health care’s quality strategy · 2012. 5. 14. · information and services among hcs and other...

Advancing Quality in Health

Centers: Bureau of Primary

Health Care’s Quality Strategy

Suma Nair, MS, RD

Director, Office of Quality & Data, Bureau of

Primary Health Care, Health Resources &

Services Administration

Annual Community Health Institute

May 9-11, 2012

Resort & Conference Center of Hyannis

Hyannis, MA

Advancing Quality in Health Centers: Bureau of Primary Health Care’s Quality Strategy

Suma Nair

Director, Office of Quality and Data

U.S. Department of Health and Human Services

Health Resources and Services Administration

Bureau of Primary Health Care

MA League of Community Health Centers

May 11, 2012

Primary Health Care Mission

Improve the health of the Nation’s underserved communities and vulnerable populations by assuring access to comprehensive, culturally competent, quality primary health care services

3

Health Center Program Growth:

National Impact 2008-2010

15,500,000

16,000,000

16,500,000

17,000,000

17,500,000

18,000,000

18,500,000

19,000,000

19,500,000

20,000,000

2008 2009 2010

Patients

Year

7,000

7,200

7,400

7,600

7,800

8,000

8,200

8,400

2008 2009 2010

Sites

Year

100,000

105,000

110,000

115,000

120,000

125,000

130,000

135,000

2008 2009 2010

Jobs

Year

2008 2009 2010 Growth from 2008-2010 (% Increase)

Patients 17,122,535 18,753,858 19,469,467 2,346,932 (13.7%)

Sites 7,518 7,892 8,156 638 (8.5%)

Jobs 113,059 123,012 131,660 18,601 (16.5%)

4 Source: Uniform Data System and

HRSA Electronic Handbooks

Health Center Program Overview

National Impact

Source: Health Center Data: Uniform Data System, 2010. National Data: U.S.

Census Bureau, 2010 Current Population Reports and Current Population Survey.

5

Massachusetts Health Centers

Calendar Year 2010

MA Health Center Grantees

In 2010, 36 Health Centers

Served 588,064 patients:

• 20.24% were uninsured

• 90.11% were at or below 200% of

poverty

• 55.1% Female • 58.8% nationally

• 23.35% Children < age 18

• 32.11% nationally

• 7.52% Seniors age 65+

• 6.84% nationally

• Served by (FTEs): – 409 Physicians

– 234 Nurse Practitioners, Physician

Assistants, and Certified Nurse

Midwives

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Map and Data to be

inserted

Source: Uniform Data System, 2010

BPHC Quality Strategy

Ability of patients to be seen in a

timely, affordable and culturally

competent manner

Provision of full scope of primary health

services, including dental, behavioral

health, and enabling services

Coordination and Integration

services within a Health Home

Coordination & integration of patient

information and services among HCs and

other community-based providers of

services

ACCESS

COMPREHENSIVE

SERVICES

INTEGRATED

SERVICES

INTEGRATED

HEALTH SYSTEM

Better Care ⃘ Healthy People & Communities ⃘ Affordable Care

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1. Implementation of QA/QI Systems

All Health Centers fully implement their

QA/QI plans

2. Adoption and Meaningful Use of EHRs

All Health Centers implement EHRs

across all sites & providers

3. Patient Centered Medical Home

Recognition

All Health Centers receive PCMH

recognition

4. Improving Clinical Outcomes

All Health Centers meet/exceed

HP2020 goals on at least one UDS

clinical measure

5. Workforce/Team-Based Care

All Health Centers are

employers/providers of choice and

support team-based care

Priorities & Goals

ACCESS

COMPREHENSIVE

SERVICES

INTEGRATED

SERVICES

INTEGRATED

HEALTH SYSTEM


1. Programs/Policies

2. Funding

3. Technical Assistance

4. Data/Information

5. Partnerships/Collaboration

Strategy Implementation

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1.Programs/Policies

2.Funding

3.Technical Assistance

4.Data/Information

5.Partnerships/Collaboration


ACCESS

COMPREHENSIVE

SERVICES

INTEGRATED

SERVICES

INTEGRATED

HEALTH SYSTEM


9

Quality Strategy Implementation:

