November 1718 2006 Health Care Access Legislators as active partners in promoting local health care innovation ltPICOTITLEHealth Care Access Legislators as active partners in promoting local health care innovation ID: 616772
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Hot Issues in Health Care Legislative Conference
November 17-18, 2006
Health Care Access
Legislators as active partners in promoting local health care innovation
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The diversity of Colorado’s communitiesSlide3
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Overview
The role of community innovation
What is the community safety net?
Legislators’ role in community innovation
Regulate
Appropriate
Facilitate
Lessons learnedSlide4
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The content of this presentation…
Is based on interviews with community innovators around Colorado
Focuses on the health care safety net
Highlights case studies in which communities have successfully collaborated with state lawmakers to create access to care solutionsSlide5
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Promoting access to care:
The role of community innovation
Three entry points into health care system: Employer-sponsored health insurance, public health care coverage and
community safety net systems
Coverage vs. direct access to care: Complementary or alternative strategies?
Access to health care is more than a health insurance card – it is health care that is available, accessible, accommodating, affordable, acceptable and culturally appropriateSlide6
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What is a community safety net?
Private and public entities collaborating to provide medical, dental and mental health care to medically underserved individuals, including (but not limited to):
Private doctors
Faith-based, nonprofit clinics
Local health departments
Rural health clinics
Community health centers
Community mental health centers
Hospital emergency departments
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What makes communities ideal innovators?
Natural laboratories for testing new ideas
Immediacy of the problem: Friends and neighbors facing barriers to medical, dental and mental health care access
Closer to the problem, clearer vision for practical solutions
Willing to try new ideas
Sustainable partnerships more likely when community members collaborate to solve shared problemsSlide8
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The role of legislators as catalysts of community innovation
Legislators…
–
P
romulgate rules and regulations
–
Appropriate state and special funds
– Facilitate local innovation through partnerships with local policymakers and community leaders
– A
re the ultimate policy connectors to the communitySlide9
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Mediating the regulatory environment…
Legislators are positioned to be arbiters of federal, state and local regulations
Regulations can serve as barriers to community innovationKnowledge of community variation is key to avoiding unintended consequencesSlide10
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Mediating the regulatory environment…
State-local partnership providing regulatory relief for community innovation:
Health District of Northern Larimer CountySlide11
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An example of mediating the regulatory environment
Health District of Northern Larimer County:
More expensive to provide substance abuse treatment in hospitalsAntiquated regulationWorked with state agencies and key legislators
Regulation was fixed to allow co-location of mental illness treatment and substance abuse treatment within acute treatment centersSlide12
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Rules and regulations that work
Effective
regulations are those that…
Remove barriers to local implementation while guaranteeing health and safety
Create incentives for innovation
Enable creative problem-solving
Respect variations that exist among communities (e.g., rural and urban)
Provide flexibility to accommodate local customs and norms
Allow collaboration across jurisdictional boundariesSlide13
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Appropriations to increase access
Amendment 35: From voter initiative to release of first round of primary care funds
Voter-approved initiative
Enabling legislation to set parameters for release of Primary Care Fund
Rule-making to establish criteria for eligibility for fundingSlide14Slide15
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Matching appropriations to local needs
Legislators can often leverage federal funding to match with state and local funds (federal/state/local funding partnership)
Monitoring return on investment outcomes
Although 80% of Colorado’s population lives in a metro area, some of the greatest access challenges occur in rural communitiesSlide16
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Facilitating policy innovation
A prospective example of legislators facilitating state-local policy innovation
Diffusion of health information technology through state-local partnerships: The case of the Colorado Regional Health Information Organization (CORHIO)Slide17
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Bridging the state-local
partnership gap
Federal
State
Local
Level of Government
Community Innovation
Facilitated by:
O
pen communication
Collaborative strategies
Engagement of key partnersSlide18
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Maximizing innovation…
Ensuring that political ideology does not trump community interests
Building creative partnerships of individuals and organizations that collaborate to fill the access gap
Being data-driven and evidence-based
Ensuring maximum community participation across community sectors
Maintaining ongoing and strong relationships with state policymakers
Being active listenersSlide19
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Lessons learned from successful state-local partnerships
Policymakers blend the interests of their communities with the interests of the state as a whole
Creative thinking, flexibility and mutual commitment are necessary ingredients for innovation and policy development at the community levelSlide20
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Now for the experts…
Sue Birch, Northwest CO Visiting Nurse Association
Dace Carver Kramer, Northwest CO Visiting Nurse AssociationMark Wallace, MD, North CO Health Alliance