Ways of the RAEs: Getting to Know Northeast Colorado with Northeast Health Partners
Third in a series of interviews with leaders of Colorado's Regional Accountable Entities, or RAEs. Jeff Bontrager, CHI's director of research and evaluation, interviews Kari Snelson, executive director of Northeast Health Partners.
This episode was recorded before the RAE was launched in July 2018.
Topics covered include challenges facing the state's smallest RAE region and Snelson's first-hand perspective on the need to build a bridge between behavioral and physical health care.
This transcript is edited from an automated transcription of the recording. It may contain typos. Please reach out to firstname.lastname@example.org for clarifications.
Hi and welcome to The Checkup, the Colorado Health Institute’s podcast about health in Colorado and the policies that affect it. I’m your host Jackie Zubrzycki, the communications specialist here at CHI.
Health First Colorado, the state’s Medicaid program, just launched five new Regional Accountable Entities, or RAEs, as part of an effort to improve care and reduce costs. The RAEs are managing physical and behavioral health together for the first time. We recently published a paper on the RAEs, which you can find on our website www.coloradohealthinstitute.org.
We wanted to get a sense of what’s going to change across the state now that these new regional organizations are managing care.
On this episode, we’ll be talking with Kari Snelson. Kari is the executive director of Northeast Health Partners, which is the RAE for northeast Colorado. Kari just moved to Greeley recently, but told CHI it felt like coming home.
Kari spoke with Jeff Bontrager, CHI’s director of health coverage and access, about managing health in a region that’s geographically large but has a small population and about this brand-new organization, which was founded by a group of behavioral health providers.
Jeff: Well, welcome Kari. Thank you so much for joining us on the podcast. So how would you explain what a regional accountable entity or a RAE is to someone like a family member or a friend who might not know very much about it.
Kari: Well, I've done this I've done presentations for my family because they cannot understand what I'm doing and I quizzed my husband.
So I would explain that we have had seven regions that have focused on. I'm physical health and they've been called Rico's and the regional care collaborative organizations that really helped to do care coordination on the physical health side of things and then we had our five BHS which focused on the behavioral health side of things and luckily the state saw the um sense in bringing those two together under one entity and saying let's line up some regions.
So we now have seven regions and let's bring together physical health and Behavioral Health under one end, too. So that we're not bifurcating the system. '
Jeff: How did your husband do on the quiz?
Kari: And he did not do well because he even tried to take notes and he at the end of the day. He's like it's with physical health and Behavioral Health and I'm like, that's all you really need to know.
Jeff: We're interested in what drives you personally to do this work.
Kari: Well, that would be a lengthy story. But um, The root of all things I am a social worker and I worked in rule in Frontier areas for about 13 years providing services and saw the gaps in care and we also were part of a RICO at that time and it's not enough to give people referrals.
I've seen it personally and professionally it's not enough to say you need the service go to the mental health center. Go to your physical care provider. We really need to help people go through those barriers there. Transportation issues there's paperwork just to be able to get into any system.
You have to do lengthy paperwork. And so when this opportunity came up to really be part of the Ray and see how things come together. I have such a passion of making sure people get the right care and that there really is no wrong door. We can't say there's no wrong door. But when people call say well that's not under us you need to call so and so.
I believe that our job is to say you know, what I'm gonna have the right person call you and so we really need to be able to help people access the care they need and build the community. And so that was my goal with being part of the RAE.
Jeff: Well, we are fortunate today to have gotten outside of Denver and to come up and be recording this today in the in the really lovely community of Greeley and I was wondering if you could tell us a little bit about your region here in Northeast, Colorado and what makes the region unique.
Kari: So, um, I am also new to this region and I fell I felt like I was coming home the moment. I came up here the region covers 23,000 square miles six of the communities are Frontier, which means that. Pretty sparse. We have three rural communities and then the urban region of Greeley, but then parts of Well County are also Rule and so our community has always had to make sure that we're trying to be very resourceful in treating anybody. We've had to build our own resources in the community. We've had to make things accessible and unique way. And so I'm just so impressed that these Partners came together to form the RAE as a non-profit and are committed to serving this region.
Jeff: I know that this community in particular is relatively diverse and can you tell us a little bit more about that diversity?
So the community of Greeley is has a large Refugee population, so. What makes that unique is when you go into a provider within this region, you will not just see signs like in English and Spanish but you'll see multiple languages. And so that was one of the unique pieces we had to establish like on our website that you could translate to multiple languages and that would include like text messaging campaigns and tools that were providing that it can't just be English or Spanish, but we have to be able to meet the needs of the people. This region is a huge agricultural region. And so we know that there is a large volume of Migrant workers. And so we really want to make sure that they're able to access care in the regions in which they're living and working as well.
