Legislative Interim Update, July

DW Admin on July 13, 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

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State Updates

Methodist Healthcare Ministries of South Texas, Inc. Announces the Appointment of New President and CEO, Jaime Wesolowski
The Methodist Healthcare Ministries of South Texas, Inc. board of directors has selected Jaime Wesolowski as the organization’s next president and chief executive officer. Wesolowski, a healthcare executive with three decades of leadership experience, currently serves as president and CEO of the Methodist Healthcare System — the largest provider of health care in South and Central Texas. Read more.

Healthcare stakeholders advocate for improving state’s Medicaid managed care system
Seventeen Texas organizations, including Methodist Healthcare Ministries, signed on to a letter to state lawmakers this week, asking for their help in addressing serious concerns with access to quality healthcare under the state’s Medicaid managed care system. The current system relies on private and non-profit insurance companies to coordinate health care for children, people with disabilities, seniors, and others enrolled in the state’s Medicaid system.

The Dallas Morning News recent investigative reporting series – Pain & Profit – shed a critical light on the state’s Medicaid Managed Care System, and its failure to provide adequate care for the system’s most vulnerable patients. The powerful testimonies in the report shared stories of hardships faced by Texans when the system failed to deliver care. As a result of these news reports, members of the Texas House Human Services Committee came together in mid-June to take testimony from state health care agencies, contracted managed care organizations as well as those families impacted in the news report. Similar testimony continued at a separate Joint Hearing of the House Appropriations Subcommittee on Article II and Committee on General Investigation and Ethics. Lawmakers will focus on addressing these issues for the upcoming 86th Legislative Session.

Survey shows health care is a priority for Texans
The Henry J Kaiser Foundation (KFF) released a report this month, highlighting the health policy priorities of Texan residents. Texas is one of the 17 states that did not expand Medicaid under the Affordable Care Act, and it continues to have the largest uninsured population in the nation. KFF partnered with the Episcopal Health Foundation and obtained survey results from nearly 1,400 Texas.

Survey results showed that health care is a priority for Texans with over half reporting that the state legislature should increase spending on services and programs. The KFF report noted that roughly two thirds of survey respondents believe state government is not doing enough to ensure low-income adults can get health care. The same percentage of individuals believe the state should expand the Medicaid program. The survey stated 70% of Texans report some connection to the Medicaid program and a majority believe that the program is working well for low-income individuals. Future KFF surveys will focus on Texans’ experience with health care affordability and access.

Governor Abbott address mental health screenings after recent school shooting
Mental health screenings in schools have become a serious topic since the recent Santa Fe ISD shooting. Governor Greg Abbott recently released recommendations for addressing school safety and stated that the Telemedicine Wellness, Intervention, Triage, and Referral Project (TWITR) could be an ideal model for the whole state. TWITR, initially funded through a grant program in the Governors’ Criminal Justice Division, is organized by The Texas Tech University Health Sciences Center (TTUHSC) and has provided mental health screenings to ten West Texas school districts. They plan to expand the program to an addition five school districts in the near future.

A new report highlights that since its inception, the project has triaged nearly 215 students via Telemedicine with the TTUHSC psychiatry department. The program had 25 students removed from school, 44 students placed in alternative schools and 38 students sent to a hospital due to their mental health. All the students were screened for multiple behavioral health concerns such as depression, anxiety and violent thoughts. Billy Philips, Executive Vice President for rural and community health at TTUHSC, stated that the project has been able to fill gaps in the lack of access to care in West Texas. Methodist Healthcare Ministries will monitor the Legislature’s implementation of the recommendations and continue to work with partners to address school mental health issues.

Texas opens applications for First Responder Mental Health Grant Program.
Texas Governor Greg Abbott’s office has established the First Responder Mental Health Resiliency Program which provides direct services to peace officers and other first responder agencies across the state. The program focuses on providing mental health services in a confidential and specialized method supported by trusted research, Funded projects under this fund source are expected to implement services that reduce stress for officers and first responders, improve coping strategies, and increase overall morale. Proposals are due on July 3, 2018 by 5:00 p.m. CST.

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Federal Updates

Healthy Futures of Texas achieves victory in class action
The U.S. District Court in D.C ruled in favor of Healthy Futures of Texas and 61 other organizations in a class action lawsuit against the U.S. Department of Health and Human Services (HHS) to continue evidence-based teen pregnancy prevention programs.

In the summer of 2017, HHS defunded the Teen Pregnancy Prevention (TPP) Program, nearly two years earlier than expected. The program has seen numerous successes in creating medically accurate and age appropriate programs to prevent teen pregnancy across the nation and led to the creation of multiple studies that have been successful in both rural and urban communities.