Programs/Policies

ACCESS

COMPREHENSIVE

SERVICES

INTEGRATED

SERVICES

INTEGRATED

HEALTH SYSTEM

PCMHHI,

CMS Demo

Public Health

Integration

ACO

Collaboration

PIN

Expanded

Services

Beacon,

HCCN

Program

Requirements


10

Recently Released Policies

• Approved Uniform Data System Changes for 2012

• CY 2013 Requirements for Federal Tort Claims Act

(FTCA) Medical Malpractice Coverage for Health Centers

• Sites, Scope of Project, and Capital Projects

• Process for Becoming Eligible for Medicare

Reimbursement under the FQHC Benefit

• Health Center Collaboration

• FTCA Health Center Policy Manual

• HRSA Patient-Centered Medical/Health Home Initiative

• HIV/AIDS Care and Treatment in Health Centers

To Access these and other policies, visit:

http://www.bphc.hrsa.gov/policiesregulations/policies/index.html

11


2012 Anticipated Policy Topics

• DRAFT Sliding Fee Discount Program

• DRAFT Sub-Recipients/Sub-Contracts

• DRAFT Quality Improvement/Assurance

Final and draft policies open for comments will be posted at: http://www.bphc.hrsa.gov/policiesregulations/policies/index.html

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Quality Strategy Implementation: Funding

ACCESS

COMPREHENSIVE

SERVICES

INTEGRATED

SERVICES

INTEGRATED

HEALTH SYSTEM


• $150M for Health Center New Access Points (~220 to 230

awards)

• $15M for Expanded Services, including Expanded HIV

Services and Support for Health Center Recruitment and

Retention Strategies, including the Health Center Veterans

Hiring Challenge

• $20M for Health Center Controlled Networks (~25 to 30

awards)

• Capital Development:

o $630M for Building Capacity

o $100M for Immediate Facility Improvements

o $75M for School-Based Health Center Capital program

(~150 awards)

13

Fiscal Year 2012

Continuation Funding Opportunities

• Health Centers:

– FY 2012 Budget Period Progress Report

(BPR) Technical Assistance: http://www.bphc.hrsa.gov/policiesregulations/continuation/index.html

– FY 2012 Service Area Competition (SAC)

Technical Assistance: http://www.hrsa.gov/grants/apply/assistance/sac/

• Cooperative Agreements:

– National

– State/Regional Primary Care Associations

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http://www.bphc.hrsa.gov/policiesregulations/continuation/index.html

http://www.hrsa.gov/grants/apply/assistance/sac/

Fiscal Year 2011/2012

Funding Levels in Massachusetts

• $58.6 M base operational grants (FY ‘11)

• $47.7 M New ACA grants

• $80 K – Planning Grants

• $1.1 M – Quality Improvement & Patient-

Centered Medical Home Program

• $3 M - School-Based Health Center Capital

Program

• $43.5M – Capital Development Grants

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Technical Assistance

ACCESS

COMPREHENSIVE

SERVICES

INTEGRATED

SERVICES

INTEGRATED

HEALTH SYSTEM


• National Cooperative Agreements

o Homeless, Farmworkers, Public Housing, AAPI,

LGBT

• Primary Care Associations

• Primary Care Offices

• Health Center Controlled Networks

• HRSA Resources

o Quality Improvement, HIT, Oral and Behavioral

Health

• SAMHSA/HRSA Center for Integrated

Health Solutions (CIHS)

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Fiscal Year 2012

Primary Care Association Requirements

Statewide/Regional Health

Center T/TA Activities

A. Program Requirements

Goal:

• XX% of Health Centers with No

Program Conditions

T/TA Focus Areas:

• Need

• Services – QI/QA Systems

• Management and Finance – Fiscal

Operations/Systems

• Management and Finance – Workforce

Recruitment and Retention

• Governance

B. Performance Improvement

Goals:

• XX% of Health Centers that

Meet/Exceed Healthy People

2020 Goals on One or More

Clinical Performance Measures

• XX% of Health Centers with

PCMH Recognition

• XX% of Health Centers with Cost

Increase Less than National

Average

• XX% of Health Centers Financially

Strong (No Going Concern

Issues)

T/TA Focus Areas:

