Legislative Interim Update, April 27

DW Admin on April 27, 2018

During the 85th legislative session, Methodist Healthcare Ministries tracked roughly 1,400 bills, supported over 500 bills, and worked to assist the passage of 224 laws that affect access to health care for Texas families. Keep up to date on how those laws are being effectively implemented and funded as intended through our legislative updates.

Interim Updates

Upcoming Meetings & Events

Health Care Policy News
 

 

View our 2017 Legislative Agenda

Advocacy

Policy

Research

___________________________________________________________________________________________

Interim Updates

Texas combats the opioid epidemic
The opioid crisis that has plagued the nation in recent years is no stranger to Texas. New data provided by several federal and state agencies stressed that comprehensive change is required to curb this epidemic. At the national level, the CDC reported that emergency department visits for opioid overdose rose 30% in all parts of the United States from 2016 to 2017. Similar trends are seen in Texas with the state’s health department reporting opioids are the main drugs related to admissions in emergency departments. In Bexar County, local county and city health officials formed the Bexar County Joint Opioid Task Force in the summer of 2017 to confront this public health emergency head-on. The interagency public-private collaboration is seeking to decrease the number of opioid deaths in Bexar County and develop strategies to address the opioid crisis in a comprehensive manner. At the state level, House Speaker Joe Straus created the Select Committee on Opioids and Substance Use. Committee members will meet over the next few months to take testimony from state and local health officials to develop a strategy of statewide proposals for the upcoming 86th Legislative Session. Methodist Healthcare Ministries is part of both local and state efforts and will develop a legislative initiative about the opioid epidemic in its 86th legislative agenda.

House Appropriations health care subcommittee reviews health care reform and 1115 Medicaid Waiver
The Texas House Committee on Appropriations met on April 4 to address some of the biggest challenges facing the Texas Medicaid program, including changes to federal policy, substantive reforms to the program and ongoing fiscal challenges from increasing costs. Testimony was shared by hospital providers expressing concerns over the federal administration’s unwillingness to make supplemental payments to cover Medicaid shortfall costs (about $2 billion per year for Texas hospitals). Several providers highlighted the transition and elimination of the Delivery System Reform Payments (DSRIP) under the renewed 1115 Medicaid waiver (learn more).

The effectiveness of adding Medicaid work requirements in Texas was also addressed. States that have adopted work requirements will reduce program coverage, including Kentucky, which is planning to reduce enrollment rates by 95,000 people. Data shared by the Center for Public Policy Priorities (CPPP) argued that work requirements would not get people off Medicaid because one in eight working Texas families live in poverty. The state’s Medicaid program plays an important role in securing access to care for Texas working families and is a legislative priority for Methodist Healthcare Ministries.

Mental health parity work group continues work to implement HB 10 provisions
In health insurance, the term “parity” describes the equal treatment of mental health conditions and substance use disorders in insurance plans, when compared to coverage for medical or surgical health care. This past legislative session, Methodist Healthcare Ministries worked to pass HB 10, which called for stronger insurance laws to ensure providers complied with equal access to both services.  

Since the bill’s passage, HHSC has formed the Mental Health Condition and Substance Use Parity Work Group and made several stakeholder presentations on the implementation of parity laws. The work group has established protocols to monitor parity complaints and provider compliance, and subcommittees that review enforcement, investigations and education efforts. HHSC is currently in the process of creating a website designed for behavioral health rights and is working with the Texas Department of Insurance to develop a formal complaint process. Methodist Healthcare Ministries is closely tracking the state’s efforts to ensure that more Texans gain equal access to mental health and other health care services needed to achieve recovery.

New Texas maternal mortality rates released
A new study by researchers at the Texas Department of State Health Services is reporting that the number of maternal deaths in Texas in 2012 was actually less than half the number previously reported. The research determined there were 56 maternal deaths among Texas residents compared with the 147 reported in national statistics. The study shows dozens of women were identified on their death certificates as being pregnant at the time of their deaths when they were not. The misclassification most likely occurred because people certifying the deaths selected the wrong pregnancy option in the electronic system used to register deaths. The more accurate, verified data is an important part of state efforts to improve maternal health, including the ability to implement and assess ways to reduce maternal deaths and other severe pregnancy complications.

This new study shows why the work of the Texas Maternal Mortality and Morbidity Task Force is so incredibly important. The Task Force and DSHS crosscheck a variety of sources to confirm a pregnancy-related death, not just a reporting mistake. Texas has important opportunities for improvement to reduce maternal death and severe morbidity. DSHS is testing out new solutions such as implementing the Texas Alliance for Innovation on Maternal Health (Texas AIM) program to help hospitals and communities improve maternal safety by implementing best practices. More than 100 hospitals have expressed interest in adopting the Texas AIM bundles for hypertension, opioid use, and severe hemorrhage. Methodist Healthcare Ministries monitors the task force and maternal mortality in Texas.

Federal Updates

Federal administration considers new rules for immigration status
On March 29, the draft regulation on public charge was sent to the Office of Management and Budget. Public charge is a ground of inadmissibility (to the U.S.) if non-citizen applicants are likely to rely on the government for subsistence in the future. Under current policy, immigration officials must look at all factors that relate to non-citizens’ ability to support themselves, including income, assets, family support and need for monthly cash assistance. The proposed rule would instruct immigration agents to consider whether an immigrant or a member of their family is likely to participate in any government assistance program (including CHIP, Medicaid and SNAP) when determining who can enter the U.S or become a permanent resident.

Administration officials state that these changes would protect taxpayers by ensuring foreign nationals seeking to enter in the U.S are self-sufficient. On the other side, critics argue that the proposed changes would represent a major step backward, pulling the entire safety net out from under taxpaying immigrant families and putting them at greater risk of falling into poverty. Methodist Healthcare Ministries will continue to monitor the proposed rules.
 

Upcoming Meetings & Events

May 5: Mental Health and Addiction Awareness Fiesta (San Antonio)
May 9: State of Texas Active Response to ZIKA (McAllen)
May 9:  House Human Services Committee Hearing (Austin)
May 10: Hospital Payment Advisory Committee (Austin)
May 30-31: Telehealth at the Crossroads Conference (San Antonio)

Health Care Policy News

Health Care Funding
The McAllen Monitor: RGV’s Rep. Longoria appointed to powerful LBB

Prescription Drug Prices
To the Point: Policy Prescriptions for High Drug Cost: Experts Weight In

Children’s Therapy Services
The Texas Tribune: Texas children’s therapy providers face dilemma over offering services

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Farewell from Kevin C. Moriarty

DW Admin on April 13, 2018

When I announced my plans to retire last June, I shared a story with my team that shaped my life in ways I could not have imagined. It’s a story that paved the road for the wonderful journey I have been on for the last 22 years at Methodist Healthcare Ministries. It begins in Africa where I served as a teacher through the Peace Corps as a young man. One day, I burned my arm and was taken to see a doctor who was there on a mission with The United Methodist Church. I was so impressed by the sense of purpose the doctors and nurses who worked in the Methodist clinic had that it inspired me to consider working in health care. I could not have known then, but that experience was the start of a journey that has been guided by a passion for public service, health ministry, and profound love for my community. Through the years my journey has had incredible peaks, filled with wonderful people who carried me through life’s valleys. I have been blessed beyond measure to have been part of the Methodist Healthcare Ministries’ team and honored to serve as the organization’s first chief executive officer. And now, I stand ready to embark upon a new journey. But, I want to first take a moment and reflect on the impact Methodist Healthcare Ministries’ has had and share my hopes for all the good it has yet to do.

Together, the team has brought much-needed care to uninsured and low-income individuals and families across South Texas. In 1996, Methodist Healthcare Ministries operated one program of $300,000 for 2,900 patient and client visits; this year we have a budgeted expenditure of more than $112 million for nearly 950,000 patient and client visits. In the beginning, we provided grant funding to fewer than five agencies and today the organization has more than 90 funded partners. I am extraordinarily proud to have been part of something that created access to care for so many and for whom it would have been unobtainable otherwise.

