Health Services Integration-A Vision For 2015: Strategic Direction and Action Plan Presentation to the Fairfax County Board of Supervisors October 9, 2012

1. Health Services Integration
A Vision For 2015:
Strategic Direction and
Action Plan
Presentation to the Fairfax County Board of Supervisors
October 9, 2012

2. Agenda
• Background and Approach
• Reminder of Key Issues
• View of Current Safety Net
• Attaining the Goals - Action Priorities to Reach 2015
• Summary
• Next Steps
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3. Background and Approach
• Fairfax County Health Care Reform Implementation Task Force
• Established December 2010
• George Mason University: Task Force Consultant
• Purpose and Approach
• Study the provisions of the Patient Protection and Affordable
Care Act and the Health Care and Education Reconciliation Act of
2010
• Analyze the operational impact of the various requirements
• Develop policy recommendations and action plan, including
community engagement and participation, on health care
integration strategies for the Fairfax community
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• Recommend strategies for implementation

4. Approach: Action Plan
• Action Plan includes:
• Policy decisions related to future structuring of safety net
services
• Analysis of existing, revised and future health insurance
coverage opportunities
• Review and incorporation of best practices from peer
jurisdictions
• Development and identification of performance measures
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5. Reminder of Key Issues
Potential Impact of Health Care Reform on Existing Public Health Care Services
• Between 130,000 and 140,000 Fairfax County residents
are uninsured or underinsured – approximately 12% of
total population
• Expansion of Medicaid eligibility, if enacted in Virginia,
would cover approximately 25,000–30,000 additional
individuals
• Virginia’s Medicaid program currently covers individuals with
incomes ranging between 80% and 133% of Federal Poverty
Level (FPL), depending upon need category, with some
services offered to very low income individuals at or below
30% of FPL; and 250% FPL for nursing home residents
• An additional 30,000 - 40,000 individuals could receive 5
subsidies under a Virginia Health Insurance Exchange (HIE)

6. Reminder of Key Issues
Even with full implementation of these options, or repeal
of the Affordable Care Act, the county’s current service
array is still needed to support primary, behavioral, public
health, oral, and support services because gaps still remain
for newly covered individuals and others not covered.
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7. Our Health Safety Net Defined
• Safety net customers are uninsured and underinsured
individuals
• Safety net providers include the constellation of county and
community sponsored health services that provide health care
to the safety net customer
• County-Based Services: Community Health Care Network;
behavioral health services offered by the Fairfax-Falls Church
Community Services Board; Health Department Dental Clinics;
and contracted services for oral health, specialty care, and
support services.
• Community-Based Services and Partners - examples: Inova
Health System, HCA/Reston Hospital, Kaiser Permanente,
Federally Qualified Health Centers, free clinics, private practices 7
and other health care professionals.

8. Key Service and Capacity Gaps in
the Current Health Safety Net
• Many uninsured are “over income” for existing programs.
• Some services are not offered – or are not consistently available
and accessible - to all who need them.
• Shortages exist for Medicaid providers and reduced/no fee care in
several specialties (e.g., cardiology, neurology, podiatry,
gastroenterology, dermatology). Patients must obtain out-of-region
care, forcing local care coordinators to use resources to find
providers willing to treat these patients.
• Gaps remain in Medicaid coverage in areas such as services to
persons with disabilities, oral care, supportive services, and
community-based services.
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9. Key Service and Capacity Gaps in
the Current Health Safety Net
• Waiting lists exist for a number of services, including
CHCN clinics.
• A lack of standardized community health data hinders
system planning and monitoring efforts.
• Limited overhead and administrative coordination
creates inefficiencies (e.g., access, referrals, enrollment, volunteer
recruitment, technology development)
• A lack of system-wide planning and policy oversight
makes integration difficult.
• The financial viability of core safety net services is a
concern; there is a need for diversified and coordinated 9
funding strategies for county programs.

10. Development of the Action Plan
• Extensive dialogue among HCRTF members.
• Reviewed data and recommendations cited in GMU
report.
• Research data, interviews, best practices
• Held briefing and feedback sessions with over 10 BACs
and interested community groups.
• Investigated and interviewed administrators of safety net
systems in other local governments.
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11. Attaining Our 2015 Goals
Vision Core Goal Areas Critical Work
1. Expand working relationships with Northern Virginia Federally Qualified
Health Centers, and other safety net providers, to create access and
service delivery processes to support full service integration.
An integrated, effective health
care delivery system that
Public/Community Safety 2. Evaluate and enhance processes to maximize access to oral, prescription
Net Service Integration and pharmacy , specialty, public health, behavioral and primary health
provides appropriate and care.
affordable health care for 3. Establish front door access process.
everyone in the Fairfax
4. Assure cultural competency in all aspects of service delivery.
community.
1. Develop and maintain long-term financial plans and sustained funding in
relation to:
• Health Insurance Exchange
Revenue Strategies and
• Medicaid expansion
Policies • Navigation of individuals to right plans
Guiding Principles 2. Advise the Board of Supervisors on appropriate policies and investment
strategies.
 Support Individual 1. Expedite utilization of the new cross-program integrated eligibility system.
Responsibility 2. Develop tools for online collaboration and information dissemination by
Information Management staff and service providers.
 Seek System
Integration/Optimization and Data Sharing 3. Develop common data exchange of information protocols.
4. Establish integrated business practices and infrastructure tools for
 Pursue Sustainable System screening, eligibility and enrollment systems.
Financing
1. Develop options on system integration.
2. Creation of a broader health safety net “Health Integration Council” to
 Ensure Accountability, Leadership & Stewardship establish agreed-upon performance targets.
Transparency, and
3. Develop strategies to address community-wide disparities .
Improvement 11
 Pursue Advocacy and 1. Implement a continuous process improvement system incorporating
Stewardship Consistent with customer care quality and outcomes.
Evaluation and Planning 2. Establish benchmarks for performance and standards-driven service
County’s Mission
delivery based on national standards .

