Medical-Legal Partnership 101: An Introduction to the Benefits of Integrated Care

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1 Medical-Legal Partnership 101: An Introduction to the Benefits of Integrated Care The problems are visible. The solutions are not. Sharena Hagins, MPH, CHES Senior Research Assistant National Center for Medical-Legal Partnership Erin Loubier, JD Senior Director for Health and Legal Integration and Payment Innovation Whitman-Walker Health

Sharena Hagins, MPH, CHES Senior Research Assistant National Center for

2 Agenda MLP Approach and Civil Legal Aid Landscape Connection Between Legal Problems and Health Problems MLP and Health Centers Presenter Name Whitman-Walker Health Overview Presenter Title Integration of MLP at Whitman-Walker Health Date Sustainability: Funding and Making the Business Case

Whitman-Walker Health Overview Presenter Title Integration of MLP at

3 What is a Medical-Legal Partnership? Health care and civil legal aid communities are both focused on addressing health-harming social conditions Medical-legal partnership (MLP) Presenter Name unites these two communities under a common Presenter mission Title to address and prevent Date healthharming social conditions for patients and for communities

health-harming social conditions Medical-legal partnership (MLP) Presenter Name unites

4 There isn t enough in the legal aid pharmacy without changing how legal care is provided. 8,000 civil legal aid attorneys in U.S. with a $1.3 billion budget & help from law schools & pro bono partners try to serve 50 million lowincome people with 2-3 needs. They are able to meet less than 20% of the need each year, and unfair, unhealthy systems go unchanged.

3 billion budget & help from law schools & pro bono partners try to serve 50 million

5 National leader Healthcare equivalent Scope Funding Case priorities Unpacking Civil Legal Services Federally-Funded Legal Services* Legal Services Corporation (LSC) Federally Qualified Health Center (FQHC) 134 organizations 4,000 attorneys $375 million (federal) Focus on basic needs: housing, income, safety State & Locally- Funded Legal Services* National Legal Aid & Defender Assoc. (NLADA) Look-alike Community Health Center 800+ civil legal services offices Private Pro Bono Resources American Bar Association (ABA) Free Clinic (staffed by volunteers) 900+ pro bono programs Academia: Law School Clinics Association of American Law Schools (AALS) Medical student rotation 200+ law school clinics $600 million (est.) $180 million (est.) $75 million (est.) Focus on basic needs, but often w/ broader range, greater focus on policy Vary widely Vary widely *significant overlap

(NLADA) Look-alike Community Health Center 800+ civil legal services offices Private Pro Bono Resources American Bar Association (ABA) Free Clinic (staffed by volunteers) 900+ pro bono programs

6 The Medical-Legal Partnership Approach Individual patient legal interventions are pathways to finding the policy interventions for improving population health.

7 Making the connection: Legal problems are health problems. Common Legal Problem Social Determinant of Health Families wrongfully denied food supports or housing subsidies Presenter Name Presenter Title Children living in housing with mold or rodents, in violation of housing laws Date Seniors wrongfully denied long-term care coverage Lack of basic resources Physical environment Lack of access to insurance

subsidies Presenter Name Presenter Title Children living in housing with mold or rodents, in

8 MLPs help patients with I-HELP issues

9 How Medical-Legal Partnership Helps Health Centers Meet Their Mission Ensuring the medical home care team includes an expert in the social determinants of health Enhancing the quality of care Ensuring maximum revenue for health centers Empowering patients to participate in their care Clip available at:

Enhancing the quality of care Ensuring maximum revenue for health centers Empowering

10 National Center for Medical-Legal Partnership = National Cooperative Agreement Helps CHCs develop and sustain medical-legal partnerships with health center specific: Toolkits Webinars / Trainings Research and Evidence

partnerships with health center specific: Toolkits Webinars /

11 Enabling Services Non-medical services intended to meet the primary care needs of patients Case Management Referrals Translation/Interpretation Transportation Eligibility Assistance Health Education Environmental Health Risk Reduction Health Literacy Outreach Legal Aid/Legal Services

Translation/Interpretation Transportation Eligibility Assistance

13 How to Develop an MLP

14 Benefits of Integrated Approach Most health center patients qualify for public civil legal aid services MLPs offer real solutions to patients civil legal problems Health professionals address problems outside of the clinical encounter The MLP approach is consistent with the health center focus

civil legal problems Health professionals address problems outside of the

15 Whitman-Walker Health th Street, NW th Street, NW Community health center serving Washington, DC s diverse urban community, through integrated services with expertise in HIV care, LGBT health, and individuals facing barriers to care. 651 Pennsylvania Ave., SE 2301 Martin Luther King Jr. Ave., SE

integrated services with expertise in HIV care, LGBT health, and individuals

16 Whitman-Walker Health Our Journey AIDS Service Organization Community Health Center and the Role of Legal Services / MLP

