Climate of Healthcare: 2017 Community Health Centers

Agenda : What are community health centers Affordable Care Act - ACA Climate / Challenges for CHC in 2017 Open discussion

Special Thanks Illinois Primary Health Care Association

National Association of Community Health Centers

What are FQHCs/CHCs?

WhatAreFQHCs/CHCs?

•  FederallyQualifiedHealthCenters

•  CommunityHealthCenters•  Rankedasoneofthe10most

effec<vegovernmentprograms(WhiteHouseOfficeofManagement&Budget)

WhatisanFQHC?

CommunityHealthCenters(FQHCs)offercomprehensive,qualityprimarymedical,behavioralanddentalhealthcare.

5BasicCharacteris<csofCHCs•  Locatedinhigh-needareas(HPSA,MUA,MUP)

•  Providecomprehensiveprimaryhealthcareservicesincludingdental,behavioralhealthandenablingservices

•  Servicesareavailabletoallresidentsinthecommunity,withchargesbaseduponabilitytopay

•  Governedbycommunityboards,thusensuringaccountabilityandresponsivenesstolocalneeds—atleast51%mustbecomprisedbypa<entswhou<lizethecenter

•  Nonprofit,publicortaxexemptagencieswithamissiontoprovidehealthcaretothemedicallyunderserved

TypesofCHCs

◦  Federally-qualifiedhealthcenter(FQHC)–FundedviaSec<on330ofthePublicHealthServiceAct.FourtypesofCHCs

�  CommunityHealthCenter–330e�  MigrantHealthCenter–330g�  HealthCarefortheHomeless–330h�  HealthCareforPublicHousing–330i�  FQHCLook-Alikes-Organiza<onsthatmeetalloftheFQHCeligibilityrequirements,butdonotreceivefederalgrantfunding.

CommunityHealthCenters•  CommunityHealthCenters(CHCs)areen<<escreatedby

Congressinthe60stomeetthehealthcareneedsofunderservedcommuni<esandhigh-riskpa<ents.

•  Dr.JackGeiger–ini<allyestablishedoneinMississippideltaandoneinBoston!

•  Morethan1300CHCorganiza<ons–providingservicesatmorethan9,000clinicalsites

CHCTimeline

•  1965:Neighborhoodhealthcenters– ArosefromWaronPovertyandcivilrightsmovement

– FundedbyOfficeofEconomicOpportunity,directlyfromfederalgovernmenttocommunity-levelorganiza<ons

– Medicaid/Medicarenotini<allyinvolved– BostonandBolivarCounty,Mississippi

CHCTimeline

•  1975:CommunityandMigrantHealthCenters– MovedtoDept.ofHealth,Educa<onandWelfare

•  SubsequentlyHEWbecameDept.ofHealthandHumanServices

– HealthResourcesandServicesAdmin.– BureauofPrimaryHealthCare

– Migranthealthprogramadded– Subsequentaddi<ons:publichousing,homeless

CHCTimeline

•  1989:FederallyQualifiedHealthCenterProgram– Establishedcost-basedMedicaid/Medicarereimbursement

•  1996:PublicHealthServiceAct330– Consolidatedallpreviousprograms– Separategrantcompe<<onsforeachprogram,toallowcommunitytotailorapplica<ons

FQHCVideo

https://youtu.be/j80B4ckjOT8

WhatSetsFQHCsApart?

-  Communitymajorityboards-  FederalTortClaimsActcoverage-  Accountability-  Federalsupport-  Comprehensiveness-  Partofna<onalnetworkforbenchmarking,qualityimprovement

WhyDoPa<entsChooseFQHCs?

WhyDoPa<entsChooseFQHCs?

•  Cost–SlidingFeeScale•  Medicaid•  CulturalSensi<vity•  Loca<on•  LiteracySensi<vity•  AvailabilityofCareProviders

•  QualityofCare•  Holis<cApproach•  Family-Centered•  RespectforAll

WhyDoCliniciansChooseFQHCs?

•  Abletofocusoncareratherthan

administra<on•  FTCACoverage•  Partofna<on’slargestprimarycare

networkwithitsinherentbenefits…•  Whilebeingpartofalocalvery

community-basedorganiza<on•  Interdisciplinaryandholis<c

approachtocare•  QualityofCare•  Family-Centered•  CulturalSensi<vityandRespectfor

All•  NHSCandstateloanrepayment•  Asenseofmission

GeographicDesigna<on

•  330granteesprovidecaretomedicallyunderservedpopula<ons(MUPs)ormedicallyunderservedareas(MUAs).

