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

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

2

3 Symptom or innovative disruption?

4 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:

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

6 Institute for Healthcare Improvement Better health care experience Triple Aim Lower cost Improved outcomes for population

7 Shifts in Health Care OUT Volume Quantity Units Carve out/silos Lone rangers Individual Clinic IN Value Quality Outcomes Integration Multidisciplinary teams Population Community

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

9 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

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

11 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

12 But is it enough? And where are children?

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

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

15 Integrated Health Neighborhood Primary Care Learning Supports Support Safety Empowerment Connected Engagement Competencies Esteem Behavioral Health Public Health

16 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

17 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

18 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.

19

20 There are currently no measures in the inventory meeting your specifications.

21 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.

22 Resources National Council for Community Behavioral Healthcare Partnering with Health Homes and ACOs Behavioral Health/Primary Care Integration and the Person-Centered Healthcare Home Improving the Quality of Health Care for Mental and Substance-Use Conditions, IOM Integrated primary care: the future of medical and mental health collaboration, A. Blount, editor

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

24 NASBHC = SCHOOL-BASED HEALTH ALLIANCE

25 My contact info:

Recommended Component: Provide a Full-Time Registered School Nurse All Day, Every Day, for Each School

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