Synthesis Conversation
Langdon
We'd like to report this out briefly. We'd like to understand the priorities and projects you've identified. We will then have a discussion about the overlap and then we'll do a round of work on the Lucille Packard Foundation projects.
Let's go in team order. Team one.
Assignment
4 Key Points
Step 1:
In your breakout group, please discuss what you learned during the prior report out, and many any changes or improvements to the models you have been working on.
Step 2:
On a sheet of flip chart paper, please brainstorm 2 lists:
- Projects or activities that are most critical to the realization of the ideal design.
- Projects or activities from List A that the Lucile Packard Foundation for Children’s Health should do, within the scope of its resources, to help move toward the ideal system.
Step 3:
Please select two items from each of the above lists that you believe are the most critical to the future success, and should be worked on in the activity we will do next.
You have 30 minutes total for this activity.
Then we will gather in the large group to discuss your work.
We went through our first list and pulled out these items.
- The foundation should build an informed political constituency.
- Create a process to generate new structures and financial incentives for PCPs to provide comprehensive care in community settings.
- Generate a regional entity that can be accountable for the system of care for children with special health care needs.
- An infrastructure that is accountable - a region probably is a state. What are they accountable for? Developing and implementing this system.
We identified multiple key activities.
- Culling together data to inform and communicate about the needs of these families.
- Advocacy training to influence public policy.
- Pilot alternatives - role of children's hospitals as a center for medical home.
- Create a pilot -
- Measuring advocacy results
We voted to choose the ones that are workable. The data acquisition and developing the story are the ones we liked. Then developing the pilot and focusing on the role of children's hospitals.
The relationship with the medical home could be one example. There could be other roles for hospitals.
We talked about involving the counties - and, as has been said the devil is in the details so we need to define the ideal plan.
One thing is building consensus on the need for this.
Build the case for a new plan. Communicating the case is important.
Financing - including private dollars - engaging employers and others.
Harness the energy of the family and the public. We lose something by not talking to one another.
We didn't talk about a pilot before so we did that now.
What is the critical message?
Engage in the 1115 process already begun in this state.
Build a case for this new system and focus on fiscal impact.
Communicate about this to all stakeholders.
Convening stakeholders is a critical role the Foundation can play.
1115 is a waiver - under medicaid rules you can waive and restructure and create new flexible ways of delivering care. We've been moving forward on an approach for a more comprehensive waiver. Under the that topic we've been looking at the most vulnerable populations and ways to deliver care in a more affordable fashion. We're in the middle of that process. We're submitting a concept paper to the Feds in the next several weeks.
We looked at the most critical elements. We started with defining the population. We were intrigued by the all inclusive idea.
We looked at funding the redesign and convening folks for the pre-design planning.
The data collection and mining will be important. Including data around health IT and what's being collected by several existing pilots.
Supporting family advocacy and family involvement will be important as well.
Getting support of key stakeholders is important. Depending on who you are talking about that support would be important.
Getting PCPs at the table is very important.
The scope of the redesign is important. Is it statewide?
What should the Foundation do?
We think they should provide funding for the redesign and the planning. Under that is some of these pieces. They should continue the data mining and collection. Continuing to support family involvement and advocacy.
The two choices are - defining the population and the scope of the redesign. It was helpful to hear what other groups were thinking about.
We ended with funding the redesign and planning and family involvement and data mining.
What are the projects we should work on next?
- There are several around financial planning.
- The critical messaging.
- Engaging stakeholders.
- Defining the population.
Defining the population has to be on its own.
Doing a pilot for the hospital as the medical home could be one of the way of thinking about the pilot. It's an example of a pilot. Is the medical home a subset? The model of comprehensive care includes some definition of a medical home.
What we're looking for are subjects we can work on for the next round of work.
There is a job to be done around building a community around this and that's separate from any of the pilots.
I'd like some detail around what data we need and building the compelling story - what data do we need to tell that story?
Another group can discuss how we can create a community.
Are there ways we can be constructively engaged in helping the 1115 process?
The other question around the room was pilot versus no pilot. Maybe that's another area to discuss?
I don't want to lose the population and how we define who is in the system. The way we do it today is based on diagnosis and that might still be the right way to do it later on.
Maybe you have pilots that go in different directions?
Is this bold enough? Is this up to scale that is worthy of the Foundation? Do you see dealing with the state waiver process leading to important new steps the Foundation can take? Is this an adequate set of agenda items to engage the capacity of the Foundation?
Telling a story that hasn't been told is worth doing.
Convening is worth doing.
The 1115 process is going along and it would be worth figuring out if we can be a part of that to help the state get what they want and get a new process for all kids in the state? If there is a way we can help people meet their goals that's good.
I think the foundation can set a new context. Maybe defining a new logic model that helps get this new outcome? We don't have enough money or power to make the end happen and we need to look at the leverage points - so these things make sense in terms of the bigger picture.
These are big and bold enough if they are put in context of the bigger picture.
The financial incentives piece may be second but if you look across the nation there could be some real value bringing people together to look at what's happening. There is fragmentation and bringing people together could be helpful.
The state leadership is engaged in discussions about health reform state wide. They are not thinking about the young people. This foundation might be able to support a group of people that understand children's services and make sure they have a seat at the table in these larger discussions. The kids are going to get squeezed out of the process if we don't get involved.
In some ways that is what the 1115 process is about. One piece of it is reforming our system of care for children with special health care needs.
What's the opportunity for anyone to influence that process? We've been engaging different groups and reaching out to different stakholders.
We haven't taken a look at how the system will look and that is also important.
Is the idea about piloting about the foundation investing in figuring out what to do there? This is to explore that further and see if a pilot should be done. It's also about defining how you would do a pilot given the make up of the state. That might have to be after you have defined the scope of the redesign. What is a pilot?
Our group discussed piloting stakeholder activities.
A substitute could be defining who's in and who isn't. Is this a system for all children? If not, who is in?
Let's get into groups and work on these now.