1. Building on the Experience… Montgomery County’s Unique Health Safety-Net Partnerships to Improve the Health of Vulnerable Populations 1 Leslie Graham, President & CEO, Primary Care Coalition Presented to: Interfaith Works Caregivers Conference Date: April 4, 2016

2. Montgomery County’s Unique Health Safety Net Montgomery County recognized importance of providing access to equitable health care for low-income residents before Affordable Care Act. Local providers form a safety-net that addresses the cultural and linguistic needs of the low income population; with ACA, almost all these providers now serve both insured and uninsured (with MC DHHS subsidizing care for the uninsured only). Highly collaborative in approach to improving population health. Significant public-private partnership; increasingly cross-sector. 2 MC DHHS invests in a portfolio of health care programs serving low income residents who are not eligible for any state or federal health care programs.

3. About the Primary Care Coalition (PCC) 3 What We Do: Foster and coordinate a high quality, efficient community-based health care system Strive for universal access and health equity for low-income community members Create models for improving the health of the population, through partnerships Administer partnerships that provide health care for low-income, uninsured, ethnically diverse county residents

4. PCC Programs… In Partnership Care for Kids MC DHHS, School Based Health and Wellness Centers, private pediatric practices, Kaiser Permanente, … Montgomery Cares –MC DHHS, foundations, 12 safety-net clinics, 6 hospitals, specialists, pharmaceutical prescription assistance programs, … Project Access: Specialty Care and Preventive Screenings (150+ specialists, mammography, colonoscopy) MedBank: Name brand prescription assistance Behavioral Health Project: integrated with primary care Capital Region Health Connector (ACA enrollment): MC DHHS and Prince George’s County HD, outreach organizations, … 4

5. Graph Care for Kids Population and Encounters Over Time 5

6. Graph Montgomery Cares Population and Encounters Over Time 6

7. Evolving and Re-Defining the Safety Net for the New Environment Health Insurance does not equate to access or quality, timely care The ACA extended health coverage to many people, but thousands remain uninsured Families may have a blend of insurance eligibility Individuals may change insurance status over time Many newly insured have limited health insurance literacy, and continue to face challenges in accessing culturally sensitive and high quality health services. 7 Program: Destination Health Health Insurance Literacy – 7 languages, text messaging campaign Partnership with ACA navigators, FQHC

8. Evolving and Re-Defining the Safety Net Changing demographics More than ¼ of MC seniors live below 300% of poverty level Growing number of school children receiving subsidized meals ½ of residents in poverty speak a language other than English at home Vulnerable defined by economic, and racial and ethnic characteristics rather than insurance status Health insurance and health care access is only one determinant of health outcomes Must improve connection between health and social service programs (food security, walkable communities, economic opportunity, affordable housing, …) 8

9. Evolving and Re-Defining the Safety Net Maryland hospitals incentivized to focus on population and community health: From volume to outcome From focus within hospital walls to health of their community’s population 9 Nexus Montgomery: A Shared Regional Partnership To reducing avoidable admissions, ED use, total cost of care; to improved health outcomes across the community population Community-based care coordination for seniors, medically frail, uninsured and those with severe mental illness Hospitals (6), subsidized Sr. housing, PCPs, skilled nursing facilities, care coordinators, services organizations, behavioral health providers, …

10. County government Core funding Dental Clinics, SBWHCs 4 Hospital Systems Core funding ( Nexus Montgomery ) Care transitions ( Medically Frail ) Community Benefit programs Specialty care procedures for uninsured ( in-kind support ) Obstetric Care ( Maternity Partnership ) Funding community Grants and donations Private Practices Pro-bono or reduced cost care Independent safety-net clinics Primary & preventive care Other clinical services ( including dental at some clinics ) Community Services Care coordination Behavioral health services Social determinants services Primary Care Coalition “Backbone” services ( collaborative facilitation, program infrastructure, funding admin, IT &analytics ) Systems design & process improvement Group purchasing ( meds, lab ) Client services/navigation (specialty care and Care for Kids) A Partnership Approach: Leveraging Community Resources to Meet Community Needs

11. Questions 11

12. Nexus Montgomery Interventions Nexus Montgomery is currently unfunded; however, a proposal has been submitted to HSCRC requesting funds to implement programs addressing four priorities. A new initiative to reduce the risk of hospitalization by identifying older adults at high risk for using hospital services and providing pre-emptive care management to keep them out of the hospital. Scaling up existing care transition programs at each of the six hospitals to ease the tension from hospital to home and reduce the risk of readmission for patients of all ages. Coordinating with community-based specialty care providers to meet the post- acute, ambulatory and specialty care needs of uninsured patients. Reducing frequent hospital use by individuals with severe mental illness by building service capacity to meet their needs. 12