•  MUAs/MUPsaredeterminedbyIndexofMedicalUnderservice(IMU)

American Recovery and Reinvestment Act of 2009 (ARRA) }  Community Health Center Highlights

–  $500 million to support new health center sites and service areas, increase services at existing sites, and support surge in uninsured populations

–  $1.5 billion to support construction, renovation and equipment, including health information technology systems

–  Of this, $338 million was released in March as Increased Demand for Services (IDS) grants. IPHCA members received $16.2 million of this amount. •  Health centers will use the funds over the next two years to create or

retain approximately 6,400 health center jobs.

}  Illinois Medicaid received an additional $2.9 billion in federal matching funds for 5 quarters starting 10/1/08

Affordable Care Act (ACA) 2010

p  Highlights of ACA n  Insurance n  Medicaid coverage n  Individual mandate n  Triple Aim

p  (1) improve the patient experience p  (2) improve population health p  (3) reduce per capita cost.

ACA - Funding p  Community Health Center Fund - $11 billion over

five year period o  $9.5 billion – operations o  $1.5 billion – construction and renovation projects

p  $1.5 billion in new, dedicated funding for the NHSC over five years, programmatic changes FQHCs

ACA - Enrollment p  Medicaid expansion and Exchanges p  Increase capacity to serve as many as 20 million new

patients p  Total of 40 million patients nationwide at the end of 5

years p  Illinois experience

o  BPHC Outreach/Enrollment funding o  Trained 414 counselors* o  Assisted 132000+ individuals; 32,000 applied; 22,000

enrolled* o  54%female* *2014 numbers

ACA - Workforce p  Workforce challenges existed before ACA p  ACA – emphasis on primary care p  NHSC funding and programmatic changes p  Teaching CHCs p  PCMH model – increase efficiency, team-based care p  Illinois experience

o  IPHCA recruitment services o  Teaching CHC grant o  Collaboration with Health Professions Program

ACA – Clinical Quality p  PCMH recognition – 65% nationally and 75% in

IL p  Over 300+ TJC accredited, 10 in Illinois p  EHR adoption – 92% nationally and 91% in IL p  UDS data – 2014, 2015 on public website

ACA - Challenges p  Managed Care

p  Medicaid expansion State option

NOTES:CurrentstatusforeachstateisbasedonKCMUtrackingandanalysisofstateexecu<veac<vity.*AR,IA,IN,MI,MT,NHandPAhaveapprovedSec<on1115waivers.CoverageunderthePAwaiverwentintoeffect1/1/15,butithastransi<onedcoveragetoastateplanamendment.CoverageundertheMTwaiverwentintoeffect1/1/2016.LA’sGovernorEdwardssignedanExecu<veOrdertoadopttheMedicaidexpansionon1/12/2016,butcoverageundertheexpansionisnotyetineffect.WIcoversadultsupto100%FPLinMedicaid,butdidnotadopttheACAexpansion.Seesourceformoreinforma<ononthestateslistedas“adop<onunderdiscussion.”SOURCE:“StatusofStateAc<onontheMedicaidExpansionDecision,”KFFStateHealthFacts,updatedMarch14,2016.hpp://kff.org/health-reform/state-indicator/state-ac<vity-around-expanding-medicaid-under-the-affordable-care-act/

CurrentStatusofStateMedicaidExpansionDecisions,2016

WY

WI*

WV

WA

VA

VT

UT

TX

TN

SD

SC

RIPA*

OR

OK

OH

ND

NC

NY

NM

NJ

NH*

NVNE

MT*

MO

MS

MN

MI*MA

MD

ME

LA*

KYKS

IA*

IN*IL

ID

HI

GA

FL

DC

DE

CT

CO

CA

AR*AZ

AK

AL

Adopted(32StatesincludingDC)

NotAdop<ngAtThisTime(19States)

Source: The Henry J. Kaiser Family Foundation, 2016.

Medicaid eligibility and State expansions

Coverage Gap

Source: The Henry J. Kaiser Family Foundation, 2016

FQHCPa<entsNa<onwide

•  22.8millionpa<ents(22,873,243)– Medical:19million– Dental:4.7million– Mentalhealth:1.26million– Enabling:2.19million

•  90millionvisits 17.1

18.819.5

21.121.7

22.8

1012141618202224262830

200920102011201220132014

Num

bero

fpa<

ents

(inM

illions)

FQHCPa<entsNa<onwide

•  SpecialPopula<ons–  Homeless:1.1million– Migrant/seasonalworkers:891,796– Veterans:289,391– Prenatal:528,074– School-based:569,107

FQHCPa<entsNa<onwide•  92.4%below200%ofpovertylevel•  71%below100%ofpovertylevel•  27.9%uninsured(compareto36%in2012)