The team at Methodist Healthcare Ministries has also grown. We started with just three employees, most of whom are still with the company, and today the team stands at 420 strong. The growth and impact have been incredible. I am so proud of all the team members who have made Methodist Healthcare Ministries’ successful—which for us, means more people received care and that’s what matters.

I wish to thank Jen, my wife, who has been by my side for 17 of my 22 years at Methodist Healthcare Ministries. She has attended countless events with me, representing Methodist Healthcare Ministries extraordinarily well.

It has been especially fulfilling growing the next generation of leadership within the organization. I have always used the words of John Wesley, founder of Methodism, to guide the decisions I made as CEO, to do all the good we can, by all the means we can, for as many people and as long as ever we can. I hope these words continue to serve as a guiding light for the team that will lead Methodist Healthcare Ministries into its future. I know Marc Raney, who will serve as interim CEO while the search for the next president of the organization is concluded, will continue to use the challenge John Wesley issued to us to inspire the organization to continue advancing our mission of “Serving Humanity to Honor God”—as he did for me when he hired me in 1996 during his tenure as chair of the Methodist Healthcare Ministries’ board of directors. It’s a reminder to me, that sometimes our journey comes full circle, and creates the opportunity to embark upon new ones. I am grateful to Marc for his mentorship, years of friendship and for his commitment to Methodist Healthcare Ministries.

I have carried countless patients’ and clients’ stories in my heart over the years as they are the reasons why Methodist Healthcare Ministries has also been a champion for policies that create access to quality care for all, regardless of ability to pay. Their stories have humbled and inspired me, and are living reminders of what the Bible tells us in Micah 6:8: To act justly, love mercy, and walk humbly. I will keep all their stories in my heart and top of mind as I continue my service to the community.

I started with a story about how my journey began and am now excited to travel down a new path, embark upon a new adventure. I know it will be just as wonderful as the last 22 years have been. I wish Methodist Healthcare Ministries, the board of directors, all the team members, partners and other entities who work so hard to advance its mission all the best and to keep doing all the good you can. Thank you for making this chapter in my own story such a memorable one.

 

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The side I saw in Marion

DW Admin on April 5, 2018

You see the girl in the picture on the right with the white t-shirt and toothbrush – that’s me. My first encounter at Methodist Healthcare Ministries wasn’t in 2015 when I became a team member, it was actually in 2002. I was eight years old and the setting was School Based Health Center at Krueger Elementary. At first, I knew little of all the amazing ways Methodist Healthcare Ministries served its communities, but I was about to go on a journey that would open my eyes to every side of the organization.

My mom was the first person to introduce me to Methodist Healthcare Ministries. She has been faithfully serving as a front office supervisor at School Based Health Center since 2002 to ensure the pediatric primary health care and dental services the clinic offers are compassionately provided to children enrolled in the Marion and Schertz-Cibolo-Universal City Independent School Districts. When I was young, she would bring me along to help at community events the clinic hosted. I have so many memories of volunteering at the clinic, but my fondest were the annual back-to-school fairs. We would get there early and start organizing school supplies — backpacks, crayons, pencils, paper, notebooks — you name it! We took up a whole conference room and created an assembly line for children to come through and fill up their new backpacks. The line usually went out the door and wrapped around the clinic with families eager to get their children’s school supplies. From little ones starting their early education to juniors and seniors in high school, no one left without receiving what they needed. Hearing kids ask excitedly, “Is this my backpack? I get to keep it?” and telling them yes warmed my heart. At the end of the day, we typically filled about 200 backpacks for each child in need.

I thought, “Wow, how great that an organization could be this committed to serving their community!” Seeing that commitment to service from an early age inspired me to join Methodist Healthcare Ministries and make it a part of my future. Fast forward to 2015 —when I became a team member I was overwhelmed with happiness to know the impact I’d seen at School Based Health Center didn’t stop there.

Growing up, I had been exposed to the health care services side of our organization and the ways our clinics provide medical, dental and behavioral health services to patients in need. I hadn’t yet learned about our grant-making and advocacy side. My jaw dropped during our new hire orientation at the fact that we offer services in 74 counties across South Texas, and help more than 90 organizations across those counties better provide health care services to those in need. Through advocacy, we increase the public’s understanding of how health care policies can affect their communities. We also educate policy-makers on policy challenges in an effort to increase access to quality health care services for others.

Since my journey with Methodist Healthcare Ministries began almost three years ago, my eyes have been opened and my heart filled to see all the important ways our organization makes a lasting difference across South Texas. While I don’t directly work with patients, I know my purpose is to share the stories of team members who’ve dedicated themselves to improving the physical, mental and spiritual health of the least served. I think each team member has met a side of Methodist Healthcare Ministries that has left a mark in their hearts. The side I saw in Marion was only one piece of the organization. It shaped a new way of thinking for me – that serving those who need you the most can be done in many ways. As I look to the future, I’m excited to learn more through telling the powerful stories of how Methodist Healthcare Ministries fulfills its mission of “Serving Humanity to Honor God.”

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Coffee with Cassandra: Intentionally appointed Pastors

DW Admin on March 28, 2018

Before you start your workday, enjoy your morning coffee with brew from Methodist Healthcare Ministries. This is your daily dose of stories that speak to the heart of our organization, paired with your favorite cup of joe!

Methodist Healthcare Ministries has nearly 400 team members who are dedicated to creating access to health care for uninsured and low-income families. We believe that caring for our communities starts by caring for the mind, body and spirit of our team members. One of the ways we embody our core value of spirituality is by intentionally placing Pastors to care for our team members in many ways.

For this episode of Coffee with Cassandra, I had the pleasure of sitting down with Pastor Aaron Gonzalez. Pastor Aaron takes care of our San Antonio and surrounding area team members along with two other Pastors. He explains how he came to Methodist Healthcare Ministries and how vital his role is in creating a culture of spiritual growth.

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Methodist Healthcare Ministries Provides Philanthropic Leadership in Value-Based Funding

DW Admin on March 22, 2018

Change is coming!

Federally Qualified Health Centers (FQHCs) will soon be subject by law to the Merit-based Incentive Payment System (MIPS). This means that part of their funding will be at risk, based on whether their patients get healthier. This is known as value-based funding. Payment reform makes sense – our health care system should encourage providers to do what it takes to get patients healthy, even if that’s not business as usual. MIPS is a huge change for FQHCs, who are used to being paid for the provision of services, not for patient health outcomes.

Many funders are starting to look at readiness for payment reform (MIPS), trying to figure out how to help their grantees adapt to the change. Methodist Healthcare Ministries’ approach to helping its grantees, or ‘funded partners,’ is different. Rather than training funded partners, the organization is using experiential learning. Methodist Healthcare Ministries is the first grant funder in the nation to engage in value-based grant funding in health care. While managed care organizations are trying it, and some state Medicaid agencies have utilized the value-based funding model, foundations and other grant funders are not. This makes Methodist Healthcare Ministries a trailblazer in the philanthropic sector.

Prior to 2017, Methodist Healthcare Ministries used a service-based grant model for all its grants. However, it shifted its funding for FQHC partners to value-based grants to “improve the health of those least served,” and not just “count the heads of those least served.” With this grant structure, the organization pays for what it really wants: healthier patients. If patients hit a targeted level of health improvement for a co-morbidity, FQHCs receive an additional amount of money for each co-morbidity. The funding is completely flexible; FQHCs can spend the grant however they want, to help patients get healthier.

Early results

The change to a value-based funding model allows Methodist Healthcare Ministries to receive patient-level data for deep analysis of strategies that are effectively improving patient health outcomes. So far, the results have been very positive both in terms of being a catalyst for innovative changes in the participating FQHC’s delivery of care – thanks in large part to the flexibility in the use of funds, and patient health outcomes. Some have developed completely new programs, with patient commitment forms, and practice changes, including nutrition and exercise support services, and “higher touch” models such as case management and home visits, with frequent patient outreach. Gateway Community Health Center in Laredo, for example, created the “Lado a Lado” model incorporating several of these elements, which has greatly increased patient compliance and has excelled in diabetes management. Before we offered the flexible funding, Gateway’s spending on their Methodist Healthcare Ministries grant was focused on routine clinic-based care.