The ruling this past June held that HHS’s early termination of the program was unlawful and ordered the federal agency to reinstate the grant program for all 62 class members. With this victory, Healthy Futures of Texas and other organizations can continue to provide services essential to prevent teen pregnancy.

Federal funding for opioid response programs available for rural communitiesThe Federal Health Resources and Services Administration (HRSA) has released a notice of funding now available for opioid response programs. The Rural Communities Opioid Response Planning (RCORP) initiative for Fiscal Year 2018, will award 75 grants to rural communities. Successful awardees will receive approximately $200,000 for one year to develop plans to implement opioid use disorder prevention, treatment, and recovery interventions designed to reduce opioid overdoses in rural communities. Interested organizations can find more information here. Applications are due by July 30, 2018.

Upcoming Meetings & Events

July 21: Mental Illness and the Criminal Justice System: Addressing the Challenges (San Antonio)
Aug 9: Hospital Payment Advisory Committee
Aug 17: Medical Care Advisory Committee
Aug 21: Bexar County Opioid Task Force (San Antonio)
Sep 15: UTRGV School of Medicine Research Symposium (McAllen)
Sep 27-29: The Texas Tribune Festival (Austin)

Health Care Policy News

Children's Health
Texans Care for Children: Report highlights strategies to prevent teen pregnancy in foster care and support pregnant and parenting teens in foster care. 

2018 KIDS COUNT Data Book Released: Report looks at child well-being using indicators across four domains – health, education, economic well-being and family and community

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A few words from your Wesley Nurse: God’s garden

DW Admin on May 25, 2018

What a beautiful spring we’ve had. I am blessed to have a firsthand view of God’s garden along the country roads I take to work. When I arrive at the church, I am greeted by God’s beautiful handiwork: the lovingly cultivated field of poppies, an assortment of bright, sunny-colored flowers, and the serene beauty of the tranquil prayer garden tended by a few of our dedicated congregation members. We’ve been fortunate that the rains came in at just the right amount so that wildflowers that normally await their turn to bloom are all clamoring for attention at once. What a sight to behold! But of course, to have this beauty, we must endure some adversity – thunderous storms, power outages and flooding. That’s springtime in Texas!

Like the ebb and flow of nature, human existence similarly goes through ups and downs. Although God gave us the beautiful gifts of forgiveness and unconditional love through His Son, sometimes we must go through some adversity and trials to see and appreciate the beauty of it all. We need the ‘watering’ of God’s love, and His word to thrive and carry us through rough times.

As a Faith Community Nurse for Methodist Healthcare Ministries (located at First United Methodist Church, Luling), I give new patients a brief spiritual assessment containing these three statements:

  1.  I find comfort in my faith or spiritual beliefs.
  2.  Difficult times have strengthened my faith or spiritual beliefs.
  3.  Even during difficult times, I know that things will be OK.

This helps me learn how to best approach a patient’s visit and get a sense of their spirituality.

Typically, most of my patients, as dire as their situations are, still respond that they do have faith. Which is why I was heartbroken when I recently met a new homeless patient that had lost his. He told me he used to attend church, but for a long time now he has felt “like gum on the bottom of God’s shoes.” He didn’t think God cared about him anymore. For me, that’s where the ‘faith’ in Faith Community Nurse kicked in. We talked for some time. Given his circumstance, it was easy to understand why this man felt abandoned. Together, we talked about God’s love and forgiveness — that no matter what may have happened in our past, we’re fortunate to have the forgiveness of a loving Father.

Moving forward for him will be challenging. It’ll also be a work in progress building his trust. But I felt hopeful and uplifted when we parted ways and I reached out to shake his hand. Instead, he hugged me like his life depended on it. He was so thankful we’d gotten to talk.

Our meeting and conversation must have meant a lot to him because the next day when I called him, a friend of his answered and thanked me profusely for taking the time with him that I did. I felt happy that I made a difference. I felt I was the vessel being used to ‘water’ his soul, and I believe in time, he will blossom again.

Until next time, be well and be blessed.

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Caring Servant: Dayanara

DW Admin on May 23, 2018

Methodist Healthcare Ministries is composed of diverse team members all working together with one common goal: "Serving Humanity to Honor God." Guided by our core values — integrity, making a difference, teamwork, compassion and spirituality — each one of our team members plays an important role in creating access to health care for low-income, uninsured patients and clients. Throughout the year, we feature the stories of team members who have been nominated by co-workers for how they exemplify these qualities in our Caring Servant spotlight.

