Next Meeting – December 8, 2004



GOVERNOR’S COMMISSION ON COMMUNITY-BASED ALTERNATIVES

FOR INDIVIDUALS WITH DISABILITIES’

HEALTH CARE COMMITTEE MEETING MINUTES

July 17, 2015 – 10:00 AM

Felton-Farmington Room, DelDOT Administration Building, Dover, DE

PRESENT: Jerry Gallucci, MD, DHSS-Co-Chair; Eileen Sparling, CDS/UD-Co-Chair; Carol Barnett, DSAAPD-DHSS (via phone); Linda Brittingham, CCHS/Red Clay; Susan Campbell, Birth-to-Three Program/DHSS; Frances Russo-Avena, School Nurse-CCHS/Red Clay; Phyllis Guinivan, CDS/HDWD; Elisha Jenkins, DVI; Jae Chul Lee, CDS/U-D; Heidi Mizell, Autism Delaware; Karen McGloughlin, DPH; Greg McClure, DPH; Carol Morris, DHSS; Chris, Oakes, DSAAPD (via phone); Ann Phillips, Delaware Family Voices; Jill Rogers, DSAAPD; and Kyle Hodges, Staff.

Guest: Bevin Hileman, Wilmington University Student

CALL TO ORDER:

Eileen called the meeting to order at 10:05 am. Everyone introduced themselves.

APPROVAL OF THE DRAFT MINUTES:

A motion was made, seconded and approved to accept the June 19, 2015 as submitted.

ADDITIONS OR DELETIONS TO THE AGENDA

• Funding Source – Dr. McClure

• Video Conferencing Possibilities – Kyle Hodges

BUSINESS

DHSS Inclusion Policy

Eileen asked how many were planning to attend the celebration tomorrow. She added that Secretary Landgraf has drafted a policy around inclusion which will be announced tomorrow. This policy will help with the implementation of the Health Equity Plan. Eileen spoke about the following elements of the policy:

1. Contracting (DHSS has 1,500+ contracts in a year).

2. Planning Committees and Councils (DHSS’s commitment to make sure that vulnerable populations, including people with disabilities, are represented).

3. Program access and how the Department provides accommodations.

4. Data and Surveillance (capturing disability status and reporting in the programs).

Eileen stated that this will put disability and access on the radar for a lot of people involved in health care. She stated that our challenge is delivering tools to these folks. Kyle commented that the contracting piece is huge piece that will address problematic issues when providers are not providing physical or program access. Ann added that many councils and committees do not provide accommodations for persons with disabilities. Eileen stated that the potential impact is significant, and there is much work to be done to have this operationalized and provide support both for staff and contractors. Dr. Gallucci commented that some of the training will be done by DMS (Division of Management Services), and we need to look at how we can engage them in developing training. Eileen said that CDS has been focused on how to assist with training and technical assistance. She said that one of the issues is where the entry point is for technical assistance. She added that we have some of the resources in place. Eileen commented that New York did the contracting part in their policy. Their Disability & Health Grant sits within their Health Department and is the point of contact for contracting. Eileen spoke about the checklist used by the contract monitoring people. She added that New York can offer some guidance on how the contracting piece works.

Update on Committee Role (Alignment with HDWD Advisory Council)

Eileen spoke about this Committee monitoring the Health Equity Plan and the HDWD Advisory Council’s role of monitoring the CDC Grant. The HDWD group met and was comfortable with the two groups aligning. Eileen is awaiting confirmation from CDC to formalize this alignment, but does not foresee any issues.

Health Equity Plan Implementation

Eileen referred to 7/25/15 New Journal Delaware Voice article (written by Rita Landgraf and Eileen Sparling): Achieving health equity is the state’s next goal (handout). Eileen commented about the importance of coinciding with the 25th ADA Celebration. She added that she has gotten a lot of positive feedback and the importance of getting the word out. Eileen will send a link to the article if anyone wanted to share with partners. Karen commented about the importance of doing more of this type of communication to get the word out to those who do not attend meetings and promote the good work being accomplished.