More importantly, patients have gotten healthier. Four core metrics were established as part of the new funding strategy in 2017, related to co-morbidities in the patient panel: 1) HbA1c control for diabetics; 2) blood pressure control for hypertense patients; 3) PHQ9 symptom reduction for depressed patients, and 4) BMI reduction. Except for BMI reduction, which was too challenging for a one-year period, most of the health centers did very well on the outcomes; 86 percent of the patients receiving care through this funding showed improvement on at least one of these co-morbidities.

Learning through doing

According to the funded partners participating in the program, it has been a tremendous source of learning. “We didn’t know what we didn’t know,” one funded partner said recently. “It’s all about the details, and you only learn those lessons through experience.”

Until one partner had to start reporting, they had no idea it would take their physicians seven hours a week to pull the data needed for MIPS. They were able to modify their Electronic Medical Record (EMR) templates and reporting system to make it faster and more efficient. That will have benefits far beyond the Methodist Healthcare Ministries grant.

As Albert Einstein said, “Anyone who has never made a mistake has never tried anything new.” We at Methodist Healthcare Ministries learned alongside our funded partners in exploring this new payment structure – lessons that may benefit other funders exploring value-based funding:

  • It’s important to gain consensus on the metrics to be used and the amounts in the payment structure. Methodist Healthcare Ministries went through an iterative process with the FQHCs to select metrics they were willing to try and worked closely with the accounting department to develop and refine the payment structure.
  • It’s important to use nationally benchmarked metrics such as those with a Medicaid average, metrics aligned to MIPS, or Healthy People 2020. That means the bar is set in a realistic place and the FQHCs are likely to be tracking those things already. The funder has a responsibility to set metrics realistically, as setting the bar too high can cost the FQHCs money in this type of payment structure.
  • It’s likely that some patients selected for the panel will leave the FQHC during the year. Low-income, uninsured populations tend to be more transitory; they could move, get a job with health insurance, change phone numbers, or lose their transportation. Methodist Healthcare Ministries adjusted its terms with funded partners so that if those type of changes occurred in the first half of the year, the FQHCs could replace those patients, within limits (to ensure there was enough time for the newly added patients to get healthier).
  • The FQHCs needed more help than anticipated with pulling data from their EMRs. Funders investing in this model should be prepared to provide technical assistance with data management. In 2018, Methodist Healthcare Ministries will fund a software project to make it easier for the FQHCs to pull report data from their systems.
  • It is important to define everything. Small differences of meaning or interpretation could affect how much money an FQHC receives. It’s important to be clear upfront about what qualifies for an incentive payment, when an FQHC will receive disbursements, what patients are eligible for panels, and which diagnosis codes qualify for each co-morbidity.
  • FQHCs need flexibility on co-payment rules. At the onset of this new funding structure, Methodist Healthcare Ministries required a co-payment waiver from participating partners. This was a problem for some FQHCs, as they found that “neighbors talk to neighbors,” and some patients that were not in the panel were distressed that those who were in the panel didn’t have to pay. For 2018, the requirement to implement a co-payment waiver was removed, allowing FQHCs to charge a co-pay, but the fee is capped at $20. Interestingly, many of the FQHCs have chosen to keep the waiver because they found it improves patient compliance. Patients are more willing to come to follow-up visits if they don’t have to pay additionally.
  • Remember that we’re all learning. We at Methodist Healthcare Ministries openly acknowledged that we were learning alongside the participating FQHCs. Listening was very important. We admitted mistakes and made any course corrections we could. For example, we changed the PHQ9 metric to a tiered structure, which allowed a more modest change for mildly depressed patients. We had expected that, on average, most patients would come in at higher levels of depression, but that wasn’t true at some of the FQHCs.

What’s next for the Methodist Healthcare Ministries’ value-based funding model?

In 2018, prevention metrics were added to supplement the disease-management and obesity metrics collected from funded partners. We have also changed the metrics to be aligned with national benchmarks and MIPS metrics, which we believe will make them more realistic and attainable. Methodist Healthcare Ministries is also commissioning a software company to build a cloud-based reporting system that will make it easier and faster for the FQHCs to report back.

The bottom line is that the experiential learning so far has been deep and detailed, both for Methodist Healthcare Ministries and our FQHC funded partners. No workshop can teach FQHCs in this much depth what they need to do to modify their EMR templates, or change the way their physicians chart, for example. This is the great value of this program; because they have learned through experience, FQHCs will be better-equipped to handle MIPS when millions of dollars, not thousands, are on the line.

 

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Legislative Interim Update, March 22

DW Admin on March 22, 2018

During the 85th legislative session, Methodist Healthcare Ministries tracked roughly 1,400 bills, supported over 500 bills, and worked to assist the passage of 224 laws that affect access to health care for Texas families. Keep up to date on how those laws are being effectively implemented and funded as intended through our legislative updates.

Interim Updates

Upcoming Meetings & Events
Health Care Policy News
 

 

View our 2017 Legislative Agenda

Advocacy

Policy

Research

___________________________________________________________________________________________

Interim Updates

Methodist Healthcare Ministries’ COO appointed to state Hospital Payment Advisory Committee (HPAC)
Congratulations to Methodist Healthcare Ministries’ Chief Operating Officer, George Thomas, who has been selected to serve on the state Hospital Payment Advisory Committee for a six-year term. The Hospital Payment Advisory Committee functions as a sub-committee of the Medical Care Advisory Committee (MCAC) and advises MCAC and the Health and Human Services Commission (HHSC) about hospital reimbursement methodologies for inpatient hospital prospective payment and on adjustments for disproportionate share hospitals. The committee advises HHSC to ensure reasonable, adequate, and equitable payments to hospital providers and to address the essential role of rural hospitals. This distinguished appointment will assist Texas hospitals in receiving adequate funding for care for our most vulnerable families.

Methodist Healthcare Ministries releases bill summaries for children's and women's health legislation
During the 85th legislative session, Methodist Healthcare Ministries supported important health care initiatives to improve services and funding impacting children and women. Legislation that passed both houses and was signed by the Governor included: maternal mortality and morbidity, reform for Child Protective Services, children’s mental health, access to women’s health services and more. Overall, Methodist Healthcare Ministries supported 58 bills that became law in 2017-2018 and will make a difference in the lives of Texas children and women. View summaries of bills impacting Texas children and women.

Robert Wood Johnson Foundation releases 2018 County Health Rankings
The Robert Wood Johnson Foundation released its 2018 County Health Rankings Report, which measures counties on how well they do across various health and well-being measures. For the first time, the report examined how race and ethnicity intersect with a county’s health score and how the availability of affordable housing, safe neighborhoods, access to jobs and high-quality education can affect a county’s health numbers. Posting the lowest rankings out of 247 counties were Duval, Brooks, San Augustine, Hudspeth and Shelby counties.

Texas Statewide Health Coordinating Council includes health literacy and oral health in state health plan
The Texas Statewide Health Coordinating Council met on March 1 to discuss proposed updates to the Texas State Health Plan (TSHP) report. The council meets regularly to ensure health care services and facilities are available to all Texans through health planning activities. Proposed updates to the TSHP report will include analyses and recommendations in five new areas: oral health, clinical site availability, health literacy, hospital trauma designation and federally qualified health centers.

The council also received an activity report on the Texas Higher Education Coordinating Board’s efforts to implement SB 2118, passed in the 85th legislative session. The board reported nine junior colleges had applied to incorporate baccalaureate degree programs in areas that demonstrated a workforce need, including nursing and dental hygiene. Methodist Healthcare Ministries' legislative agenda targeted key initiatives impacting access to care, including health literacy and the state’s workforce shortage. We will continue to monitor the progress made by both state agencies and share updates as they develop.

Texas E-Health Advisory Committee implements key telemedicine bills
The Texas E-Health Advisory Committee met on March 2 to share updates on the latest policies and services impacting the use of health information technology, health information exchange systems, telemedicine, telehealth and home telemonitoring services. HHSC staff provided an update on the implementation of SB 1107, regarding protocols and reimbursement for telemedicine services. Proposed rules are on track to be available for review in the next 3-4 weeks.