• Clinical Performance Measures

• Financial Performance Measures 17

Technical Assistance (TA) Resources

Federal TA Support:

• Project Officer

• TA Calls/Trainings

• Onsite Consultant Support

• BPHC TA Website-New Search Engine Feature Added

For more information visit the BPHC TA Website: http://www.bphc.hrsa.gov/technicalassistance/index.html

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http://www.bphc.hrsa.gov/technicalassistance/index.html

Bureau of Primary Health Care

Help Line

Single point of contact to assist grantees and stakeholders

with information in the following areas:

• BHCMIS – System in EHB (Electronic Handbook)

• Health Center Quarterly Reporting (HCQR)/ARRA 1512

• Reporting Uniform Data System (UDS)

• Federal Torts Claims Act (FTCA) for Health Centers and

Free Clinics

Phone: 1-877-974-BPHC (2742)

Email: [email protected].

Available Monday to Friday (excluding Federal holidays),

from 8:30 AM – 5:30 PM (ET), with extra hours available

during high volume periods.

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https://mail.nih.gov/owa/redir.aspx?C=58dffad65c0b4ee89673240f5f46e418&URL=mailto:[email protected]

UDS Website:

http://www.hrsa.gov/data-statistics/health-center-data/index.html.

o Data analysis tools

o Data download functionality

• UDS Grantee/State/National Summaries

• Health Center Trend Reports

• State and National Roll-up Reports

• Reporting and Training Resources

UDS Mapper: www.udsmapper.org

• HRSA has developed a mapping and support tool driven primarily from data within the Uniform Data System (UDS)

• Webinar trainings on using Mapper functionality available: http://www.udsmapper.org/webinars.cfm

UDS Web Tools

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http://www.hrsa.gov/data-statistics/health-center-data/index.html







http://www.udsmapper.org/

http://www.udsmapper.org/webinars.cfm

ECRI risk management and patient safety resources are available to Health Center Program grantees and Free Clinics. Resources include:

– Risk management courses

– Continuing medical education (CME) credits at no cost to health care providers

– Links to archived audio-conferences/webinars to supplement evidence-based risk management training

– Guidance articles, self-assessment tools, ready-made training materials on patient safety, quality and risk management for the health center and free clinic setting

– Risk & Safety E-news

Visit: www.ecri.org/clinical_RM_program.

Risk Management and

Patient Safety Web Resources

21

http://www.ecri.org/clinical_RM_program


Partnerships/Collaboration

ACCESS

COMPREHENSIVE

SERVICES

INTEGRATED

SERVICES

INTEGRATED

HEALTH SYSTEM


• National Partners o Federal: White House, HHS, Other Federal

agencies

o Non-Governmental Partners

• State Partners o Primary Care Associations

o Primary Care Offices

o Medicaid

• Local Partners o HCCNs

o Other Safety Net Providers

o Hospitals

o CBOs

22

All Health Center and Primary Care Associations are encouraged

to explore and participate in the following key HHS public health

initiatives:

• National Quality Strategy

http://www.ahrq.gov/workingforquality/nqs/

• HHS Action Plan to Reduce Racial and Ethnic Health Disparities

http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf

• National Prevention Strategy

http://www.healthcare.gov/prevention/nphpphc/strategy/index.html

• National HIV/AIDS Strategy

http://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf

Primary Health Care and

Public Health Leadership

23

http://www.ahrq.gov/workingforquality/nqs/

http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf

http://www.healthcare.gov/prevention/nphpphc/strategy/index.html

http://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf

http://www.collaborateforhealthyweight.org/

• National Oral Health Initiatives

http://www.hrsa.gov/publichealth/clinical/oralhealth/

• Behavioral Health Initiatives

http://bphc.hrsa.gov/technicalassistance/tatopics/clinicalcareservices/index.html#Behavioral