Jeff: And so, uh, tell us a little bit about Northeast Health Partners and your approach to serving some of these diverse populations or or diverse, uh regions within your region, you talked about rural and urban populations Frontier populations within Northeast what are what are some of the approaches that you're taking?
Kari: So we're really going into all the communities. I I've been to so many small rural communities on the border of Kansas and we're going in and trying to identify what the community identifies as the needs. What are the Medicaid members identifying as the needs and so that we don't have one solution that's going to fit all but hearing what they are identifying. We have a lot of tools in our toolkit, but they may not be appropriate for the members and Wray Colorado. And so we're really looking at those pieces. Building health neighborhoods is one of the core components of the Ray and so identifying not just the Health Resources not just Behavioral Health Resources, but what are the Community Resources if I'm running low on food if I'm having housing issues or utility issues or I need food how do I access all those resources so building a health neighborhood within the different communities is really important.
Jeff: What might be some examples of different organizations that you would bring within a health neighborhood or that you might partner with for the health neighborhood?
Kari: Well, this region has just been so welcoming. So Public Health would be a significant one, with the women infants and children programming were working with them. The Department of Human Services, of course is a key partner with all of these things. And but then there's local resources their local food banks. There's local homeless shelters a huge partner.
We have within the whole region is the North Colorado Health Alliance and they are a care coordination program, but there's so much more than that. They have so many programs that they've put in place or have been Partners in so developing community action plans if there has been an identified need so they were.
Um, all of our partners were active in a plan when there was really high utilization that wasn't necessarily appropriate utilization. So they did 100 day action plan. And so the community really pulls together with all these unique Partners, the hospital's medical providersm all of them come together and sit at the table and make plans.
Jeff: And would you say that those Partnerships are something that uh, you found to be already established within Northeast, Colorado or - talk a little bit more about those Partnerships.
Kari: So these Partnerships are long-standing. I can look at the history and some of these Partnerships go back decades. And so that's what makes doing work in this community so much easier is that these people are actually community members. They attend each other's events. They've been to weddings and funerals and they're active community members and they really are committed to developing their community and they truly care.
Jeff: So I'd like to ask you a little bit about what Medicaid members in your region can expect. In terms of changes that will come about when the phase 2 of the Accountable Care collaborative rolls out on July 1st of this year.
Kari: So I My overall goal is that they won't notice a big change, so I don't want members to lose services or providers, but I know they're going to get a letter from the state. That's going to say you're now part of this RAE here's your primary care medical provider. And so what I do want them to know is that the services will be in place their benefits are in place and that we are here as an added resource in the community to help meet their needs and what about for different providers?
Jeff: For Behavioral Health Providers, you mentioned Primary Care oral health providers. Will they experience changes as well?
Kari: So one of the primary changes especially for the physical health providers is that the state has historically paid their payment to them for the added value. We will be paying that now but it is identified as added value and so we'll be working with them to identify what type of care they want to provide if they want to just do basic care coordination or if they want to do intensive care coordination or if they want to have another entity do that and provide the full linkage will be working on referral systems with them which is a key component of the rate contracts and making sure we're doing formal referral systems instead of just saying well just go see the other provider down the street but really following the medical societies guidelines.
And so I think that providers will feel a difference but we're also here to provide support and tools to help them along the way.
Jeff: could you tell us a little bit about Northeast Health Partners as an organization. It's a relatively new organization as I understand it and um who came together to form it and a little bit about its background.
Kari: Yes, so Sunrise Community Health, which is a federally qualified Health Center and salute Family Health Center, which is also an fqhc and then North range Behavioral Health and Centennial Mental Health Center who are two of the community mental health centers in the region came together and based on their years of partnership said, let's partner together and bid on the RAE. And Beacon Health Options came along as the administrative service organization to help develop the proposal and identify the role they could fill in this region Beacon was in this region several years ago. So they had some established Partnerships and relationships as well which made it such a natural fit.
So the Partners came together formed a non-profit because one of their primary Mission and values is that they want to put the money back into the community. So the money the resources will go back into the communities in which we're serving.
Jeff: And as I understand it Beacon Health Options is a national company. What role are they playing in Northeast Health Partners?
Kari: So Beacon Health Options is our administrative service organizations. So they will be providing roles such as utilization management. They will um have these staff that is overseeing the call center. They have helped with developing certain resources.