Committee members also received an update on HB 1697, which involves the availability of pediatric telemedicine services in rural counties. The bill was passed in the 85th legislative session but failed to get state funding. HHSC has moved forward to develop a workgroup on tele-NICU and tele-ER to study the costs of transporting children from hospital NICU departments to other hospitals, and to study rural hospitals’ capacity and interest in telemedicine. Research data will evaluate the possibility of developing a pilot program in 2019. Methodist Healthcare Ministries will continue to monitor HHSC’s efforts in implementing telemedicine services that serve to increase access to care for rural and underserved areas of the state.

Texas Public Health Coalition applauds the City of San Antonio for Tobacco 21 ordinance
The Texas Public Health Coalition convened for its first meeting of the year on March 2. The statewide coalition works to reduce preventable disease by advancing effective public policies that promote healthy environments and healthy behaviors for Texas residents. Coalition members applauded the City of San Antonio on the recent passage of its Tobacco 21 ordinance and will follow up with a letter to City Council members thanking them for their efforts. Members also identified key priorities to develop for the upcoming 2019 legislative session, including community access to healthy food, maternal and infant health, and childhood immunizations. Methodist Healthcare Ministries is an active member of the coalition and will work to develop and promote efforts to improve public health in Texas communities.

Upcoming Meetings & Events

March 27: House Select Committee Hearing on Opioids & Substance Abuse
March 28: TexasAIM Webinar on Implementing AIM Maternal Safety Bundles in Texas
March 29: UTRGV M.A.S.S Lecture Series
March 31: Application for the Maternal Mortality and Morbidity Task Force
April 5-6: Texas Primary Care and Health Home Summit
April 13-14: RGV Medical Education Conference & Exposition
April 20-21: San Antonio Substance Use Symposium
April 24-25: Eliminate Tobacco Use Summit
April 26-27: Active for Life Health & Wellness Conference
 

Health Care Policy News

Women’s Health
The Texas Tribune: Four highlights from the Texas Tribune’s women’s symposium roundtables

Immunizations
MySA: Immunize our kids from HPV-related cancer

ACA Special Enrollment Periods
CPPP: New outreach materials for special enrollment periods

Spinal Screening
Texas Department of State Health Services: Spinal screening policy effective 2018-2019 school year

Eugene Washington PCORI Engagement Awards
PCORI: Funding Opportunities

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Lifestyle Changes and Population Health: The Words of John Wesley

DW Admin on March 6, 2018

As a health care organization affiliated with Methodism, I think it’s important to celebrate the wisdom, pragmatism, and vision of “Primitive Physick or, an Easy and Natural Method of Curing Most Diseases,” written by John Wesley. First published in 1747, this book of practical medical advice touched on population health before we even defined the term “population health.” Wesley attempted to divulge the best treatments physicians provided to wealthy clients and make them available to everyday people who couldn’t afford that care.

Compared to many of the ineffective or even harmful treatments of that time period, some of Wesley’s advice in “Primitive Physick” is strangely sensible, such as the prescription for “extreme fat”:  

Use a total vegetable diet. I know one who was entirely cured of this, by living a year thus: she breakfasted and supped on milk and water (with bread) and dined on turnips, carrots, or other roots, drinking water.

Beyond its insight into 18th-century medicine, I have two significant takeaways from “Primitive Physick”:

1.  Wesley repeatedly emphasizes the importance of lifestyle changes, which are just as essential now as they were in his time. In the preface, he specifically highlights the role of diet, exercise, sleep and faith: 

Observe all the time the greatest exactness in your regimen or manner of living. Abstain from all mixed, all high seasoned food. Use plain diet, easy of digestion; and this as sparingly as you can, consistent with ease and strength. Drink only water, if it agrees with our stomach; if not, good, clear small beer. Use as much exercise daily in the open air, as you can without weariness. Sup at six or seven on the lightest food; go to bed early, and rise betimes. To persevere with steadiness in this course, is often more than half the cure. Above all, add to the rest, (for it is not labour lost) that old unfashionable medicine, prayer. And have faith in God who "killeth and maketh alive, who bringeth down to the grace, and bringeth up.

As we work to positively impact the health of people and communities across South Texas, tackling chronic diseases like obesity and diabetes, we can remember that our holistic approach to health – mind, body, and spirit – is part of a long Methodist tradition.

2.  Beyond individual health, Wesley cared deeply about population health. “Primitive Physick” is Wesley’s attempt to democratize safe, affordable, and easy medical care by making it available to poor and working-class people.

Moreover, Wesley seems just as eager to prevent sickness as he is to treat it. He declares that a regimen of exercise and healthy diet is “one grand preventative of pain and sickness of various kinds,” noting that “the power of exercise, both to preserve and restore health, is greater than can well be conceived.” He also offers directives about sanitation, bathing, abstinence from strong liquors, and emotional health.

Population health forces us to look carefully at outcomes, especially for disadvantaged communities, and recognize the impact of social, physical, and economic factors on those outcomes. By publishing “Primitive Physick,” Wesley attempted to improve health outcomes for low-income people throughout England and North America. Clearly, Wesley recognized the significance of factors beyond proficient medical care in maintaining good health.

Increasingly, I see Methodist Healthcare Ministries embracing a population health approach to our work. This is critical because it will fundamentally improve our ability to fulfill our mission to improve the physical, mental, and spiritual health of those least served in the Rio Texas Conference area of The United Methodist Church. By moving upstream to prevent chronic disease, by disaggregating data to examine health outcomes for specific groups, by collaboratively addressing factors beyond clinical care, our funding and resources will be even more effective in affecting the health of communities throughout the 74 counties we serve. Wesley would be proud.

In closing, I offer a quote from Wesley about faith and health: 

"the love of God, as it is the sovereign remedy of all miseries … by the unspeakable joy and perfect calm serenity and tranquility it gives the mind … becomes the most powerful of all the means of health and long life."

John Wesley wrote these words at the conclusion of his preface in “Primitive Physick.” May they be just as healing for us today as they were for his readers almost three centuries ago.

For those interested in additional reading on this topic, I recommend two articles beyond the text of “Primitive Physick” itself:

 

About the author
Tim Barr is the Collective Impact Strategy Manager for Methodist Healthcare Ministries. He supports, develops, and facilitates collaborative efforts in the Coastal Bend region and throughout the 74 counties that Methodist Healthcare Ministries serves.

 

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Legislative Interim Update, March 2

DW Admin on March 2, 2018

During the 85th legislative session, Methodist Healthcare Ministries tracked roughly 1,400 bills, supported over 500 bills, and worked to assist the passage of 224 laws that affect access to health care for Texas families. Keep up to date on how those laws are being effectively implemented and funded as intended through our legislative updates.

Interim Updates

Upcoming Meetings & Events
Health Care Policy in the News
 

 

View our 2017 Legislative Agenda

Advocacy

Policy

Research

___________________________________________________________________________________________

Interim Updates

Texas Statewide Health Coordinating Council addresses the impact of health literacy
During the 85th Legislative Session, Methodist Healthcare Ministries worked with Representative Diana Arévalo (D-San Antonio) and Senator Eddie Lucio (D-Brownsville) to draft HB 3682, which requires the statewide health coordinating council and state health plan to examine and report on the impact of low health literacy on consumers and the health care system. HB 3682 passed through the House Public Health Committee with bipartisan support, but died on the House Floor due to lack of time.

The Statewide Healthcare Coordinating Council, who identifies challenges and concerns that Texas faces in health care services, is working to incorporate the issue of health literacy into the state health plan. The full council met on March 1 to learn more about the impact of health literacy on consumers. Read the meeting agenda.

As part of our legislative initiative to increase access to quality health care, Methodist Healthcare Ministries focused on the issue of health literacy. Only 12 percent of adults have proficient health literacy, according to the National Assessment of Adult Literacy. Low literacy has been linked to poor health outcomes, such as higher rates of hospitalization and less frequent use of preventive services. Methodist Healthcare Ministries commends the Texas Health and Human Services Commission (HHSC) and members of the Statewide Healthcare Coordinating Council on being proactive and addressing the health care challenges associated with low literacy rates.