17 Our Journey ASO to CHC Our Early Years as DC s Gay/Lesbian Community Center Gay Men s VD Clinic began in operates as volunteer program housed in Georgetown Lutheran Church Separate peer support/coming out programs for gay men and lesbians Incorporated Whitman-Walker Clinic, Inc. in 1978 as affirming health center for DC s gay and lesbian community Pre-AIDS epidemic Organizational Model: DC s gay and lesbian community center Patients/clients from DC s gay/lesbian social networks Volunteer-driven governance and program delivery Funding from private donors

AIDS Epidemic Before Effective ARVs 1983-1996 Our Emergence as DC s First Responder and Community Leader in Fighting AIDS Hire 1 st legal director / beginning of MLP Organizational Model: DC s first

18 AIDS Epidemic Before Effective ARVs Our Emergence as DC s First Responder and Community Leader in Fighting AIDS Hire 1 st legal director / beginning of MLP Organizational Model: DC s first responder and community leader helping persons with AIDS die with dignity legal services a key component Volunteer governance based on membership model Mixed staffing plan with both employees and volunteers delivering direct services Funding from private donations and DC government grants

persons with AIDS die with dignity legal services a key component Volunteer governance based on membership model Mixed

19 AIDS Epidemic After Availability of Effective ARVs Our Evolution as an AIDS Service Organization Federal Ryan White funding led to major expansion at WWC in mid/late 1990s Patients/clients living longer due to ARVs Service model more complex as WWC provides a host of health and supportive services including legal services, food bank, housing as well as operates 4 clinics in DC, suburban MD, and Northern VA Financial difficulties post-9/11 culminating in major financial crisis in 2005

complex as WWC provides a host of health and supportive services including legal services, food bank, housing as well as

20 Transition from ASO to Community Health Center Our Business Model Transition from ASO to FQHC BOD votes to become a federally-qualified health center in 2005 to seek improved Medicaid reimbursement and other financial benefits Primary care infrastructure from Washington Free Clinic helps secure FQHC-LA status in 2007 Major financial challenges in lead to 2 restructurings including employee layoffs and program closings MLP critical to success as a health center why? how?

care infrastructure from Washington Free Clinic helps secure FQHC-LA status in 2007 Major financial challenges in 2007-2008

21 Transition from ASO to Community Health Center Organizational Model: Community health center with designation as FQHC-LA Patients living with HIV as well as those without HIV who seek primary care services Professional workforce with limited volunteering opportunities Funding from patient care revenues (including pharmacy), federal grants and private donations

22 Why MLP mattered? WWH s MLP is the oldest in the U.S. Early AIDS epidemic few medical solutions meant other services were more important including legal interventions. What protected Legal Services? Insurance navigation services Professionalism and deep relationships with law firms and others Expertise in health insurance and public benefits Relationships with governmental agencies Advocacy

23 Changes in How We Practice Integrating for Success Our public benefits and health insurance expertise are critical to WWH s financial future Transition from a volunteer / staff model to professional staff model and transition from silos to integrated teams Lawyers involved in health center operations and leadership Lawyers changed the way we think and talk about our work: from justice to enabling health or access to health

24 Strategies for Improving Health Our specialty populations HIV + LGBT + people facing face social, legal, and economic barriers that call for legal interventions Lawyers help make people better patients Payment reform and value based options will require integrated care to improve outcomes and reduce costs MLPs where integration is across all care opportunities are going to be key Mirroring health care care is provided by specialists Leadership integration Senior Director for Health and Legal Integration

25 MLP Innovations in Service Delivery Red carpet* Name and Gender Change Legal Clinics* Public Benefits and Insurance Navigation services* Social Security Disability Clinics Medicare Part D Clinics Healthcare Power of Attorney Clinics *Highlighting these innovations in our panel.

26 Considerations for Integration and Sustainability Financial investment to support MLP Making the business case

28 Sources of MLP Program Funding 75 programs reported $15.7 million in funding 26 % 23 % 7% 19 % 25 % Healthcare (Institutions, Community benefits, health foundation, Insurance) Legal (Legal aid, Law schools, Law firms, Bar grants) Gov't (State & Federal) Philanthropy Other *Data from the 2012 MLP Network Site Survey

29 Pressing Issues Justifying the financial investment and using data to estimate and document value of the MLP to the health outcomes Prioritization of values for cost effectiveness Role of MLP in value based health care payment reform Client fees for legal services Engagement tool or barrier to care?

30 For more information: NCMLP Presenter Name National_MLP Presenter Title Date

31 Panelist Contact Information Sharena Hagins, MPH, CHES Senior Research Assistant National Center for Medical-Legal Partnership Erin Loubier, JD Senior Director for Health and Legal Integration and Payment Innovation Whitman-Walker Health

New Hampshire. Resource List

New Hampshire. Resource List New Hampshire Resource List December 2014 Contents CIVIL RIGHTS 1 GENERAL LEGAL SERVICES 1 GENERAL HUMAN SERVICES 3 HIV/AIDS 3 OTHER HEALTH/DISABILITY 4 DOMESTIC VIOLENCE/SEXUAL ASSAULT 5 YOUTH/SCHOOLS