• Healthy Weight Collaborative


• Million Hearts Campaign

http://millionhearts.hhs.gov/

• Text4baby

http://www.cdc.gov/women/text4baby/index.htm

• Viral Hepatitis Initiative

http://www.hhs.gov/ash/initiatives/hepatitis/index.html

Primary Health Care and

Public Health Leadership

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http://www.hrsa.gov/publichealth/clinical/oralhealth/

http://bphc.hrsa.gov/technicalassistance/tatopics/clinicalcareservices/index.html


http://millionhearts.hhs.gov/

http://www.cdc.gov/women/text4baby/index.htm

http://www.hhs.gov/ash/initiatives/hepatitis/index.html




QA/QI plans





Recognition


recognition




clinical measure





Priorities & Goals

ACCESS

COMPREHENSIVE

SERVICES

INTEGRATED

SERVICES

INTEGRATED

HEALTH SYSTEM



2. Funding


4. Data/Information



25



All Health Centers fully implement their QA/QI

plans


All Health Centers implement EHRs across all

sites & providers

3. Patient Centered Medical Home Recognition

All Health Centers receive PCMH recognition


All Health Centers meet/exceed HP2020 goals

on at least one UDS clinical measure


All Health Centers are employers/providers of

choice and support team-based care

Priorities & Goals

ACCESS

COMPREHENSIVE

SERVICES

INTEGRATED

SERVICES

INTEGRATED

HEALTH SYSTEM


26

Quality Priority:

Implementation of QA/QI Systems

• OIG study of quality assurance and care

provided at health centers recommendations:

– Provide additional guidance on:

• Elements of QA/QI program

• Information required in patient records

• Required primary health services

– Establish procedures to independently assess

patients’ receipt of services and patient records

• Draft QI PIN

• Site Visits

27

FTCA Program Updates

• FTCA Deeming Application enhancements

• Focus is on implementation of risk management

and quality improvement systems

• FTCA site visits

• Training and Technical Assistance Available

– Risk Management Resources: https://www.ecri.org/clinical_rm_program

– For FTCA Programmatic TA: Email: [email protected] Phone: 1-877-974-2742

• FTCA Claims Management

28

https://www.ecri.org/clinical_rm_program

mailto:[email protected]



All Health Centers fully implement their QA/QI plans







All Health Centers meet/exceed HP2020 goals on at

least one UDS clinical measure




Priorities & Goals

ACCESS

COMPREHENSIVE

SERVICES

INTEGRATED

SERVICES

INTEGRATED

HEALTH SYSTEM


29

Health Center EHR Adoption

National and Massachusetts 2010

51%

64%

14%

8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

National Massachusetts

EHR at Some

Sites

EHR at All

Sites

2015 Goal: 100% of Health Centers use EHR at All Sites

30 Source: 2010 UDS

2012 Goal: 50% of Health Centers use EHR at All Sites

Adoption and Meaningful Use

of EHRs

• 2012 UDS includes additional EHR adoption questions

• Participation in CMS Meaningful Use Incentive Payment Program

• Beacon Supplemental

• New HCCN Funding Opportunity

• HRSA’s Network Guide - The guide, currently including information on 46 networks, is available at http://www.hrsa.gov/healthit/networkguide/index.html

31

http://www.hrsa.gov/healthit/networkguide/index.html





All Health Centers implement EHRs across all sites &

providers



recognition


All Health Centers meet/exceed HP2020 goals on at least

one UDS clinical measure


All Health Centers are employers/providers of choice

and support team-based care

Priorities & Goals

ACCESS

COMPREHENSIVE

SERVICES

INTEGRATED

SERVICES

INTEGRATED

HEALTH SYSTEM


32

Health Center PCMH Recognition

National and Massachusetts 2012

22% 22%

8%

0% 0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

National Massachusetts

PCMHHI

Participants

PCMH

Recognized

33

2013 Goal:

25% of Health

Centers

Recognized

as PCMH

Data as of March 2012;

PCMH Recognized Includes: NCQA, Joint Commission, and AAAHC

2012 Goal:

13% of Health

Centers

Recognized

as PCMH

Patient Centered Medical/

Health Home Initiative (PCMHHI)

• Encourages and supports health centers to transform their practices

and participate in the PCMHH recognition process to:

– improve the quality of care and outcomes for health center populations;

– increase access; and

– provide care in a cost effective manner.

• HRSA/BPHC will cover recognition process fees and provide

technical assistance resources for practice transformation.

• Participation is strongly encouraged and provides an opportunity for

health centers to achieve PCMH recognition.