Voluntary guidelines proposed for hospital emergency departments to minimize opioid misuse
As part of its efforts to minimize the use of opioid painkillers in emergency rooms across Texas, the Texas Hospital Association (THA) has proposed voluntary recommendations to help reduce the number of opioid-related deaths in Texas. With input from the association’s behavioral health council, hospital physician executive committee and quality and patient safety council, the recommendations range from risk identification to prescribing guidelines.

Included in the recommendations are the development of processes for identifying patients both at risk for developing a substance use disorder and for those with a substance use disorder, including a protocol for treating pregnant and postpartum women. Hospitals should also consider adopting a multi-modal non-opioid medication model for acute pain management treatment and use short-acting opioids. The recommended guidelines are written in a way where hospitals can adjust them to fit their community’s needs, as reported by KXAN.

At the local level, Methodist Healthcare Ministries is taking part in Bexar County’s Opioid Task Force efforts. The issue will also be addressed by state lawmakers through upcoming hearings held by the House Select Committee on Opioids and Substance Abuse. 

Federal administration considers rule targeting immigrants who receive public benefits
The federal administration is considering new rules that would make it more difficult for immigrants to be admitted to the U.S. or to get green cards if they or their children receive certain public benefits, including some forms of Medicaid or Head Start. As defined in the proposed language, a public benefit includes cash benefits such as TANF, Head Start’s educational and developmental supports, CHIP coverage, financial help to purchase health coverage, SNAP assistance, WIC assistance, some housing support and transportation vouchers. The new rule does not exempt refugees and people seeking asylum from the public charge test. Read more on Reuters.

Although this rule is not final, if passed it would slow immigrants’ social and economic integration and raise public health issues. It would also deter people from seeking medical care when they need it most. Methodist Healthcare Ministries is working with its advocacy coalition partners to learn more about the proposed rule and educate state policymakers on the negative impact the rule would have on immigrant families.

Statewide stakeholder meetings scheduled to address immunization policies
Methodist Healthcare Ministries is working with The Immunization Partnership to hold several stakeholder meetings throughout the state to educate communities on current national and state immunization issues and policies. The meetings will be held in San Antonio on April 10 and in Laredo on May 10. There is no cost to attend, however, registration is required.

In Bexar County, only two-thirds of children are up-to-date on their immunizations, according to Texas Public Radio. The San Antonio Metro Health District has created multiple programs in place to make sure vaccines are accessible to the public, including free flu shots to the public.

This past legislative session, Methodist Healthcare Ministries supported legislation that would allow greater transparency with collection and access to immunization data. The bills were heard by the House Public Health Committee but failed to garner the necessary votes to pass.
 

Upcoming Meetings & Events

March 6: Texas Health and Human Services' Regional Community Partner Forum
Texas HHSC and the Community Partner Program (CPP) are hosting Regional Community Partner Forums around the state. Join them in San Antonio on March 6 for training and updates from HHSC, CPP, and YourTexasBenefits.com. Network with local community partners and develop relationships to connect clients to services. Learn more.

March 15: House Human Services Hearing
The House Human Services Committee will meet to review the history of Medicaid Managed Care in Texas and determine the impact on quality and cost of care. They'll also review initiatives that managed care organizations have implemented to improve quality of care, and review the Commission’s oversight of managed care organizations. View hearing notice.

March 15: Mental Health Awareness Art Contest
Texas HHSC invites students and adults to tell their stories about why mental health matters to them through poster art, writing, videos, and photography. Participants will have their work displayed and published across the state. The deadline to register is March 15.  View guidelines and entry form. 

March 20: Senate Finance
The Senate Finance Committee will meet to discuss options to increase investment earnings of the Economic Stabilization Fund and monitor the state’s progress in coordinating behavioral health services and expenditures across state government, including new local grant funding. View hearing notice.

March 21: RHP6 Stakeholder Forum
University Health System will present the draft RHP 6 Plan Update for Demonstration Year 7-8 of the Medicaid 1115 Waiver, and providers will share their transformation goals and strategies for the DSRIP program. The event is scheduled to begin at 1:00 p.m. at the San Antonio Food Bank. Register here.

March 22: Senate Health and Human Services
The Senate Health and Human Services Committee will meet to review child welfare issues and reviewing substance use prevention, intervention and recovery programs, including services for pregnant and postpartum women enrolled in Medicaid or Healthy Texas Women Program. View hearing notice.

April 20-21: San Antonio Substance Use Symposium
The San Antonio Substance Use Symposium will bring health care providers and community members to collaboratively identify opioid challenges and solutions to this public health crisis. Topics will include prescription monitoring programs, medication to treat opioid use disorder, and special populations. Learn more and register.
 

Health Care Policy in the News

Federal budget
How the President’s Proposed FFY 2019 Budget Impacts Critical State Health Programs (NASHP)
The Office of Management and Budget released the president’s FFY 2019 budget request that proposes $68.4 billion for health programs administered by the U.S Department of Health and Human Services, $17.9 billion less than 2017 funding levels. The budget proposal included an addendum designed to align the proposed White House budget with the recently passed Bipartisan Budget Act. Read more.

Mental health care services in the RGV
Mental health and treatment in the Rio Grande Valley (The Monitor)
The Rio Grande Valley is considered an underserved community of medical and mental health care, but some efforts have been made to abate this mental health care shortage. The local mental health authority, Tropical Texas Behavioral Health, has expanded its mental health programming with help from organizations, such as Methodist Healthcare Ministries, to provide low-cost mental health services to the community. Read more.

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Legislative Interim Update, Feb. 14

DW Admin on February 14, 2018

During the 85th legislative period, Methodist Healthcare Ministries tracked roughly 1,400 bills, supported over 500 bills, and worked to assist the passage of 224 laws that affect access to health care for Texas families. Keep up to date on how those laws are being effectively implemented and funded as intended through our legislative updates.

Interim Updates

Upcoming Meetings & Events
Health Care Policy in the News
 

 

View our 2017 Legislative Agenda

Advocacy

Policy

Research

___________________________________________________________________________________________

Interim Updates

Texas awards $27.5 million for local mental health programs 
The Texas Health and Human Services Commission (HHSC) recently announced it is awarding up to $27.5 million in grant funds through two grant programs that support local mental health services and programs. The Mental Health Grant Program will award up to $12.5 million to justice-involved individuals (SB 292), and the Community Mental Health Grant Program (HB 13) will award up to $15 million. Methodist Healthcare Ministries informed all funded partners of the grants and assisted interested organizations with the application process (read more).

Congratulations to our partners Border Region Behavioral Health Center, Center for Healthcare Services, Gulf Bend Center, and MHMR Services for the Concho Valley for being among the 25 local mental health authorities selected by HHSC as awardees for HB 13. All selected organizations will begin providing services pending execution of contracts. Final contract terms will be negotiated over the next few weeks with anticipated start dates in April.

All 14 local mental health authorities who submitted applications under SB 292 were chosen to receive funding.

Congress passes continuing resolution (CR) to fund Community Health Centers 
After technically allowing the federal government to shut down for five hours on Feb. 9, Congress passed a continuing resolution (CR) that will keep federal programs running through March 23. The CR includes a two-year funding extension for Community Health Centers, with an increase of $600 million for the program over the two-year period. It also includes funding for the Teaching Health Center Graduate Medical Education program which funds residency programs in community health centers and adds an additional four years to the Children’s Health Insurance Program bringing the total CHIP funding period to 10 years. The CR increases the budget caps by $300 billion for fiscal year 2018 and fiscal year 2019 and provides nearly $90 billion in hurricane disaster relief for Texas, Florida and Puerto Rico.

In Texas, more than 1.3 million residents were at risk of losing access to primary care services if the federal government had not renewed funding for community health centers. The budget impasse that began five months ago had forced many centers to freeze hiring, put off service expansions, and tap into financial reserves.

Methodist Healthcare Ministries releases bill summaries for new behavioral health laws 
Of the more than 1,400 bills tracked by our Policy & Advocacy department this past session, 34 bills impacting mental health services and funding were signed into law. View our bill summaries for behavioral health bills that impact programs and services for children, veterans, and homeless populations. In the coming weeks, we will share bill summaries on health care workforce shortage bills and women and children’s health bills.