Timeline

Eileen stated that three work groups recently met. They are: Access & At-Risk (combined), Inclusive Health Promotion, and Data & Surveillance. Emergency Preparedness will be meeting soon. All of the objectives from the Health Equity Plan have been sorted by work groups. The plan is that each work group will take their subsets and “fill in the blanks” regarding resources and partners, lead agency, identify if there is a legislative issue or fiscal impact that needs to be noted. Once this happens, priorities needs to be set in terms of years moving forward. Eileen said that she hopes by the end of this year we will have compiled the work and activity, have a completed plan. She thinks in January we can go back to the Commission with this update. The shift from planning to implementation was discussed in the work groups; they also discussed who should be included. Jae Chul will share the list developed by the Data & Surveillance work group of those who should be included. He added that they are trying to work with electronic health records and Department of Education. Eileen commented that they received funding through the ACCEL grant in collaboration with Christiana Care and Nemours. Eileen noted that no accommodations have been provided in the schools when administering the Youth Tobacco Survey. She is working with Liz Dubravcic from Division of Public Health and Steve Martin from the Center for Drug and Health Studies on an accommodation protocol that would expand participation. If this is made more inclusive, the findings will inform and make the programming more inclusive. Jill commented that another source of data is the Claims Data through the payors. She added that if this group would be supportive of a position on availability of utilization and claims data, it would be helpful to this Committee, the Cancer group and the SIM work, along with the clinical data.

Eileen spoke about a recent Health Care Innovation meeting she attended. There was a presentation on TAG and piloting a scorecard. Eileen suggested that it would be beneficial if disability status was on the scorecard in the demographic variables. Jill explained that the test phase is already set, but there will be different versions before it is live and there will be ongoing changes over time as quality measures change. Eileen stated that getting disability status and capturing it is at the core of the data and surveillance’s work. Jill spoke about proxies and looking at a combination of existing data fields and say that this equals disability. Jae Chul spoke about the claims data and issues about accessing dental and long term care facilities data in Medicaid. He plans to have further discussion with DMMA. Jill commented that she anticipates getting Delaware’s Medicare claims data. Jill will assist Jae Chul with getting CMS data. Eileen added that the work Jae Chul is doing with the Medicaid data with the Consortium of other states looking at disability utilization would be helpful to do that same kind of analysis. Jill noted that SIM’s states have an accelerated path to CMS claims data.

Updates from Work Groups

Data & Surveillance – Jae Chul commented that this is a small but dedicated work group. They have clear ideas on what they want to do and reaching out to potential partners. He will staff the committee and a Chairperson will be identified soon. They are working out meeting frequency.

Inclusive Health Promotion – Eileen commented that this work group met and discussed organization of the work group. Terri and Heidi are the Co-Chairs. Heidi said the model they will be working on had been previously discussed.

Access to Health Care Services - Dr. Smalls is interested in playing a role in this work group. Karen will serve as Co-Chair. Bhavana will be staffing this work group.

Inclusive Emergency Preparedness and Response - Tim Cooper will serve in a leadership role. Phyllis commented that there is a good cross-section of people in this work group, including Emergency Managers from all three counties. She added that Tim had invited people with disabilities to participate in a point of distribution exercise, which provided much insight in terms of what was needed. There will be training for those who work on these exercises. They are currently working on dates to meet. Dr. Gallucci spoke about including persons with disabilities in the planning for large events that are not weather related or natural disasters, for example, Firefly and Big Barrel. Phyllis noted that it has been discussed by the Kent County Emergency Planner. Karen spoke about her experience at Firefly and dealing with the bad weather conditions. Eileen stated that the goal of this work is that disability is integrated into the planning from the beginning.

