2021: Finding the Way Forward

Aurrera News
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As 2021 comes to a close, we have been reflecting on the past year with gratitude and humility.  We are proud of our strong relationships with our clients, our investment in serving new health care sectors and communities, and the growing expertise and perspectives of our firm leadership, as well as our staff team.In the context of the ongoing pandemic, we have become further committed to working to ensure access to comprehensive behavioral health AND physical health care and viewing our work through an equity lens – with our clients as well as within our firm.

Building our Medicare Practice

This year, nationally-recognized experts, Meg Koepke and Melissa Cohen joined the Aurrera Health team to launch a consulting practice designed to advance and improve Medicare. Together with Brede Eschliman who joined in June, the team is working with government, provider, payer, and non-profit organizations to optimize policies and strategies to support and improve the value Medicare delivers. We are identifying innovations in payment and financing for populations with special needs, developing new APMs for organizations interested in improving care and managing cost, and helping payers, providers, and innovators navigate the changing landscape of value across government and commercial markets. We started the Medicare Meet Up podcast in May, and the Medicare Weekly News Round Up in September – check us out and be sure to subscribe to the weekly newsletter!

Enhancing Behavioral Health Care Systems

Vice President for Behavioral Health Policy, Molly Brassil, and her team have continued to support projects that expand access to behavioral health services across California. Aurrera Health supports the implementation of the California Department of Health Care Services’ (DHCS) California Advancing and Innovating Medi-Cal (CalAIM) initiative by providing policy expertise, research, data analysis, strategic advice, and technical assistance on the CalAIM initiative’s key behavioral health elements. We are also working with DHCS to implement California Senate Bill 803, which authorizes a Medi-Cal certification program for peer support specialists. Peer support specialists are individuals with lived experience navigating behavioral health diagnoses who can help others experiencing similar situations on their path to recovery.With nearly half of adults reporting mental health challenges due to the COVID-19 pandemic, Aurrera Health is also supporting the CalHOPE initiative. CalHOPE is designed to build community resiliency and help people recover through free outreach, crisis counseling, and support services.Our Behavioral Health Policy team also supports California’s implementation of the Behavioral Health Response and Rescue Project, which is financed using grant funds made available by the Coronavirus Response and Relief Supplemental Appropriations Act and the American Rescue Plan Act. This program is focused on expanding the behavioral health workforce, access to mobile crisis and recovery services, among other projects. Aurrera Health Group is proud to support the state in promoting access to behavioral health services through these many vehicles.

Reaching New Heights for California’s ACEs Aware Initiative

Since 2019, Aurrera Health Group has had the privilege of supporting the California ACEs Aware initiative on behalf of the Office of the California Surgeon General and the Department of Health Care Services. We could not have predicted how important and timely our work to prevent and address Adverse Childhood Experiences (ACEs) and toxic stress would be.Despite the all-consuming challenges brought on by the COVID-19, the ACEs Aware team, led by Tanya Schwartz and Jennifer Ryan, have helped make significant process in raising awareness of the physical and behavioral impacts that ACEs and toxic stress can have on our well-being.  To date, nearly 25,000 people have completed the Becoming ACEs Aware training and California Medi-Cal providers have screened more than 500,000 children and families for ACEs and risk of toxic stress.Our team has also had the opportunity to work with and provide technical assistance to nearly 150 health clinics, community-based organizations, academic institutions, and social service agencies through $45 million in grant funds across the state. We are working with 35 communities to establish Trauma-Informed Networks of Care designed to leverage a cross-sector approach to responding to ACEs and toxic stress based on a Roadmap our team developed. While there is still more work to be done in the years ahead – in California and nationally – Aurrera Health is proud of the lessons and promising practices that have been identified through this important program. Read more about our work over the last two years in our Case Study.