Maternal mortality crisis in Texas 
Across the United States, maternal mortality jumped by 27 percent between 2000 and 2014. In Texas, researchers were stunned to learn that the maternal mortality rate had doubled between 2010 and 2012. However, the state’s maternal mortality rate is now a matter of public debate. Although the Department of State Health Services website currently shows that Texas’ maternal mortality rate was 35.2 deaths per 100,000 births between 2012 and 2015, agency officials now say that the number of mothers who died during that period is actually 30 percent lower — thanks to new methodology the state recently began using to calculate deaths. A study published by Birth this month analyzed CDC data from 2006 to 2015 and found that the state’s maternal death numbers are inflated. Marian MacDorman, a research professor with the Maryland Population Research Center and the Birth study’s lead author, stated that the new methodology is also flawed because it omits women who died after miscarriage or other complications that prevented them from giving birth.

Major causes of maternal deaths in Texas are often linked to overdose or a lack of access to health care before, during and after pregnancy. Texas moms often have difficulty getting prenatal care and other services they need due in large part to current state policies. Texas Medicaid typically doesn’t cover working-age adults unless they have a disability or are pregnant — making it harder for women to manage health conditions prior to pregnancy. Just two months after delivery, Texas Medicaid cuts off a new mom’s health care coverage at a time when it is needed most. Improving women’s access to health care will save the lives of mothers and ensure that more children get a healthy start in life.

Methodist Healthcare Ministries' advocacy partners share voter guides and toolkits 
In Texas, the most important election for many communities is the March primary election, due to the fact that the winning candidate often has no opposition in the general Nov. election. However, most Texans aren’t in the habit of voting in the critical March primaries. In 2014, only 10 percent of registered Texan voters took part in the Republican primary, and only 4 percent of registered voters voted in the Democratic primary. Primary campaigns provide the best chance for voters to declare which solutions and governing approaches best fit this moment in our state’s history. Below you'll find helpful voter guides and toolkits developed by Methodist Healthcare Ministries' advocacy partners:

The League of Women Voters has released its voter guide for the Texas primary election. The voter guide allows you to see the races on your ballot, compare candidates’ positions side-by-side, and print out a “ballot” indicating your preferences that you can take along with you on Election Day. Personalized information on candidates and issues, verification of registration status, and upcoming debates and forums can be found at vote411.org.

The Texas Hospital Association has helped increase engagement and participation in the March 6 primary election by sharing a voter toolkit with their hospital partners. The toolkit includes a sample CEO email to emphasize the importance of voting and provides resources and information to prepare for voting. It also contains imagery for emails, webpages, monitors, and digital posters for elevators and employee break rooms. Social media posts that advertise key deadlines and voter resources are included as well.

Texans Care for Children released a voter guide on children’s issues that state policy-makers will have to address if elected in 2018. The guide encourages voters to: ask candidates about urgent state policies, educate them on issues, and let them know what issues are important to them.

Important Primary Election Dates:

  • Early voting: Feb. 20 to March 2, 2018
  • Election day: March 6, 2018

The Nonprofit Council releases ‘State of the Nonprofit Sector’ report 
The Nonprofit Council released its “state of the sector” report, sharing an organizational snapshot of more than 421 nonprofits in Bexar County and 16 surrounding counties. Funded by Methodist Healthcare Ministries, the report concludes that nonprofit survey respondents provide services across a broad spectrum of areas; the largest are human services (22 percent); arts and culture (10 percent) and education. Human service organizations are the most financially stressed as they govern the gap between service costs and reimbursements. The most frequently expressed challenge, outside of funding issues, was the need to engage in community education and awareness. Read the report here.
 

Upcoming Meetings & Events

February: LUPE Mobile Clinic Calendar
La Union Del Pueblo Entero (LUPE) has released the monthly schedule for its Health on Wheels program. Funded by Methodist Healthcare Ministries, the Health on Wheels program seeks to broaden access to health care in the Rio Grande Valley — particularly in low-resource communities — by connecting border residents with local and accessible health care providers. View the schedule.

February 15: Medical Care Advisory Committee 
Texas HHSC’s Medical Care Advisory Committee will meet Feb. 15 at 9 a.m. in Austin, Texas to review the 1115 Medicaid Waiver DSRIP program amendments and mental health screenings. View the meeting agenda.

February 20: Mental Health Condition and Substance Use Disorder Parity Workgroup
Texas HHSC’s Mental Health Condition and Substance Use Disorder Parity Workgroup will meet Feb. 20 at 9 a.m. in Austin, Texas to hear updates from HHSC and the Texas Department of Insurance on parity violations. View the meeting agenda.

February 28: Members Sought for the Texas Brain Injury Advisory Council
Texas HHSC is accepting applications for membership to the Texas Brain Injury Advisory Council. The executive commissioner will appoint members to the council to serve a three-year term. Applications are due by Feb. 28. Download the application.

March 6: Texas Health and Human Services' Regional Community Partner Forum
Texas HHSC and the Community Partner Program (CPP) are hosting Regional Community Partner Forums around the state. Join them in San Antonio on March 6 for training and updates from HHSC, CPP, and YourTexasBenefits.com. Network with local community partners and develop relationships to connect clients to services. Learn more.

March 14: Fourth Annual San Antonio Food Bank Food IQ Nutrition Summit
The San Antonio Food Bank will host its fourth annual nutrition summit, "Preventing Food Waste: Initiatives to Decrease & Recover Wasted Food," March 14 from 7:30 a.m. to 2 p.m. The summit will propose initiatives to address food waste reduction from the government to households. The event is free to attend. Register now.

April 16-18: The Texas Campaign to Prevent Teen Pregnancy’s 7th Annual Symposium
Texas Campaign to Prevent Teen Pregnancy’s Annual Symposium will bring together professionals from across the state to participate in panel discussions, presentations and professional development workshops. The event will focus on creating change and improving adolescent health in Texas. Register by March 31 for a discounted rate. Scholarships are available to assist with travel costs. Register now.

April 17: Bexar County Joint Opioid Task Force Meeting
The Joint Opioid Task Force is seeking to decrease the number of opioid deaths in Bexar County and develop strategies to address the opioid crisis in a comprehensive manner. The next meeting will be held April 17 at 9:30 a.m. Meetings are held at the Robert B. Greene Pavilion (903 West Martin Street). Learn more.
 

Health Care Policy in the News

Texas Healthy Women Program
Abbott Requests Federal Medicaid Exemption for Texas Healthy Women Program (Texas Public Radio)
Gov. Greg Abbott appealed to the federal administration for federal money to help fund the state’s Healthy Texas Women’s program. The proposal, submitted through a federal 1115 waiver, would allow the state to receive and re-distribute federal Medicaid dollars for women’s health care services. Read more.

Foster Care
Texas Should Begin Implementing Parts of the Foster Care Order Now (Texans Care for Children)
On Jan. 19, Judge Janis Jack issued her final order instructing the state of Texas to improve child safety in the foster care system managed by Child Protective Services and overseen by the state legislature. The order was based on years of testimony in a federal lawsuit against the state of Texas. Read more.

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Investing in livelihood

DW Admin on February 13, 2018

These days, PowerPoint slide decks are relied upon to illustrate and guide the business stories we need to deliver to our audiences, yet it is often seen as a worthy effort if you can keep the number of slides to 10 or less. The challenge persists to include enough information to be useful, but not so much that your audiences’ eyes glaze over. So, I challenged myself to create what I call: “The one slide presentation.” It’s my way to counter-intuitively present a minimum of relevant information and narrative I hope will spark questions and conversation, and hopefully a deeper understanding of the focus area, and ideas to activate my audience. The slide includes a heading, a question, a number, and a 55-word story explaining the number. Oh, and two logos, a hashtag, and our brand colors. That is it.

I tried this approach for the first time during a cross-departmental meeting with colleagues at Methodist Healthcare Ministries and was thrilled with the results. What I hoped would happen, did – and more. (Again, we are talking about one slide and five minutes.)

The intention of the one slide presentation was to begin sharing numbers from mining the (non-rigorous evaluation) data from our federally-funded Sí Texas Project (now in year three of five) while telling the story of the data point. I am the program officer for this project, which is designed to implement and evaluate eight models in South Texas on Integrated Behavioral Health (IBH) and Primary Care in Behavioral Health (PCBH). My charge and challenge from the inception of the project has been to demonstrate our sub-grantee’s progress and change – with the unspoken expectation of explaining the barriers to that progress and change.