SIM Collaboration

Jill commented that she wants to make sure that these two groups stay connected. She stated that all the things discussed at the April meeting are moving ahead in a meaningful way. She stated that RFPs are out on the Practice Transformation Support that primary providers will receive. She added that the new policy is a tangible way to include disability access issues because these contracts will come through the DHSS contracts process. Jill stated that the Healthy Neighborhoods are beginning to take shape. She added that it will be important for this Committee to inform and move this forward. One of the things is to make sure that the aging and disability lens is brought to bear in each one of the Healthy Neighborhoods when it comes together. DSAPPD will be deploying a nurse and case manager in each healthy neighborhood (there are 50 nurses and case managers statewide). She sees that as an efficient use of resources and a good way to support and connection to the Healthy Neighborhood. The 8-12 nurses and case managers will be there to help the Healthy Neighborhood evolve. Jill offered to be the connector in these groups. Ann commented that she appreciates the aging and disability perspective, but stated that there needs to be disability looking at children also. Jill commented that she does not think this is necessarily missing. She explained that there will be four priority areas of focus in each neighborhood from which they can choose. One is Maternal & Child Health. She stated that if we crosswalk Maternal & Child Health and the Aging & Disability, it would be there and we will need to make sure that lies there. Jill noted that each Neighborhood will choose what element is most relevant to their neighborhood. Jill noted that it is important to stay involved and included. Phyllis asked if there are any areas that are essential and need to be addressed. She asked why children or aging & disability would be optional and that it should be considered essential. Jill commented that is important feedback that she will send back to the Healthy Neighborhoods. Jill encouraged everyone to be part of the conversations. Jae Chul commented that it is important for us to make sure that disability counts. Ann commented that the new policy will help with this. Comment was made about including multi-dimensional whole family dimension. Eileen commented that dedicating the resources is great, but that Ann’s point about children need to be part of the discussion and noticed that it has been missing in the Committee meetings in which she has participated. She noticed that they are not completely missing but the focus is clearly adults with chronic disease. She spoke about ADRC as a good resource and how to get Family Shade and Family Voices as the children’s counterpart to ADRC in terms of connecting families with resources and specialized services. She added that how to tie-in pediatric resources as the companion to ADRC. Jill commented that is what is needed as we are in this creation to say what is important and what do we want it to look like. Eileen said that if Family Shade and ADRC shared the same data base, it is the same kind of services in theory. Eileen added that inserting that resource in the Neighborhood is ideal, but needs to go across the lifespan.

Eileen asked about the staffing for the Healthy Neighborhoods. Jill responded that the Delaware Center for Health Innovation is its own 5013(c). Matt Swanson is the Chair of the Board and will have their own dedicated staff. She said they are in the recruitment phase for an Executive Director. Once that person is on board, they will be hiring Healthy Neighborhood Managers and other staff to support clinical areas and the work force, etc. Currently, there is contracted staff support, but the plan is build, operate and transfer. Also, some different agencies will bring support around community organizing. The exact shape and dimensions will be determined. The model is being tested, along with outcomes and the explicit connection to health care delivery system. Eileen commented that one of the critical decisions is the size of the Neighborhood. She added that one of the Neighborhoods had 200,000, which seems larger than a neighborhood. In terms of pulling the community together, there probably is a sweet spot; big enough to make an impact, but not be unmanageable. Jill added not we do not want it so small to supplant some of the excellent community-level/neighborhood-level work already going on. Jill spoke about an example of this and how it would work with the DCHI Healthy Neighborhood and gain better data. She added that there needs to be a real balance.

Jae Chul spoke about meeting the triple aim in Healthy Neighborhoods and how to address the super utilizers. Jill commented that solving the super utilizer problem as an individual problem may not be as efficient as building a system and checking in with the super utilizer population to see if this system is working out as it should. She added that if we are delivering more coordinated care in the setting and if it is explicitly connected to our Healthy Neighborhoods, if our medical and ancillary staff are practicing as a team and working across disciplines, if our payment models are supporting all the changes, if we are exchanging health information the way we should, then the super utilizer population should look different, for example, fewer Emergency Department visits. The super utilizers will measure for us if the changes are working. She noted that if we look at them as individual problems and have a specific intervention, we miss the whole system change. Ann asked if dual eligibles are included in super utilizers. Jill spoke about providers identifying the top five percent of their high-risk populations in their primary care practice, she would say so. Jill added that the term super utilizers is a function of cost and utilization, but does not speak to the larger system change. She stated that if someone is connecting with their community, they will no longer be a super utilizer. Dr. Gallucci stated that when we looked at the disability data and looked at addictions and behavioral health, there are some issues with the demographics and health conditions that add to the super utilizer broader definition. He added that this is not necessarily only a systems issue that is intrinsic to these conditions. He also stated that it could be said that if the system supports the individual properly, and the system does influence the super utilizer. He said that there is also a degree that the condition is contributing to the super utilizer. Jill commented that some people will use the health care system more because they need it more and conditions require more interactions. Those should be reduced to some extent with the highest quality care. Ann spoke about dual eligibles being without coordination between Medicare and Medicaid and end up falling through the cracks and getting needed care; she added that they are one of the small groups, but most expensive. She said this will continue if this is not addressed and coordinated because they do not get things they should have because they do not know how to get them.

