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John SchlittNational Assembly on School-Based Health Care
School Health in Era of Health Care Reform
School Health: A Force
• 74,000 school nurses• 14,000 SWers• 99,000 counselors• 30,000 psychologists• 2,200 SBHCs• Unknown #s physicians, mental health and substance
abuse specialists
Source: Lear JG. Health at school: a hidden health care system emerges from the shadows. Health Aff (Millwood) 2007;26:409–19.
School Health: A Force
• Surveillance data• Extensive child development knowledge• Cross-disciplinary competencies• System infrastructure
Triple Aim
Better health care experience
Improved outcomes
for population
Lower cost
Shifts in Health Care
OUT INVolume Value
Quantity Quality
Units Outcomes
Carve out/silos Integration
Lone rangers Multidisciplinary teams
Individual Population
Clinic Community
Redesign Experiments in State Medicaid Programs
• Health Homes• Pay for Performance• Integrated Care Models
Health Homes
• Primary care redesign• Building block for most reforms• Patient-centeredness at the core• Care coordination/management• Enhanced access (24/7)• Electronic linkages to health neighborhood • Quality improvement
Pay for Performance (P4P)
• Provider incentives for tracking quality measures, adopting new roles/behaviors – Enhanced rates/fees– Augmented payments/bonus– Behavioral health????
Integrated Care Models
• Accountable Care Organizations– “vertical integration”– Provider-driven, not insurance-driven– Emphasis on accountability = performance– Shared savings as incentive to drive down costs, make
smarter investments in front end
Realigning Health with Care
• Product: broaden concept to ameliorate effects of nonclinical determinants– Inadequate food, housing, safety
• Place: beyond medical complex neighborhoods
• Provider: nontraditional team members–Community outreach workers, heath
educators, coaches, resource coordination
Integrated Health Neighborhood
Learning Supports
Primary Care
Behavioral Health
Public Health
Asthma
Depression
School failure
Substance use
Teen pregnancy
Obesity
Schools in the Health Neighborhood
• Point of entry to primary prevention, risk reduction and care management system
• Inter-disciplinary team: whole child approach that unifies mind and body
• Screen/address behavioral health needs often undetected and unmet by mainstream PC system
• Meets young people where they are (literally) in terms of problems, pain, social and developmental challenges
• Unprecedented opportunity for population health
SBHC Lessons for Reformers
• Co-location > collaboration > integration• Structural issues related to integration -
space, data, scheduling – are not insurmountable
• Breaks down hierarchy; maximizes skill sets• Minimizes stigma by normalizing within school
setting
New Competencies for School Health
• Think “SYSTEMS.”• MEASURE quality.• Get WIRED. • Get COUNTED (and paid). • Know your VALUE.• Get to the TABLE.• Practice INTER-DISCIPLINARILY.
New Competencies for School Health
• Think “SYSTEMS.”• MEASURE quality.• Get WIRED. • Get COUNTED (and paid). • Know your VALUE.• Get to the TABLE.• Practice INTER-DISCIPLINARILY.
General Reform Resources
• National Academy of State Health Policy• Health Affairs• Kaiser Family Health Foundation
SCHOOL-BASED HEALTH ALLIANCE
NASBHC =