The question on the slide was: How many people are paid by the grant? The number was 114. The 55-word story was: “People are the power. They deliver services, build the culture, receive the investment of capacity building, sustain what is built, communicate and educate about the services offered through them in organizations, listen to and care for patients, and much more. They also have their own lives to build and sustain. Methodist Healthcare Ministries is investing in livelihood.” I intentionally chose the word “livelihood” because it means income, means of support, living, sustenance, nourishment, daily bread, occupation, and vocation – meanings that resonated with a faith-based organization such as ours. I explained that our project is an economic engine, but it is so much more.

I talked about how, in my lead-up to the meeting, I dropped by the office of a colleague and presented the question, number, and narrative. I told her how I wanted to mine our project’s data to get at numbers such as the average pay for certain positions. She asked how average pay was germane. Her question gave me the opportunity to explain how difficult it has been for most of our sub-grantees to offer competitive salaries to medical providers, especially smaller community-based clinics, resulting in the need to think differently about attraction and retention of personnel. I asked, open-endedly, if there was the possibility of appealing to mission-driven candidates. Our conversation led to how clinics could speak to the meaning of this work and appeal to spouses and families of providers, and how they might join a community and a culture—after all, selecting a job is often a family decision.

The presentation sparked thought-provoking questions and dialogue. One question in particular, about which positions were most difficult to fill, led to a discussion about the health care professional workforce shortage that is pervasive in Texas and across the nation.

I explained how our sub-grantees have been resourceful to fill functions such as nutritionists by shifting nurses or by expanding the role of community health workers, also known as ‘Promotores de Salud.’ I described how difficult it has been for some clinics to attract primary care providers, in one case, waiting several months for one provider’s contract to end at another clinic. In terms of IBH, I talked about the challenge of hiring and retaining behavioral health consultants, a critical function in IBH, especially in rural areas. In fact, it has been difficult to fill many key positions in rural communities, often creating hardship for current staff shifted to serve in outlying communities when they have family and must adjust for longer commutes and transporting their own children to school.

All of this quality content resulted from a question, a number, and a 55-word story.

We live in a complex world and health care is a complex industry. I believe the counterintuitive technique of offering one data point and an interpretation of the data enabled our team to focus on a topic and to dive deeper together into the story of our project and what we are learning.

What are some of the ways your organization is addressing these issues? And, what techniques are you finding effective at communicating these issues to your audiences?

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Texas House Bill 13, guiding funded partners with state mental health grants

DW Admin on February 9, 2018

It is widely known that Texas ranks near the bottom of the list nationally when it comes to mental health spending per capita. During the 85th Texas Legislative Session, however, a momentous move was made to correct this negative trend when House Bill 13 (HB 13) — a bill Methodist Healthcare Ministries supported throughout the session — was passed into law.

As a result of HB 13, the state of Texas will funnel $27.5 million into select mental health programs — over the course of two years — through a matching grant program to support community mental health programs providing services and treatment to individuals experiencing mental illness. A couple key aspects of the bill include greater organizational collaboration and the fact that, at a minimum, 50 percent of those funds will benefit rural communities with populations under 250,000. HB 13 is significant to Methodist Healthcare Ministries given its promise to increase access to mental health, promote organizational collaboration, and potentially aid our own funded partners and the communities we serve.

Because we are a not-for-profit organization with experience as both a grantor and grantee, we understand the challenges nonprofits might face when searching for funding opportunities like HB 13. Whenever possible, we offer funded partners unique insight and guidance on how to secure grant awards from other funders in order to create diverse revenue streams and additional sustainability. (Diversified revenue streams establish credibility and create the potential to attract even more funders because funders see that multiple entities believe in the organization’s cause and efforts.) With HB 13, we didn’t want common constraints — lack of development staff, time, state grant experience, etc.— to keep partners from benefiting from these grant funds to advance mental health care. So, as soon as the bill passed into law, Methodist Healthcare Ministries sprang into action.

To start, one of our advocacy partners, the Meadows Mental Health Policy Institute, hosted a conference call to provide information about HB 13 to our funded partners. Next, we sought to support those partners in their efforts to apply for HB 13 funding by hosting informational meetings, offering letters of support, maintaining open lines of communication and providing technical assistance to interested organizations to ensure they had the opportunity to apply for funding. Finally, we are continuing to support our funded partners in applying for grants similar to HB 13, because we know that when partners obtain funding outside of Methodist Healthcare Ministries, they open doors to more opportunities and organizational growth. By earning diverse sources of revenue and grants, a funded partner is positioned to expand services to a larger capacity in the communities they serve. This, in turn, contributes to our goal of creating more access to care.

The Texas Health and Human Services Commission (HHSC) implemented HB 13 through two procurements: a competitive Needs and Capacity Assessment distributed to Local Mental Health Authorities (LMHAs) and Local Behavioral Health Authorities (LBHAs), and a competitive Request for Applications (RFA) to be distributed more broadly to solicit applications from both nonprofit organizations and governmental entities. The recipients of the first round of funding were announced Jan. 23. Of the 39 LMHAs in Texas, 25 were selected to receive HB 13 funding — four of which are Methodist Healthcare Ministries partners (Border Region Behavioral Health Center, The Center for Health Care Services, Gulf Bend Center, and MHMR Services for the Concho Valley). Those four, as well as all other organizations selected by the state, will soon enter the negotiation stage to solidify their contracts for their proposed projects. Proposals for the second round of funding were due Jan. 31, and awards will be announced later this year. All projects, independent of which round, will begin in 2018.

Longevity of HB 13 is unknown; it may or may not become a project that Texas elects to continue funding for years to come. However, even if Texas decides to stop HB 13 funding, a benefit that selected partners have is that they can now establish a track record for properly managing a state grant. This proves to the state that the organization is a good investment for additional state grants for which the organization may wish to apply. Additionally, just by helping funded partners apply for the first time, we were able to help them obtain procedural experience on how to navigate a sometimes complicated and lengthy RFA — crafting the best application, and helping them find necessary attachments for application submission, along with other requirements.

It was validating to see a multitude of organizations support mental health funding since it is essential to the health of Texas communities. We appreciate that funded partners were open to this new opportunity, despite its challenges, and we’re proud that all our funded partners strive for excellence, improvement and innovation. These qualities are essential for improving South Texas’ capacity to provide top of the line health care services to individuals who otherwise might not have access to health care.

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Legislative Interim Update

DW Admin on January 29, 2018

During the 85th legislative period, Methodist Healthcare Ministries tracked roughly 1,400 bills, supported over 500 bills, and worked to assist the passage of 224 laws that affect access to health care for Texas families. Keep up to date on how those laws are being effectively implemented and funded as intended through our legislative updates.

IN THIS ISSUE:

Interim Updates

Upcoming Meetings & Events

Health Care Policy in the News

Action Center

 

View our 2017 Legislative Agenda

Advocacy

Policy

Research

___________________________________________________________________________________________

Interim Updates

Children’s Health Insurance Program (CHIP) reauthorized for six years
Families in the Children’s Health Insurance Program breathed a sigh of relief after Congress voted to end the government shutdown and extend CHIP for six years. The decision secures health care coverage for more than 400,000 children in Texas. Funding for the program had originally expired at the end of September 2017, forcing states to rely on reserve funds to keep the program going until December when Congress moved to approve an additional $3 billion for CHIP. This would have carried states through March to maintain coverage for an estimated 9 million children. The Valley Morning Star reports that the Congressional Budget Office estimated a 10-year extension of CHIP would decrease the federal deficit by $6 billion, as it would be more expensive for the government to pay for health coverage through Medicaid or subsidies on the health care marketplace. According to National Public Radio, some advocates worry that the months of uncertainty around CHIP may have already caused children to drop out of the program, thus increasing the uninsured rate among children. View Texas CHIP enrollment data by county.