Taking on Challenges from New Public Option to School Health

In 2021, our team provided policy and strategic assistance to a range of clients in the Medicaid policy realm, including state Medicaid and behavioral health agencies, consumer groups, nonprofit Medicaid plans and hospitals, and health care start-ups seeking to expand access to coverage and care.Led by Vice President, Marie Zimmerman, and Principal, Stacie Weeks, highlights of our Medicaid Transformation & Financing team’s work during the past year include:

  • Providing policy advice and support for the development of Nevada’s new state public option;

  • Helping a network of urban community health centers in Minnesota develop a roadmap for partnering with public and private payers to improve patient care and outcomes;

  • Providing strategic advice and policy analysis to the District of Columbia and Alaska on large-scale Medicaid and behavioral health delivery system and payment initiatives;

  • Conducting a 50-state survey and report identifying barriers schools across the country are facing in billing Medicaid for school-based health care services and providing recommendations for states seeking to remove these barriers;

  • Developing strategies for securing and strengthening state Medicaid coverage of home visiting programs for pregnant women and their families;

  • Advising a network of community mental health programs in Minnesota on options for improving the state’s behavioral health delivery and payment system; and

  • Supporting Minnesota’s largest county, Hennepin, in its ongoing effort to redesign its service delivery model including case management and behavioral health services.

Integrating Care for Dual Eligibles

Under the California Advancing and Innovating Medi-Cal Initiative (CalAIM), California’s DHCS has renewed its decade-long commitment to creating more integrated care options for California’s dual eligible individuals, who receive both Medi-Cal and Medicare coverage. Dual eligible are a diverse and complex population, including beneficiaries with multiple chronic conditions including physical, behavioral, and cognitive impairments, as well as limited English proficiency and low health literacy. Dual eligible individuals can greatly benefit from programs designed to better coordinate and integrate their care. Aurrera Health Group has worked with DHCS to develop and implement the Coordinated Care Initiative (CCI) since 2012. CCI created Managed Long-Term Services and Supports (MLTSS) and integrated Medicare-Medicaid Plans, called Cal MediConnect (CMC) plans, under a CMS federal alignment demonstration.Our work has expanded to support DHCS in the transition from CMC and the CCI to a statewide MLTSS and Medicare Advantage Dual Eligible Special Needs Plans (D-SNP) structure. The intent is to maintain focus on person-centered health care and integration across Medicare and Medi-Cal services through aligned D-SNP and Medi-Cal Managed Care Plans (MCPs) operated by the same parent health plan.

Federally Qualified Health Centers (FQHCs) and the Pandemic

The COVID-19 pandemic placed unprecedented pressure on the health care delivery system in 2021. As face-to-face visits declined during the pandemic, community health centers faced a financially challenging time. In a report entitled Risky Business: California Health Centers Weakened by the COVID-19 Pandemic Prepare for the Future, Lauren Block and Carol Backstrom discussed how COVID-19 magnified issues related to health disparities and access to care and how policy and reimbursement improvements could strengthen the FQHC model – all in service of ensuring access to high-quality, team-driven care for low-income Californians.This report was the third in a series in partnership with Capital Link and supported by the California Health Care Foundation (CHCF) designed to provide a window into the financial and operational impact of the COVID-19 pandemic on California’s FQHCs. The initial two reports include: California FQHC Financial and Operational Performance Analysis (November 2020) and Holding On: How California’s Health Centers Adapted Operations and Care for Patients During the Pandemic (February 2021).

Enhancing our Team

With a persistent feeling of awe and disbelief, we spent a good amount of time over the past year reflecting on what it means to be a 73-person, national, diverse, woman-owned firm with established teams in Sacramento, Minneapolis, and DC versus a 27-person California-focused organization operating from Hilary and Peter’s dining room table.We recognized that we needed to continue to expand our team in hopes of benefitting from new perspectives and experienced leaders. This fall, we were thrilled to welcome Megan Thomas to our Senior Leadership Team as Principal, Medicaid Quality Initiatives, and Michelle Mills as our first Staff Director and Principal for Medicaid Policy & Programs.  The addition of these two accomplished women to our strategy and leadership conversations has already had a positive impact on our company culture and we are excited for the year ahead.Wishing all of you a happy and healthy 2022 and thank you for your partnership!

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