young, racial/ethnic minority males most underrepresented Increases in victim participation in criminal proceedings

enrollment Only 8% of victims of aggravated assault receive VOCA services (unchanged 1993-2008) Reduction in VOCA disparities Proportion twice

12 RESEARCH GAPS: How much violence do HVIPs prevent? How does this translate into cost savings from different payer perspectives (e.g., hospitals, Medicaid, criminal justice)? What are HVIPs impacts on health care outcomes? Better coordination of injury care? Better injury outcomes? Better health outcomes? How much of a burden do HVIPs relieve from hospital billing staff? How much money do HVIPs bring in to hospitals through facilitating health insurance enrollment and reimbursement? What are HVIP impacts on VOCA outcomes? Application? Obtaining benefits? Participation in criminal proceedings?

How much of a burden do HVIPs relieve from hospital billing staff?

13 PROFESSIONALIZATION AS A MEANS TO HVIP SUSTAINABILITY Standardization Professionalization Sustainability

14 PROFESSIONALIZATION:

15 PROFESSIONALIZATION: Professionalization is the social process by which any trade or occupation transforms itself into a true profession E.g., medicine (19 th -20 th century), medical specialties, community health workers Components of Professionalization: Specialized knowledge Shared commitments to a service ideal Exclusive jurisdiction Means to Achieving Professionalization: Professional schools Professional associations Professional licensing and accreditation systems

, medicine (19 th -20 th century), medical specialties, community health workers Components of Professionalization:

16 PROFESSIONALIZATION: COMMUNITY HEALTH WORKERS (CHWS) Community Health Workers as Model/Opportunity:

17 PROFESSIONALIZATION: COMMUNITY HEALTH WORKERS (CHWS) Community Health Workers as Model/Opportunity: 1960s: CHWs start practicing across the U.S. to meet community needs

18 PROFESSIONALIZATION: COMMUNITY HEALTH WORKERS (CHWS) Community Health Workers as Model/Opportunity: 1960s: CHWs start practicing across the U.S. to meet community needs 1970s-1980s: Small public grants/philanthropic funding for CHW projects, research demonstrating outcomes

19 PROFESSIONALIZATION: COMMUNITY HEALTH WORKERS (CHWS) Community Health Workers as Model/Opportunity: 1960s: CHWs start practicing across the U.S. to meet community needs 1970s-1980s: Small public grants/philanthropic funding for CHW projects, research demonstrating outcomes 1990s: Standardization of training, bills introduced to support CHWs across states

to meet community needs 1970s-1980s: Small public grants/philanthropic funding for CHW

20 PROFESSIONALIZATION: COMMUNITY HEALTH WORKERS (CHWS) Community Health Workers as Model/Opportunity: 1960s: CHWs start practicing across the U.S. to meet community needs 1970s-1980s: Small public grants/philanthropic funding for CHW projects, research demonstrating outcomes 1990s: Standardization of training, bills introduced to support CHWs across states 2000s: States launch CHW worker certification programs (e.g., Texas, Ohio, Indiana)

to meet community needs 1970s-1980s: Small public grants/philanthropic funding for CHW projects, research

21 PROFESSIONALIZATION: COMMUNITY HEALTH WORKERS (CHWS) Community Health Workers as Model/Opportunity: 1960s: CHWs start practicing across the U.S. to meet community needs 1970s-1980s: Small public grants/philanthropic funding for CHW projects, research demonstrating outcomes 1990s: Standardization of training, bills introduced to support CHWs across states 2000s: States launch CHW worker certification programs (e.g., Texas, Ohio, Indiana) 2007: Definition of CHW added to Health Care Provider Taxonomy that can be used for fee-for-service claims States files Sec waivers to have CHW services reimbursed under Medicaid (e.g., Minnesota)

22 PROFESSIONALIZATION: Establish HVIP Frontline Staff as Community Health Workers Establish Violence Intervention Specialist as Unique Profession

23 PROFESSIONALIZATION: Health Care Provider Taxonomy Definition

24 PROFESSIONALIZATION: Health Care Provider Taxonomy Definition Propose that HVIP frontline staff are covered under this definition Propose new definition for violent intervention specialist

25 PROFESSIONALIZATION: ADVOCACY STRATEGY FOR NNHVIP Community Health Worker Pathway Join CHW advocacy movement Learn status of CHW payment initiatives in states Support front-line staff in CHW training/certification Violence Intervention Specialist Pathway Propose new VIS taxonomy definition Advocate for VIS services to be reimbursed Develop standardized training/certification program

26 STANDARDIZATION: Training: Online training that frontline staff of all programs across NNHVIP would complete as a condition of their membership in the Network NNHVIP would: Develop training Provide technical assistance Track completion Grant certificates

27 COMPONENTS OF STANDARDIZED TRAINING: Case management Traumainformed care What else? What else? Knowledge about public systems Cultural competence Research basics Best practices for working with clients What else?

28 NNHVIP POLICY WORKGROUP CALLS: 1 st Thursday of every month 4:00 Eastern Standard Time Next call: October 3 rd JPP46@drexel.edu

Medicaid Support for Community Prevention

Medicaid Support for Community Prevention ASTHO Million Hearts Peer Call April 4, 2014 Anne De Biasi Director of Policy Development About TFAH: Who We Are Trust for America s Health (TFAH) is a non-profit,