Mega-Projects and Policy Reform
2017 Central California Alliance for Health Mega-Projects
Since 1996, the Central California Alliance for Health (the Alliance) has worked to “improve access to health care for lower income residents who often lacked a primary care ‘medical home’ and so relied on emergency rooms for basic services.” To continue to fulfill this mission and to address its 28,000 new members since Affordable Care Act (ACA) expansion in 2014 in Santa Cruz County alone, the Alliance is taking on three mega-projects for 2017. Alan McKay, CEO of the Alliance, presented these projects at HIP Council.
The first project is the Whole Child Model with the goal of uniting the county’s California Children’s Services (CCS) and Medi-Cal services in a “one touch,” integrated program. This model will provide a single system of care for children with serious illnesses (of which there are approximately 6,000) that will unite utilization management and payment process for these children from primary care provided by the Alliance and CCS benefits for specialty care.
The second project involves an Alternate Payment Method (APM) pilot program to ultimately allow Federally Qualified Health Centers (FQHCs) to have a more “flexible use of workforce” to stress a value-based model of health care. This payment reform project will provide FQHCs across three counties with clinic-specific capitated rates of funding, in which, each clinic is payed a specific rate per enrolled patient assigned to them, whether or not they seek care.
The last mega-project is centered around the building and funding of Health Homes to provide care for Alliance members with the most complex medical and behavioral health needs. These Community-Based Care Management Entities (CBCMEs) will serve as a way to engage about 3-5% of Alliance members (about 3,000 individuals in Santa Cruz County) and provide them with increased services and enhanced coordination of medical, behavioral health, and community services.
4th Annual Health Care Forum: Community Impact of Drug Policy Reform
The Santa Cruz County Medical Society invited CA Lieutenant Governor Gavin Newsom to the Chaminade Resort & Spa to discuss the community impact of cannabis legalization with medical professionals and cannabis growers. Lt. Gov. Newsom described several benefits of legalization, including a reduction in cannabis-related arrests, as well as tax revenues from cannabis sales utilized to further public health interests. The Lt Gov. accentuated that legalization will not happen overnight, but will take place over a number of years. He mentioned that while cannabis would not be easy to regulate, it would be an improvement on current regulations of medical cannabis. Lt. Gov. Newsom asserted that this legislation will not usher in a “new California gold rush”, nor is it a strategy to solve the debt problem. Cannabis legalization, as articulated by the Lt. Governor, is in the interest of public health to address problems and barriers that have arisen due to the drug’s current scheduling.
Lt. Gov. Newsom stated that passing of Proposition 64, slated for the November ballot, would help to mitigate the effects of the War on Drugs, which has disproportionately affected people of color and low-income communities. In addition, underage possession will now be considered an infraction instead of a misdemeanor or felony, lessening the negative effect on an individual’s future, right to vote, access to housing, and employment opportunities.
As indicated by Lt. Gov. Newsom, the tax revenue accrued from legalization will be applied to various programs and public health research outcomes. Such funding plans include county drug treatment-on-demand programs, children’s programs, prevention programs, and research. Research funding will be allocated to the UC system in order to assess the health benefits and contraindications of cannabis use in addition to developing methods to test impairment levels. Furthermore, 20% of the revenues are to be applied to the prosecution of violent crimes and another 20% devoted to researching environmental issues associated with cannabis cultivation, such as pesticide use and impact on wildlife.
Dr. Donaldo Hernandez, Hospitalist and a Trustee of the Santa Cruz County Medical Society provided highlights of Gov. Newsom’s presentation in the HIP Council meeting. HIPC participants held a healthy discussion regarding impacts on taxation, educational funding, changes to the penal system and decriminalization, changes in clinical testing, and implementation of the tobacco model, however the HIP Council has not taken an official stance on the legislation.