RD162 - Joint Commission on Health Care 2016 Annual Report

Executive Summary:


In keeping with its statutory mandate, the Joint Commission completed studies; received reports; considered comments from public and private organizations, advocates, industry representatives, citizens and other interested parties; and introduced legislation to advance the quality of health and health care services in the Commonwealth.

Joint Commission on Health Care

The full Commission met four times in 2016. These meetings were held in Senate Room A of the General Assembly Building on May 26th, September 7th, October 5th and in Senate Room B on November 9th. Meeting materials (including presentations, handouts and minutes) are posted on the website at http://jchc.virginia.gov.

Six staff reports were presented during the 2016 Joint Commission meetings:

• School Vaccination Requirements in the Commonwealth
• Palliative Care in the Commonwealth
• Medical Care Costs in Virginia State Prisons
• Development of Life Sustaining Treatment Guidelines
• Virginia Foundation for Healthy Youth Mission Expansion
• Expanding Access to Brain Injury Services and Barriers to Placement for Virginians with Challenging Behaviors that Result from Brain Injuries, Dementias and Post-Traumatic Stress Disorder

In addition to the staff reports, members received reports and heard presentations from a number of guest presenters:

Beth A. Bortz, President and CEO with the Virginia Center for Health Innovation, presented an update on the State Innovation Models (SIM).

Michael T. Lundberg, Executive Director, and Dr. Ibe Mbanu, President of Virginia Health Information gave a presentation of the 2016 Annual Report and Strategic Plan Update.

Christy T. Morton, Executive Director of the Virginia Rural Center, presented on the findings and recommendations of the workgroup requested by the JCHC to study the needs of rural Virginia.

The Office of the State Inspector General (OSIG) provided a letter to JCHC members soliciting recommendations for inclusion in their 2017 Annual Work Plan.

Behavioral Health Care Subcommittee

The Behavioral Health Care Subcommittee met on August 3rd and October 5th.

One staff report, “Integrating Behavioral Health and Physical Health Care Services" was presented during the 2016 Behavioral Health Care Subcommittee meetings.

Sarah Stanton discussed the mission and accomplishments of the Mental Health Services in the 21st Century Committee. She explained the number of meetings they have had and the expected outcomes of the work groups.

Mark Larsen, Director of Adult Behavioral Health Services at Mount Rogers CSB, presented information on the Mount Roger’s Alternative Transportation Pilot Program. Currently individuals with mental health problems are transported to hospitals by law enforcement in police/sheriff vehicles. That model negatively impacts the individuals and their families and places a burden on smaller and understaffed law enforcement offices. The Alternative Transportation Program has been very successful with these patients and relieving law enforcement of the transport responsibility.

Priscilla Smith presented her findings on the FY2015 Unannounced Inspection of the Commonwealth Center for Children and Adolescents. During her presentation, she highlighted data on admission and bed numbers as well as the observations and issues that were noted during the inspection such as inadequate operational programs in communities, high staff overtime hours and turnovers, and lack of master staffing plans and training. She then spoke about the Department of Behavioral Health and Developmental Services (DBHDS) updates. Mention of Department of Juvenile Justice facilities issues such as lack of funding and resources and staff recruitment problems were discussed. Daniel Herr made final comments on the research DBHDS is doing to help children and adolescents with hospital stays. A request for fiscal data and issues, for the time period of 2011-2014, was made.

Jodi Manz provided an update on Prescription Drug and Heroin Task Force initiatives. She began her presentation with data on overdose deaths from 1999 to 2016 showing a significant increase. She highlighted a program called angel wings which aides in treatment for addiction and spoke about Virginia starting similar programs. A state website which will aid in steps to take with addiction and recovery was discussed. She also spoke about suboxone and how it is used as a tool for treatment and recovery; She mentioned that counseling also needs to be provided in conjunction with suboxone. Finally, Ms. Manz summarized the focus areas of harm reduction, treatment, illicit use prevention, prescription abuse prevention and culture change. In conclusion, she provided upcoming task force meeting dates.

Dr. Barber, Interim Commissioner of the Department of Behavioral Health and Developmental Services (DBHDS), updated Commission members on the department’s activities. He discussed improvements to Virginia’s Behavioral Health System pertaining to hospital operations, jail waiting lists and prevention. The overall number of state hospital admissions rose 54% since 2013 due to private hospitals refusing patients with specific diagnosis. Credentials for emergency evaluators were discussed, then Dr. Barber spoke about updates on the Certified Community Behavioral Health Clinics (CCBHC) program. He presented a chart of eight participating CSBs and services they need to provide to meet CCBHC standards. He stated that in order to have all services ready in the eight CSB’s, $6.52M would be needed and then $38.02M to continue the operations. Virginia continues to strive to address issues of access to care, quality, consistency and accountability. He presented the STEP-VA (System Transformation, Excellence and Performance in Virginia) model as a way to improve Virginia’s behavioral health care system. Finally, Dr. Barber discussed Virginia’s Justice Involved Transformational Team.

Healthy Living/Health Services Subcommittee

The Healthy Living/Health Services Subcommittee met on August 3rd and September 7th.

Dr. Mike Royster, Vice President of the Institute for Public Health Innovation, presented information on the Community Health Workforce in Virginia. He explained that community health workers are charged with identifying and discussing social obstacles with patients and promoting health and quality of life. He spoke about several pilot projects that used community health workers and successfully decreased rates of re-admission to hospitals. He also mentioned the CHW advisory work groups and their tasks. Lastly, he discussed the legislative issues the CHW advisory group faces such as official recognition and identification in the Code.

Barbara Lowe-Fisher, National Vaccine Information Center, spoke about the legal right of parents to not vaccinate based on religious beliefs and how one-size-fits-all laws are not good for citizens. She described her own family experiences with adverse reactions to vaccines and asked that no change to be made to the current vaccine laws.

Karrie Delaney from Voices for Vaccines stated that parents who choose to vaccinate have science behind them. She then summarized concerns associated with a reduction in vaccination rates in the U.S. The loss of herd immunity can result in outbreaks in communities which may result in at-risk individuals, such as infants and the ill who cannot be vaccinated, getting vaccine-preventable diseases.

Secretary William Hazel provided an update on Health and Human Resources activities. Key behavioral health issues were discussed as well as recent progress in improving Virginia’s behavioral health system. Topics included prescription, fentanyl and heroin overdoses; the Department of Justice waiver redesign; training centers; MLTSS vision and goals; Medicaid expansion; DSRIP (delivery system reform); high-cost medications; and the Health Information Exchange.

Commissioner Marissa Levine, from Virginia’s Department of Health, discussed Virginia’s Plan for Well-Being. Her presentation included the metrics being used for the plan, the data framework, the process for plan development, components of the plan, the Virginia Health Opportunity Index, and next steps.

Dawn Traver presented “Redesigned Waivers for Persons with Developmental Disabilities". She stated the three waivers have been amended with new services and discussed the new online system for maintaining waivers and how successful it has been functioning. Ms. Traver also spoke about the CMS final regulations on settings requirements and how DMAS will comply with them.

Lastly, Keisha Smith gave an update on the Graduate Medical Education Task Force. She spoke about the meetings that were held so far as well as the components of DMAS’s residency grant program and the timeline for applications. She concluded by saying that the task force will be examining other options to improve GME in the Commonwealth.