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John Schlitt National Assembly on School-Based Health Care

John Schlitt National 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.

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John Schlitt National Assembly on School-Based Health Care

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  1. John SchlittNational Assembly on School-Based Health Care School Health in Era of Health Care Reform

  2. 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.

  3. School Health: A Force • Surveillance data • Extensive child development knowledge • Cross-disciplinary competencies • System infrastructure

  4. Shifts in Health Care

  5. Redesign Experiments in State Medicaid Programs • Health Homes • Pay for Performance • Integrated Care Models

  6. 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

  7. Pay for Performance (P4P) • Provider incentives for tracking quality measures, adopting new roles/behaviors • Enhanced rates/fees • Augmented payments/bonus • Behavioral health????

  8. 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

  9. 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

  10. Integrated Health Neighborhood • Primary Care • Behavioral Health • Asthma • Depression • School failure • Substance use • Teen pregnancy • Obesity • Learning Supports • Public Health

  11. 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

  12. 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

  13. 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.

  14. 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.

  15. General Reform Resources • National Academy of State Health Policy • Health Affairs • Kaiser Family Health Foundation

  16. NASBHC = School-Based Health Alliance

  17. My contact info: jschlitt@nasbhc.orgwww.nasbhc.org

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