12. Attaining Our 2015 Goals
• Vision: An integrated, effective health care delivery system
that provides appropriate and affordable health care for
everyone in the Fairfax community.
• Integration among private, public, and community-based
providers; stakeholders; and other critical system participants to
maximize service access, capacity, and effectiveness
• Guiding Principles:
• Support Individual Responsibility
• Seek System Integration/Optimization
• Pursue Sustainable System Financing
• Ensure Accountability, Transparency, and Improvement
• Pursue Advocacy and Stewardship Consistent with County’s
Mission 12

13. Attaining Our 2015 Goals
Core Goal Areas:
• Public/Community Safety Net Service Integration
• Revenue Strategies and Policies
• Information Management and Data Sharing
• Leadership and Stewardship
• Evaluation and Planning
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14. Public/Community Safety Net
Service Integration
Critical Work
1.Expand working relationships with Northern Virginia Federally
Qualified Health Centers, and other safety net providers, to
create access and service delivery processes to support full
service integration.
2.Evaluate and enhance processes to maximize access to oral,
prescription and pharmacy, specialty, public health, behavioral
and primary health care.
3.Establish front door access process.
4.Assure cultural competency in all aspects of service delivery.
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15. Revenue Strategies and
Policies
Critical Work
1.Develop and maintain long-term financial plans and sustained
funding in relation to:
• Health Insurance Exchange
• Medicaid expansion
• Navigation of individuals to right plans
2.Advise the Board of Supervisors on appropriate policies and
investment strategies.
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16. Information Management and
Data Sharing
Critical Work
1.Expedite utilization of the new cross-program integrated
eligibility system.
2.Develop tools for online collaboration and information
dissemination by staff and service providers.
3.Develop common data exchange of information protocols.
4.Establish integrated business practices and infrastructure tools
for screening, eligibility and enrollment systems.
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17. Leadership and Stewardship
Critical Work
1.Develop options on system integration.
2.Create a broader health safety net “Health Integration Council”
to establish agreed-upon performance targets.
3.Develop strategies to address community-wide disparities.
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18. Evaluation and Planning
Critical Work
1.Implement a continuous process improvement system
incorporating customer care quality and outcomes.
2.Establish benchmarks for performance and standards-driven
service delivery based on national standards.
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19. Fairfax County Health Safety Net
Our vision for the future…….
Further integrate our
“front door” services
to improve access
Build on strengths
…Individuals
Engage and
strengthen
and expertise of
individual network
provider models and
are at the
community
infrastructure with
service providers
best practices to
align resources and
create a coordinated
center of a
system approach
coordinated
continuum of
Leverage all available
Plan for the future
care.
funding
and define success
opportunities
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20. Summary
• Current county investment in the health safety net is still
critical and necessary.
• Creating a comprehensive and effective network is a significant
community effort.
• All community health providers – primary, behavioral, oral
health care and support service providers (e.g.,
prescription/pharmacy assistance, access and referral,
transportation) – must be engaged to achieve the vision for the
system.
• The county must leverage its health safety net investments to
provide incentives to bring the safety net providers together.
• e.g., tax strategies, shared lease arrangements, use of public
space, realignment of funding for publicly provided/supported 20
services

21. Summary
• The county will need to continually assess multiple aspects of
health care reform implementation.
• State and Federal actions: policies, financing, grant opportunities,
initiatives, and legislation
• System results: eligibility and participation, payment
reimbursement, essential health benefits
• Economic impact on health care network: national, state, local
• Market conditions: payor sources, insurance and provider
capacity (e.g., Inova’s recent purchase of Amerigroup’s Virginia
Medicaid operations, Medicaid expansion)
• Public policy recommendations to the Board of Supervisors
will include options for leveraging county’s current investment
to achieve a comprehensive and effective system of care. 21

22. Next Steps
• Create work groups to support critical work activities
• Involve key community providers and health funders, including
Federally Qualified Health Centers, community health
providers, hospitals, business community, foundations, and
others.
• Create a Board-sanctioned Health Integration Council to:
1) develop and monitor a coordinated annual plan for
addressing the health safety net needs, 2) develop
strategies for integrating service delivery, and 3) create
system performance measures and evaluate performance
regularly.
• Integrate the Inova Community Health Needs Assessment
within the annual safety net plan. 22

23. Next Steps
• Continue development of the action plan
• Dynamic process but ready to begin implementation on critical
work areas.
• Link the action plan to cross-system human services efforts –
Partnership for Healthier Fairfax/Community Transformation
Grant, prevention efforts, and others.
• Develop regular communication strategies to obtain
community input into planning and advocacy activities.
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