This month’s Caring Servant spotlight shines brightly on one of our parenting programs coordinators, Dayanara Santiago Quiñones, who demonstrated our core value of ‘making a difference’ when she stepped in to save the life of her client. Below is her story.

“Dayanara is committed to serving others. On multiple occasions, she has gone above and beyond to assist those in her Meld Special Needs class — a parenting group designed for parents and guardians of children living with a range of illnesses and disabilities.

During a recent group session, Dayanara witnessed one of the parents in her class suddenly choking on an apple. Having just completed her CPR and first aid recertification the week before, she sprang into action. After quickly verifying that the client was indeed choking and needed help, Dayanara immediately began first aid by giving back blows and performing the Heimlich maneuver. All the while she was concerned that the client had recently fallen and suffered a broken rib, but knew she had to take action and help. Within moments, the client spat out the piece of apple she was choking on and was fine thanks to Dayanara’s help.”

Dayanara's ability to quickly assess the situation, act, and avoid what could have been a detrimental situation helped save a life. Her actions that day, and every day are a testament to her desire to improve the physical, mental and spiritual health of those she serves.

It’s because of team members such as Dayanara that our organization truly carries out its mission of “Serving Humanity to Honor God.”

Get to know more of our Caring Servants on YouTube.

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Legislative Interim Update, May 22

DW Admin on May 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

More women being served in Texas women’s health programs
The Texas Health and Human Services Commission (HHSC) released a report highlighting the increasing number of women enrolled in Texas Health Programs, including the Healthy Texas Women program and the Family Planning Program. These programs provide a wide range of services to eligible individuals such as STD screening, mammograms, contraception coverage and much more. HHSC reports 122,406 clients were served in Healthy Texas Women in 2017, an increase from 70,366 clients in 2016. The Family Planning Program also saw an increase of 58,586 clients from 2016 to 2017. However, HHSC states that these enrollment numbers cannot be compared to the number of women accessing services prior to the massive budget cuts in 2011, due to changes in program eligibility and benefits.

HHSC notes that the Family Planning Program and the Healthy Texas Women program are projected to save millions of dollars on Medicaid and the Children’s Health Insurance Program. The report comes at a time when Texas is waiting to receive more than $400 million in federal funding over five years to fund the Healthy Texas Women program, which would further improve health outcomes. These programs play a critical role in increasing access to women’s health services, which is a legislative priority for Methodist Healthcare Ministries. 

Members appointed to Judicial Commission on Mental Health
Thirty-one newly appointed members of the Judicial Commission on Mental Health convened their first meeting earlier this month at the Texas Law Center in Austin. Created under the direction of the Texas Supreme Court and the Texas Court of Criminal Appeals, the statewide Commission is charged with developing a plan that recommends best practices in the administration of civil and criminal justice for individuals with mental illness. The Commission will also develop an outreach campaign to create awareness of its mission and organize a Judicial Summit on Mental Health in the fall of 2018.

Recognizing the importance of input from a broad spectrum of individuals involved in mental health, the Courts also called for the creation of a Collaborative Council, to provide the Commission with additional expertise and guidance. Methodist Healthcare Ministries’ Director of Governmental Affairs, Chris Yanas, was chosen as a member of the Collaborative Council and will take part in scheduled meetings throughout the remainder of 2018. The Commission will wrap up its work with a report of recommendations to members of the 86th Legislature.

Task Force of Border Health Officials identifies health issues
The Task Force of Border Health Officials, formed by the passage of SB 1680 by Senator Eddie Lucio, brings focus and attention to the challenges and hardships that the entire border region faces every day. The task force will make recommendations to the Department of State Health Services (DSHS) commissioner for short-term and long-term border health improvement plans to enhance public health and create a healthy binational community. Since its inception in December, the task force has identified five key health issues: Border Public Health Infrastructure, Communicable Diseases, Arbovirus, Chronic Diseases, and Maternal and Child Health. Currently, the task force is working on creating issue statements and recommendations, which are due to DSHS by Nov. 1. Members include local health officials from Cameron County, Brownsville, Harlingen, McAllen, Hidalgo County and Laredo. Methodist Healthcare Ministries will continue to monitor task force meetings and look to develop legislative initiatives based on Task Force recommendations.

