School-Based Health Care

1. School-Based Health Care May 2, 2014

2. History SBHC Initiative In 2009, TCHF Board approved, 4-year investment in school-based health care to fund new or expanded • School-based health centers • School-based mental/behavioral health services • School-based oral/dental health

3. Goals of the SBHC Initiative • Support the planning and implementation of at least 20 new or expanded school-based health centers (SBHC) • Identify and address policy barriers • Improve the quality of care delivered by SBHCs • Improve the effectiveness of SBHCs at reaching underserved populations • Ensure the financial sustainability of SBHCs

4. SBHC Application Process • Step 1: Complete Readiness Assessment • Submit with grant application • Awarded up to $20,000 for planning • Step 2: Develop 4-year Business Plan • Includes financial pro forma (best and worse case) • Submit with grant application • Awarded up to $400,000 for implementation • Step 3: Implementation • Participation in evaluation

5. Outcomes of Our Investment

6. School-Based Health Centers • October 15th2014 • 2 implementation proposals 36 --------------------------------------------------- Expanded 20 New 10 Achieved

7. Planning & Implementation Planning Only Current Planning

8. Policy Wins • Two provisions in the Patient Protection and Affordable Care Act • Authorization of a federal SBHC grant program • Creation of an emergency appropriation that has provided Colorado SBHCs $2.9 million in capital funding • Passage of HB11-1019, which exempts SBHCs from deductible and co-payment requirement from privately insured patients • Increase in state general line-item for the SBHC grant program by approximately $4.3 million

9. Quality • Partnership with CDPHE and key stakeholders in development of Quality Standards for Colorado School-based Health Centers • Staff participation on advisory group in creating Quality Standards • Advisory member on federally funded Colorado School-Based Health Center Improvement Project

10. Evaluation of Initiative • Selected Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco to conduct evaluation • Timeline: January 2010 – January 2014 • Purpose: Determine if TCHF’s Initiative process was effective in driving Colorado SBHCs toward increased self-sustainability

11. Initiative Process Develop Readiness Assessment Develop Business Plan Financial Template

12. Sustainability Indicators Marketing &Outreach

13. Sustainability Not in Place In Planning Process Partially Implemented Fully Implemented

14. Successes: • Policy wins • Facility expansions and renovations • Increased operational support • Increase in billing infrastructure • Medicaid revenue higher than projections • Slight increase in private insurance • Integration of primary and behavioral health care • SBHC reach within Colorado • Medical home designations

15. Challenges: • Lead agency and community partner collaboration • Changes among leads over course of grant • New medical sponsors • School integration • Reimbursement for integrated service delivery • Oral health services • Parent and student engagement • Supportive but difficult to engage • Implementation of marketing and outreach activities

16. What’s Ahead • Closed initiative in December 2013 • Two grants grandfathered in for implementation • Bridge grants to SBHCs in 2014 • Time for new CDPHE monies to be distributed • Insurance expansions • Policy support • CASBHC grant • Address network adequacy via Policy team • Support policies that promote integrated care

17. Strategy Refresh • TCHF has made changes to our long-term goals, strategies, grantmaking approach and evaluation model- www.coloradohealth.org • Future connections to SBHCs • Healthy Schools Collective Impact • Health care focus on prevention within community • Health care continued focus on integrated care

18. Questions?