–  23.4%inIL•  47.3%Medicaid/CHIP(compareto41%in2012and2013)

–  58.4%inIL•  62%racial/ethnicminori<es•  23%bestservedinalanguageotherthanEnglish•  20%ofna<on’slow-income,uninsuredgettheircareat

communityhealthcenters

FQHC’sNa<onwide

•  1,300HealthCenters– 9,000sites

•  AllUSstatesandterritories•  170,331staff(FTEs)

– 11,202FTEPhysicians– 5,879FTENP– 2,594FTEPA

HealthCenterPa<entsbyAge

Note: Percent may not total 100% due to rounding. Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

HealthCenterPa<entsbyRace

Note: Percentage of known race Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

CHCFunding

•  Publicfunding:– Directgrantmoneyfromfederalgovernment– EncounterratefromMedicaid

•  Otherfunding– Commercialinsurers– Pa<entpayments– Privategrantfunding– Dona<onsetc.

CHCFederalAppropria<ons

Prospec<vePaymentSystem

•  Replacedcost-basedreimbursementin2001•  LessgenerousthanCBR•  TiedtoaverageofeachFQHC’sallowablecostsFY1999and2000

•  Star<ngin2001,per-encounterrateadjustedforinfla<onbyMedicareEconomicIndexannually

Encounterrate

0

20

40

60

80

100

120

Dol

lars

99211 99212 99213 99214

Mediciad fee-for-serviceMedicare

Health Center

Services–PrimaryMedicalCare

•  FamilyMedicine•  Pediatrics•  InternalMedicine•  Obstetrics/Gynecology

FQHC–OtherClinicalServices

•  Den<stry– 75%provideden<stson-site

•  Pharmacy– 33%havepharmacyon-siteorcontractwithlocalpharmacy

– Otherprograms•  340Bfederaldrugpricing• Manufacturer’sassistanceprograms

FQHC–EnablingServices

•  Transporta<on•  Transla<on•  Healtheduca<on•  Outreach•  Financialcounseling

– Eligibilityassistance– Slidingfeescaleassessment

FQHC–BehavioralServices

•  Crisisinterven<on(socialwork)•  Counseling

– LicensedClinicalSocialWorkers– Psychologists– Psychiatrists

•  SubstanceAbuse

FQHC–ImpactonAccesstoCare

•  Uninsuredpa<entlivingnearFQHC:– Lesslikelytohaveunmetmedicalneed– Lesslikelytopostponeseekingmedicalcare– Morelikelytohavehadgeneralmedicalvisit– SignificantlylesslikelytohaveERvisit– Lesslikelytohaveahospitaladmission

FQHC–ImpactonQualityofCare

•  Pilotstudy:CHC’smet/exceededna<onalqualityofcareaverages:– Cervicalcancerscreeningrates– Diabe<ccholesterolandHbA1clevels– Pa<entsmorelikelytoreportthattheirproviderlistensandspendsmore<mewiththepa<ent

FQHC–ImpactonHealthCareCosts

•  Savingthena<onalhealthcaresystem$9.9to$17.6billionperyear

•  Largelythrough:– decreasedemergencydepartmentvisits– preven<vecare

FinancialBenefitsuniquetoCHCs

•  Federalgrantfunding•  EnhancedMedicaidrates•  FTCAcoverageofmalprac<ceinsurance

Climate / Challenges for CHC in 2017 NACHC slides

Additional Resources Community Health Centers

Partnerships

•  Localhospitals•  Localpublichealthdepartments•  Community-basedorganiza<ons•  Othercommunityhealthcenters•  IllinoisPrimaryHealthCareAssocia<on•  Na<onalAssocia<onofCommunityHealthCenters

HealthCentersintheLiterature-

}  hpp://nachc.com/literature-summaries.cfm}  Providesummariesofar<clesrelatedtocommunityhealthcentersaccesstoandqualityofcare,costeffec<veness,andhealthcaredispari<es.

April-2015StudiesofHealthCenterQualityofCare

April-2015StudiesofHealthCentersImprovingAccesstoCare

October-2014StudiesofHealthCenterCost-Effec<veness

June-2013StudiesofHealthCentersReducingDispari<es

Federally Qualified Health Centers

(excludes Cook County)

Federally Qualified Health Centers

City of Chicago

Federally Qualified Health Centers

Cook County (excludes Chicago)

RememberingthefoundingfatherofCHCmovement

•  “Forallthosewhosecareshavebeenourconcern,theworkgoeson,thecauseendures,thehopes<lllives,andthedreamshallneverdie.”SenatorTedKennedy

•  Source:“AndtheDreamShallNeverDie,”Speechatthe1980Democra<cNa<onalConven<on,accessedonline08/29/2009