Eileen asked about identifying high risk patients. She added that in the Health Care Innovation work, that is the first step in the model. She asked if the innovation work identified this and a profile of how this would be. She also asked if there will be direction on the system level or is that left to individual practices. Eileen sees this as an opportunity for us to contribute to that discussion and share some of our work in terms of disparity. She added that we need to figure out where that conversation will happen. Jill commented that high-risk patients are those with mental or medical disabilities and there is a wide variety of reasons why they come back, from lack of support, etc. Jill added that it runs the gamut. Ann commented that she hears from families and understands where they are coming from. Jill stated that if this is designed correctly, we will put together a clinical system and a supportive system outside that meets the needs of the most complex problems. Jill stated that she wants to keep these two groups connected. Kyle commented that everyone is interested in what is going on with the Delaware State Innovation Models (SIM) Initiative Health Innovation. Eileen commented that that timing is good and there is a lot of alignment and the challenge of that. Comment was made about the importance of common language because otherwise something will be missed. Eileen added that a glossary had been created for the Healthy Equity Plan because meanings are different for different people; this came out of the Patient & Consumer Advisory Committee. Jae Chul spoke about the super utilizer are consuming the health care costs and other resources. They most likely are people with complex health care needs. These are people with disabilities who have several chronic conditions. Although one percent (1%) of the population, they consume most of the health care expenditures. He said we need to discuss how to identify and profile on an individual level on a clinical level.

Dr. McClure spoke about getting oral health initiatives into these committees to work on. He commented that practically anything can be applied to oral health. He spoke of a study that Christiana Care did last year and the number of ER visits due to dental care. DPH’s epidemiologist estimates over 9,000 visits to the ER annually for dental problems. There is a lot of coordination of care, etc. they hope will be included in the overall SIM. Jill commented that the scorecard is the first step of the testing phase. She said that the clinical group felt the importance of including a behavioral health and oral health component on the scorecard. She sees what we are all individually and collectively doing that connects to this, including SIM and DCHI. Jill said that she asks her organization (DSAAPD) how we are going to execute this to support and align with the transformation. She said we all have this opportunity. We need to ask how we will align with this to support the transformation. Part of the testing is to see if an organization, for example, DCHI can be a place where we come together and build a consensus across all our organizations and say this is what is important to Delaware. Then we go back and execute at our own organizational levels so we are as active participants as when we are at DCHI.

Eileen agreed and spoke about the challenge of getting the community partners engaged. She had a suggestion about public participation in the process. She spoke about one of the inconsistencies amongst the work groups is the opportunity for the public (who are not part of the committee) to comment or ask questions. She added that some groups are open for comment and others are not. She said that their feedback could be informative. Eileen also spoke about the lack of availability of the Committee documents on the Health Care Commission website. Jill responded the DHCI Board gives their thinking and position on the issues. Eileen gave an example of a Committee document that would be informative—the slides from decks of the Committee meetings. Jill will take this suggestion back. Phyllis suggested that if there is not enough time to comment during the meeting that there is a mechanism for comment on the website. She added that the public does not have a real opportunity to comment. Jill responded that there is an explicit asking at the Board level and posting of the materials at the Board level. She added that no Board level decisions are made without discussion and feedback. Jill encouraged this involvement, but will take the suggestion regarding the Committees back. Ann added that this is a good way to start educating people now, so they are aware of what is happening and have a chance of buy-in. Eileen asked if it is an open collaborative process or not; she said if that is what we are shooting for, then let’s practice. Jill commented that the Board level is the place where the work comes together because the vastness of the work. Eileen thanked Jill for the update.