Methodist Healthcare Ministries releases bill summaries for 'Access to Care' legislation
During the 85th Legislative Session, Methodist Healthcare Ministries tracked over 1,400 health care bills, of which 220 were signed into law. View summaries for 48 bills impacting access to care for Texas’ working families. Summaries of bills related to health care workforce, behavioral health, and women and children’s health will be made available in the next few weeks.

Texas granted Medicaid 1115 waiver extension for five years
Late December, the Centers for Medicare & Medicaid Services approved a new five-year, $25 billion Medicaid 1115 waiver for Texas. The waiver preserves critical funding for the state’s safety net system of hospitals, clinics and providers. The Texas Health and Human Services Commission has developed a summary of the renewal, specifying changes to the Uncompensated Care (UC) funding pool and Delivery System Reform Incentive Payment (DSRIP) funding pool. Methodist Healthcare Ministries will follow the implementation of the waiver and share any updates and developments.

Federal administration announces work requirements for state Medicaid recipients
On Jan. 11, the federal administration announced that states can now apply to add work requirements to their Medicaid programs. Ten states have already applied, but Texas isn’t one of them. The Dallas Morning News reports that requiring its Medicaid recipients to work wouldn’t have much of an impact because Texas didn’t expand its program to include more people under the Affordable Care Act. Out of roughly 4 million Medicaid recipients in Texas, there are only about 150,000 impoverished adults covered by Medicaid who aren’t pregnant, elderly or disabled, according to the San Antonio Express-News. State Senator Charles Schwertner, who chairs the chamber’s Health and Human Services Committee, states that the federal policy change gives states more control over their own Medicaid programs. On the contrary, State Senator Carlos Uresti, vice chair of the committee, said the Legislature should further study the issue before making any decisions that could unnecessarily drive families and children further into poverty.

Methodist Healthcare Ministries’ coalition partners aid in enrollment outreach
Enrollment for health insurance under the Affordable Care Act soared in the final days before the federal sign-up deadline, bringing 2017's total within a few percentage points of the total number in 2016, when the enrollment period was twice as long. With the help of Cover Texas Now, 1.1 million Texans signed up for health insurance for 2018, according to Public News Service. Nationally, total enrollment in 2017 topped 8.8 million people, 4 percent below the 2016 total of 9.2 million, even while battling confusion among many potential enrollees regarding the fate of the law. More than 4.1 million people signed up in the final week alone.  Despite enrollment numbers, Texas will likely continue to have the highest rate of uninsured people in the country in 2018, according to the Austin American Statesman. People needing marketplace coverage will continue to face uncertainty, as some members of Congress continue their efforts to repeal the Affordable Care Act.

Mental health parity law gains traction in Texas 
The Texas legislature passed House Bill 10 during the 85th Legislative Session, which prevents health insurance companies from offering mental health benefits differently from medical benefits and offers more help for consumers who believe their insurance is wrongly denying them from coverage. Methodist Healthcare Ministries worked closely with the bill's author, Representative Four Price, and mental health stakeholders, to change how mental health and substance use care are provided through private insurance health plans.

Although HB 10 took effect September 1, 2017, the implementation process is ongoing. The legislation addresses parity from four different angles: regulation, data collection, collaboration, and consumer assistance. These different pieces are moving ahead in different stages. Mental health parity laws hold a great promise in helping Texans access needed health care to achieve recovery, but that promise of parity has not been fully realized. HB 10 helps to address ongoing challenges with oversight, data collection, cross-agency collaboration, and consumer assistance. All of these pieces will help ensure that more Texans have equal access to mental health, as well as other health care services through their health plans.

The Hogg Foundation created a fact sheet with information on how parity works and what you can do if you believe you or a loved one has experienced a parity violation. Methodist Healthcare Ministries’ advocacy partner, Center for Public Policy Priorities, released a brief on mental health parity history and implementation.

Methodist Healthcare Ministries supports state and local efforts to increase tobacco age to 21 
During this past legislative session, the House Committee on Public Health considered House Bill 1908, by Representative John Zerwas, to raise the minimum tobacco age in Texas from 18 to 21. The bill was approved by the committee but did not make it to the House floor for a vote. On Jan. 11, after two hours of deliberation and testimony from more than 30 people, the San Antonio City Council approved a new law prohibiting merchants in the city limits from selling tobacco products to anyone under 21 years old, reported by the San Antonio Express-News. San Antonio is the first city in Texas to enact such a law. The new ordinance, which city officials discussed since August, passed by a 9 to 2 vote. The “Tobacco 21” ordinance will take effect Oct. 1, 2018, allowing the San Antonio Metropolitan Health District more time to implement provisions and gather input from surrounding cities. 

The city of San Antonio will work to educate the public and retailers about the new law. New signage will be placed in stores, and if a retailer is suspected of selling tobacco products to someone under the age of 21, the city’s health department may check compliance. If a retailer is caught violating the law, a citation with a maximum fine of $500 will be issued.

As reported in the San Antonio Current, according to Colleen Bridger, director of San Antonio Metro Health, 95% of smokers begin before the age of 21, during a period of time when the brain is especially susceptible to addiction. An online survey of more than 5,000 San Antonians showed that 77.5% of participants supported the age hike. Supporters included physicians, cancer survivors, health insurance companies, the San Antonio Chamber of Commerce, high school students and teen ambassadors. Several opposed the changes including convenience store owners and the Association of Convenience Store Retailers in San Antonio due to lack of input from merchants and potential financial consequences. KXAN reports that ordinances like Tobacco 21 are critical to reduce and eventually eliminate tobacco’s toll, especially considering that nationally about 95% of adult smokers started before they turned 21.

 

Upcoming Meetings & Events

January 31: Medicaid Waivers: Work Requirements and Beyond
Join Families USA for a free presentation on how state advocates can address Medicaid waiver proposals that include work requirements and other restrictions. Experts will review recent HHS approvals of work requirements for Medicaid, and the tools available, for state advocates to address similar proposals. The webinar will start at 1 p.m. CST. Register now.

February 3: 11th Annual Community Service Learning (CSL) Conference
Join Methodist Healthcare Ministries and UT Health San Antonio at the Annual CSL Conference to share best practices in service learning and recognize excellence within the UT Health System. There is no cost to attend, but registration is required. Register now.

February 28: Members Sought for the Texas Brain Injury Advisory Council
HHSC is accepting applications for membership on the Texas Brain Injury Advisory Council. The HHSC executive commissioner will appoint members to the council to serve a three-year term. Applications are due by Feb. 28 at 11:59 p.m. View the application.

April 16-18: The Texas Campaign to Prevent Teen Pregnancy’s 7th Annual Symposium
Texas Campaign to Prevent Teen Pregnancy’s Annual Symposium will bring together professionals from across the state to participate in panel discussions, presentations and professional development workshops. The event will focus on creating change and improving adolescent health in Texas. Register by January 31 for a discounted rate. Register now.

 

Health Care Policy in the News

Maternal Mortality in Texas 
It’s impossible to solve Texas’ maternal mortality problem with faulty state data (Dallas News)
Texas has a problem: Deaths of women linked to pregnancy and childbirth are increasing. How bad is the problem? We don’t know. That’s another problem. A new study in the medical journal, Birth, suggests that the reporting and data collection system in Texas is inaccurate, making it impossible to develop a clear picture of how many women are dying of childbirth-related complications. Read more.

 

Action Center

Medicaid work requirements make no sense for Texas – or other states. 

 

 

 

 

 

 

 

Read more by Cover Texas Now.

 

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Jaime Wesoloski

President & Chief Executive Officer

Jaime Wesolowski is the President and Chief Executive Officer at Methodist Healthcare Ministries. A healthcare executive with three decades of leadership experience, Jaime is responsible for the overall governance and direction of Methodist Healthcare Ministries. Jaime earned his Master’s Degree in Healthcare Administration from Xavier University, and his Bachelor’s of Science from Indiana University in Healthcare Administration. As a cancer survivor, Jaime is a staunch supporter of the American Cancer Society. He serves as Chair of the American Cancer Society’s South Texas Area board of directors and he was appointed as Chair to the recently created South Region Advisory Cabinet, covering eight states from Arizona through Alabama. Jaime believes his personal experience as a cancer survivor has given him more defined insight and compassion to the physical, emotional, and spiritual needs of patients and their families.