Federal administration proposes $7B reduction in CHIP
The federal administration has advanced proposals that look to rescind nearly $7 billion from the Children’s Health Insurance Program (CHIP). These changes have been proposed despite a bipartisan agreement earlier this year to extend CHIP funding for 10 years. Another $2 billion of the proposed cuts targets the Child Enrollment Contingency Fund, which is available to states that experience an unexpected surge in enrollment, such as natural disasters or economic downturn. Child advocates argue that these cuts would undermine historically bipartisan agreements designed to use these funds for future investment needs in other programs serving children and vulnerable families. Today, more than 400,000 low-income children in Texas get health insurance through CHIP, which provides for wellness check-ups, screenings and access to a provider for more serious illnesses. Methodist Healthcare Ministries has signed on to a national letter with the American Academy of Pediatrics in opposition to the White House’s proposal, urging members to protect the wellness of children and families.

Laredo health care community collaborates on immunization policies
Methodist Healthcare Ministries’ advocacy partner, The Immunization Partnership, held a stakeholder meeting in Laredo to discuss immunization policies and collaborate on efforts to increase access to vaccinations for Webb County residents. The data noted that Texas is doing better than the national average on most vaccinations, but numbers have exponentially declined within the last several years. There were approximately 50,000 conscientious objections to required vaccines last year, an increase from 2016.  

Providers and community leaders addressed the need for collaboration and communication about vaccinations in Laredo and surrounding areas. Clinic providers stated that they are unsure if students are getting vaccinated at school clinics because it is not recorded in an electronic database system and parents do not have proof. School officials and clinical staff stressed the need to input vaccination data on a timely basis. The Laredo community discussed several strategies to educate parents about vaccinations, such as providing training to providers on how to recommend vaccinations. The Immunization Partnership will be hosting a stakeholder meeting in Corpus Christi on May 30. You can register and obtain more information here. Methodist Healthcare Ministries will continue to work with partners to increase access to vaccinations and improve data collection processes at both the state and local level.

CMS releases new report on Marketplace enrollments 
In April, the Centers for Medicare and Medicaid Services (CMS) released their annual report on the Affordable Care Act (ACA) Marketplace enrollment period for 2018, highlighting the number of families and individuals who signed up for health insurance through the federal marketplace. The data shows that 1.1 million Texans selected a 2018 Marketplace plan, a decrease of 8 percent from 2017. The lower participation number is largely attributed to a cut in enrollment time and reduced funding for outreach and enrollment efforts. Given these obstacles, 8 percent is deemed a modest decrease due to the tireless efforts of in-person assisters, community groups and foundations.

The report also provides county-level enrollment numbers of the 10 most populous counties in Texas. Reductions found in the marketplace varied among Texas counties. Fort Bend and Bexar County saw a 2 percent and 9 percent decrease, respectively, whereas Denton County saw a 17 percent decrease. Supporting access to care through affordable health care coverage is a legislative priority for Methodist Healthcare Ministries.
 

Upcoming Meetings & Events

May 24: House Appropriations Committee Hearing (Austin)
May 30: The Immunization Partnership Stakeholder Meeting (Corpus Christi)
May 30-31: Telehealth at the Crossroads Conference (San Antonio)
May 31: HHSC Executive Council Meeting (Austin)
June 1: Texas Tribune: Austin & the Legislature (Austin)
June 12: Bexar County Opioid Task Force (San Antonio)
June 12: Texas Tribune: A Conversation with Sen. Menendez and Reps. Gutierrez & Minjarez (San Antonio)
Sept 27-29: The Texas Tribune Festival (Austin)

Health Care Policy News

Telemedicine 
Kaiser Health News: Telemedicine opening doors to specialty care for inmates

Health Care Systems
The Commonwealth Fund: 2018 Scorecard on state health system performance

Health Care Workforce
CBS DFW: Texas mental health counselors waiting months to be licensed

Child and Maternal Health
Texas Tribune: Panelists say more funding, education and access to care are needed to reduce Texas’ maternal mortality rate

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Coffee with Cassandra: Increasing access to care through grant-making

DW Admin on May 18, 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!

At Methodist Healthcare Ministries, one of the ways we fulfill our mission — “Serving Humanity to Honor God” — is through strategic grant-making. In order to increase access to affordable health care for the least served, we fund organizations who share similar missions across our 74-county service area. Our goal through grant-making is to create measurable impact at the community and regional levels.

For this edition of Coffee with Cassandra, I had the opportunity to talk with Jane Hevezi a senior program officer in our Community Grants department. Jane works with a portfolio of our funded partners to guide them through their grants. She describes how our grant-making structure focuses on building a firm relationship with our Funded Partners to make a difference in South Texas communities.

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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

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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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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.