ADA 25th Anniversary Celebration

Kyle spoke about the ADA 25th Anniversary Celebration on Saturday, July 25, 2015, from 11 am – 5 pm. There will be a parade, with over 35 organizations involved. There will be events at Legislative Mall, with presentations by Dover Mayor Christensen. Daniese McMullin-Powell, John McNeal and Emmanuel Jenkins will speak about the Past, Present & Future. Other speakers are: Secretary Landgraf, Tony Coelho (one of the authors of the ADA legislation), Representative Heffernan and several other legislators. Secretary Cohan and Vice President Biden are speaking via video. The Disability Museum on Wheels will be there. The first 500 attendees will receive a commemorative t-shirt (near the Townsend Building). Kyle passed around a map of the events. He said there will be a tent set up near Legislative Hall, with vendors and bands. DelDOT has provided mobi-mats and helped organize the day, along with DHSS. Karen added that transportation will be provided with a drop-off/pick-off point by the Dover Public Library. Kyle said there are designated parking lots and side street parking. Ann asked if there is a contingency plan for rain. Kyle stated that a large tent will be set up near Legislative Hall. Kyle asked Committee members to spread the word. He stated that the DDC and their staff and GACEC and their staff have done a lot of the planning. Dr. McClure asked if Special Olympics were involved in the planning. Kyle said they were not part of the planning process, but they may have an exhibit at the event. He said that four DelDOT buses have ADA 25th Anniversary wraps on them; also information is displayed at the bus stops.

OTHER BUSINESS

Funding Source

Dr. McClure spoke about one of the overriding goals in oral health has been has been to have oral health be woven into the fabric of other health programs. He gave an example of Home Visiting programs to include oral health, along with chronic diseases. He said that recently DPH was awarded an Oral Health Workforce Activities grant from HRSA. It is specifically designed to increase the activities of the oral health workforce for improving oral health in the state. Dr. McClure explained that workforce is not just dentists and dental hygienists; it includes non-traditional providers such as physicians, nurses and physicians assistants. The grant is developed to develop innovative ideas. The amount of the grant is $1.45 million over three years and 40% of that will go to increasing the activities relating to providing people with disabilities more access to care. Dr. McClure is collaborating with UD-CDS. He explained that part of this is intended to change the culture among the dental professionals. He added that dental professionals do not receive a lot of training in how to treat persons with disabilities. They want to increase the number of dentists who can provide training in a regular dental office. They estimate that 80% of the people with complex medical needs can be treated in a dental office, but there has to be a change of culture amongst dentists and the community. They will provide direct training opportunities for dentists in Year 2 and 3. They may have training at Wilmington Hospital in conjunction with their residency program. Trainers may be brought in. He has spoken to Dr. Gallucci about using the facilities at our clinics. Dr. McClure hopes this will spawn indirect effects, for example, awareness about the importance of oral health. He stated that legislation for funding for oral health for adults on Medicaid did not make it this year and said that maybe it can be taken up by SIM. He hopes this will create more opportunities than those in the grant. The grant will integrate oral health into primary care practice through funds set aside in community centers. There are also funds available to increase activities in schools with outreach, etc. Dr. McClure plans to bring key players together to create a consortium to become directly involved and start making plans.

Dr. McClure announced that the Oral Health Coalition will have its Annual Meeting on September 18 at Dover Downs. Flyers will be sent out soon. Interested people are encouraged to attend and become part of this group. They are also looking for one Chair for the Partners & Collaboration group to work within the state to bring in various partners. Jill encouraged Dr. McClure to reach out to Dr. Alan Greenglass and Dr. Nancy Fan, who are Co-Chairs of the Clinical group regarding integrating oral health with primary care providers. Dr. McClure will provide information cards on oral health for distribution.

Video Conferencing Possibilities

Kyle spoke about video conferencing possibilities at the meetings. He said that video-conferencing is currently not available at the DelDOT Felton-Farmington Room. Comment was made that the Child Development Watch Office in Milford has video-conferencing capability. Eileen commented she recently used video-conferencing at the Star Campus with mixed success. He will check into other possibilities and locations, but said that the two systems must be compatible to work. Carol spoke about some internet options.

ANNOUNCEMENTS

Carol announced that H.B. 69 was signed by the Governor on July 7, 2015. This legislation mandates private insurance reimbursement for services delivered using telehealth. It also drops language into practice acts for various health care professions including physicians, speech therapy, dentistry, etc. to allow language for the use of telemedicine and technologies for delivery of care and the equity in reimbursement for those services from private insurance.

Carol also spoke about a conference in October 20th, in partnership with the University of Delaware’s Continuing & Professional Studies, DHSS and Delaware Health Care Coalition. This will be an institutional conference for the provider community across disciplines on telehealth. Carol will forward the flyer to Kyle for distribution.

ADJOURNMENT

The meeting adjourned at 11:59 am. The next meeting will be held on Friday, August 21, 2015, at CDS, Room 132A, in Newark.

Respectively submitted,

Jo Singles

Administrative Specialist

ExecOrder50hcmin 7-17-15

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