Reflections and Looking Ahead

This week marks a significant anniversary for me personally, and for Harbage Consulting. February 3rd is the fifth anniversary of Peter Harbage’s death, making February 4th the fifth anniversary of my tenure as President of this amazing organization.We have come a long way in that time, and I am so proud of what Harbage Consulting has become over the past five years. It is an amazing honor and gift to lead an incredible team working hard every day to improve access to quality health care for those who need it most.While we carry forward the legacy of Peter’s mission and vision to make health care more affordable and accessible for all, Harbage Consulting is a very different place. Last year, in particular, saw dramatic growth in our work and our team.We began 2019 with a great set of clients and projects – in California, Alaska, Hawaii, Maryland, Minnesota, Maine, and Colorado – that enabled us to continue doing the mission-focused work that is our passion.In midyear, we grew our expertise by adding a Strategic Communications and Public Affairs practice to help our clients tell the stories of the important work they are doing to improve the health of individuals and communities.We ended last year feeling honored that the California Department of Health Care Services (DHCS), one of our long-standing clients, selected us as its lead partner in two signature initiatives that will change and improve the health care experience for Californians served by the Medi-Cal program.In 2020, we expect to see our firm double in size and broaden its reach to new states and new policy areas, while simultaneously maintaining our commitment to the important work we do in California.Here are a few of the key initiatives we’re working on:

Combatting the Substance Use Disorder Crisis

Over the past five years, Harbage Consulting has built deep expertise and experience assisting states in designing programs that leverage Medicaid funding to combat the opioid epidemic and the SUD crisis more broadly.  This work started in California with the approval and implementation of the Drug Medi-Cal Organized Delivery System, which is now available to 94% of the state’s Medi-Cal population. In addition, Harbage Consulting is supporting the state in its execution of the State Opioid Response (SOR) grant from the federal government.  Among many other important purposes, the SOR funds are being used to promote access to Medication Assisted Treatment (MAT) across the state. Our team also oversaw the distribution of thousands of Naloxone (overdose reversal) kits to health care providers, harm reduction programs, first responders, community, and tribal organizations to help families struggling with addiction.Building on the foundation established through our work in California, the Harbage team successfully shared its expertise with other states interested in applying for Medicaid Section 1115 waivers to expand access to SUD treatment services.  We worked with West Virginia -- the second state to receive CMS approval after California -- followed by Minnesota, Alaska, and Colorado, to design, negotiate and implement their SUD waivers.  The critical combination of strategic, policy and operational advice and support has facilitated successful and timely waiver and implementation plan approvals for our states.  After years of steady increases in the overdose death rate nationally, these Medicaid coverage expansions are an important part of the solution, although the problem persists.

Promoting Health Care Innovation Through Learning

As California’s Medi-Cal 2020 Section 1115 waiver comes to a close at the end of this year, Harbage Consulting has been proud to support several critical aspects of the demonstration by planning and executing a series of Learning Collaboratives. The information sharing and best practices that were exchanged through the Public Hospital Re-Design and Incentives in Medi-Cal  (PRIME), Whole Person Care pilots, and Health Homes Program learning collaboratives have advanced the goals of the programs, provided technical assistance, and recognized successful strategies across the state in quality improvement, care coordination for populations with complex needs, and addressing the social determinants of health.  These important initiatives are now in the process of transitioning into the broader fabric of the Medi-Cal program as a part of the Medi-Cal Healthier California for All initiative.  

Helping California Become ACEs Aware

California Surgeon General Dr. Nadine Burke Harris, in partnership with the California Department of Health Care Services (DHCS), is creating a first-in-the-nation statewide effort to screen for childhood trauma and treat the impacts of toxic stress. The bold goal of this initiative is to reduce ACEs and toxic stress by half in one generation and to launch a national movement to ensure everyone is ACEs Aware.Harbage Consulting is honored to have been selected to support DHCS and the newly-created Office of the California Surgeon General (CA-OSG) in building the infrastructure for a public health response that offers Medi-Cal providers training, clinical protocols, and payment for screening children and adults for ACEs. Detecting ACEs early and connecting patients to interventions, resources, and other support can improve the health and well-being of individuals and familiesACEs are stressful or traumatic events experienced before age 18 that relate to ten categories of adversities across three domains: 1) physical, emotional, or sexual abuse; 2) physical or emotional neglect; and 3) household dysfunction (e.g. a parent with a mental health condition or substance use disorder, absence due to separation or divorce, or intimate partner violence).Effective January 1, 2020, DHCS is providing a $29 payment to Medi-Cal providers for conducting ACEs screenings for children and adults. By July 2020, providers must self-attest that the training has been completed in order to be eligible to continue receiving Medi-Cal payment for conducting ACEs screenings.Throughout 2020, Harbage Consulting will be working with CA-OSG and DHCS to encourage Medi-Cal providers to complete the training and become certified to screen for ACEs respond with trauma-informed care.  With CA-OSG and DHCS, we also will be working with providers and community organizations as they look for new ways to respond to this largely unrecognized public health crisis.

Charting the Future of Medi-Cal  

As the largest state Medicaid program, California is in a unique position to lead the nation in efforts to simultaneously improve the quality of care and enhance the availability of intensive care coordination services for the state’s most complex populations. Initially announced in late October 2019, and formally included in Governor Gavin Newsom’s proposed 2020-2021 budget, the Medi-Cal Healthier California for All initiative is intended to continue to leverage the state’s mature managed care delivery system to ensure that all beneficiaries get the care they need in the right place at the right time. Harbage Consulting is providing broad support to DHCS on this initiative, ranging from leading the stakeholder workgroup process on behalf of the state, to providing policy and operational analysis and advice, to preparing the Medi-Cal section 1115 waiver renewal request for submission and negotiation with the Centers for Medicare & Medicaid Services. This will be an exciting year for determining the future of the Medi-Cal program, and we are honored to be a part of this critically important work. Harbage Consulting has evolved, grown, and achieved success in ways we could not have anticipated five years ago. We look forward to continued opportunities to support our clients and partners in their efforts to advance access to affordable, high quality health coverage and care for all. Thank you for being on this journey with us.

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Author

Hilary Haycock [President]