They are participants in a lot of our community meetings. The Chief Financial Officer comes from Beacon, but she's actually the CFO for Northeast Health Partners. So they're filling a lot of those pieces so that we can then just focus on building our resources within the community.
Jeff: As you're planning for the rollout of the Accountable Care collaborative Phase 2 have there been any challenges?
Kari: There's definitely challenges. We are the smallest population as far as attribution. The last number we'll know for sure tomorrow. We think but the last number we heard was around 86,000 would be attributed to our region. That's a really um significantly smaller number. You know, they did remove Larimer from our region. And so that's had a huge impact on on this area.
So that's been one of the challenges and then with things being so spread out and being a medically underserved area. So seven of our counties is medically underserved for physical health and all of our counties are for Behavioral Health. So that's tough to find work for. And to meet the needs because the person in Kit Carson is entitled to the same benefits as the person in Denver.
And so we have to make sure we're filling that role.
Jeff: So help me understand a little bit more about what challenges are created by having a smaller member population that is attributed to your region.
Kari: So, um, Based on how they the rate setting process goes. Um, the financial resources have significantly impacted our region.
And so we have reduced financial resources. And but that's also why we're being creative I said that I am the primary staff member for Northeast Health Partners, but I have a great team behind me through the ASO and Beacon. And also through the board members and any of their staff that if I need assistance, they're willing to jump in and provide that so that's primarily the impact.
Jeff: So as you're thinking down the line, you know, maybe three or four years how will you know, if these approaches that you've described today have been successful?
Kari: you know at the at the end of the day we'll know. If we've been successful if the community had sees us as part of their their role if they identify us as a key resource, and if members have been able to receive the access and outcomes in the satisfaction that they want from Services, we know that the state's going to grade us on quality metrics and financial savings and all their components, but at the end of the day, it's going to come down to the members and the community and.
You know, members are only members for a brief time but they stay apart of the community. So we have to impact that whole system.
Jeff: Are there specific things that you're measuring in terms of your success or what are some of the key, um metrics that you might be watching over the next couple of years.
Kari: So I know one of the top goals and one of the issues that always existed on the. BHO and RCCO side of things is access and so we want to make sure that access really is seamless that people are getting in and getting the right Care at the right time that we're not waiting and delaying people getting in and so then issues become more significant.
So I think access is really going to be a key one for us.
Jeff: And how do you measure something like that?
Kari Oh that the data analytics that we have to measure that. But really we we measure from the first call from the first touch we are responsible in Access has so many points along the way somebody goes to the emergency department then we need to be following up with them within a set amount of days. If somebody calls a Community Mental Health Center and says, I'd like to receive Services we have to have them within them into our system within seven days if somebody. Has a hospitalization we have to help assist them in getting back out into the community and also do the follow up with them on those on their health needs and on their behavioral health needs so we have so many metrics and then we have all those preventative ones.
So we want to make sure you know in the RCCO side we had well-child visits that we were monitoring now, we're going to measure well visits. I want to make sure everybody gets into the doctor because we know more efficient care. Leads to lower costs, so we aren't waiting until something so severe that it takes a lot more resources to help you get back to a baseline of health.
Jeff: So what makes you most excited about the rollout of the phase two of the ACC?
Kari: I would say that. The opportunity to serve in this region. There's so many things that make me excited. The RAE is just such an amazing movement forward. I feel like we're part of history, um, the improved member access and remembering that when we have people in the community that are calling a provider they're calling for help of some sort, we don't kind of prepare our health needs we go, oh my gosh, I've experienced something. I'm going to call my doctor. I'm call my mental health provider and so really being able to know that we can respond immediately to them and that we can help wrap the services around them in a way that will be efficient and will improve their satisfaction that providers will feel supported in this and know that we really are a team based approach.
Is there anything that I haven't asked you today that you feel like you would like the listeners of this podcast to know?
Kari: Well, one of my goals for the future of the Ray would be the we remove the word medical from it. So we we've gone from you know, Primary Care Providers and Community Mental Health Centers, and we've moved the system and we're bringing the two together now, but we have Primary Care Medical providers and we have medical homes.
So I'd really like to move to health because it's all about health care. And health outcomes and so separating continuing to join together the head and the body and the whole person Health would be a key component for me.
Jeff: Well, thank you so much for joining us on the podcast today.
Kari: Thank you.
You can listen to our interviews with other regional leaders on our website, . There, you can also read our new report on the RAEs and how they work and more of our work on other health policy issues.
Make sure to follow us on Twitter and Instagram @cohealthinst, and follow us on Facebook. Thanks for listening! I’m Jackie Zubrzycki at CHI.