For further information on the PCMHH Initiative:

• PCMHH Initiative PAL:

http://www.bphc.hrsa.gov/policiesregulations/policies/pal201101.html

• BPHC Helpline: [email protected] or 1-877-974-BPHC (2742)

• PCMHH email: [email protected]

34

http://www.bphc.hrsa.gov/policiesregulations/policies/pal201101.html








All Health Centers implement EHRs across all sites

& providers




All Health Centers meet/exceed HP2020

goals on at least one UDS clinical

measure


All Health Centers are employers/providers of choice

and support team-based care

Priorities & Goals

ACCESS

COMPREHENSIVE

SERVICES

INTEGRATED

SERVICES

INTEGRATED

HEALTH SYSTEM


35

o Over 80% reported the overall quality of services

received at the health center were “excellent” or

“very good.”

o Over 80% reported that they were “very likely” to

refer friends and relatives to the health center.

o Over 75% reported the main reason for “going to

the health center for healthcare instead of

someplace else” was because it was convenient

(28%), affordable (25%), and provided quality

healthcare (22%).

Health Center Performance

2009 Health Center Patient Survey

36

Health Center Performance

Health Disparities

• Access to Primary Health Care

– No racial/ethnic differences in the proportion of HC patients who are

satisfied with the overall care received (98% overall).

• Preventive Services Counseling

– No racial/ethnic differences in the proportion of HC patients who

receive weight management counseling.

• Diabetes

– Patients were more likely to be current with their A1c testing and see

or talked with an eye doctor if they received diabetes management

support from HC staff.

• Hypertension

– Patients reporting unmet healthcare needs in past year were more

than twice as likely to have a hypertension-related ED visit or

hospitalization.

• Cancer Screening

– African American and Hispanic/Latino colorectal cancer screening

rates are higher than national average.

37

2010 National and Massachusetts

Health Center Performance and Healthy People

2020 Goals

38

56%

72%

12%

26%

35%

50%

35%

64% 58%

68%

2%

6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

National MassachusettsHypertension Control

Diabetes Control

Childhood Immunization

Early Entry to Prenatal Care

Low Birthweight

Cervical Cancer Screening

Percentage of Health Centers Meeting or

Exceeding Healthy People 2020 Goals

2012 Goal: 10+% of Health Centers Meet or Exceed HP 2020 Goals

Source: 2010 UDS and Healthy People 2020

2012 UDS Reporting

Changes to CY 2012 UDS:

1. New staff tenure table;

2. Three new clinical measures;

– Coronary Artery Disease (CAD): Lipid Therapy

– Ischemic Vascular Disease (IVD): Aspirin Therapy

– Colorectal Cancer Screening

3. Reporting on all (versus primary) diagnoses for selected

conditions; and

4. Questions about electronic health record capabilities and

national quality recognition

Refer to the UDS website for more information:

http://bphc.hrsa.gov/healthcenterdatastatistics/index.html 39

http://bphc.hrsa.gov/healthcenterdatastatistics/index.html





All Health Centers implement EHRs across all sites

& providers




All Health Centers meet/exceed HP2020 goals on at

least one UDS clinical measure




Priorities & Goals

ACCESS

COMPREHENSIVE

SERVICES

INTEGRATED

SERVICES

INTEGRATED

HEALTH SYSTEM


40

Quality Priority:

Workforce/Team-Based Care

• Student/Resident Education &Training (Bureau of Health

Professions)

o Teaching Health Centers

• Recruitment and Retention (Bureau of Clinician Recruitment and

Services)

o NHSC

o Loan Repayment

• Training and Development

o Guidelines & Best Practices

• Inter-Professional Team-Based Care

o Integrated within Medical/Health Home

o Enabling Services Providers

41




QA/QI plans





Recognition


recognition




clinical measure





Priorities & Goals

ACCESS

COMPREHENSIVE

SERVICES

INTEGRATED

SERVICES

INTEGRATED

HEALTH SYSTEM



2. Funding


4. Data/Information



42

Thank You!

Questions?

43

Contact Information

Suma Nair MS, RD Director, Office of Quality and Data

301-443-7587

[email protected]

44


health care’s quality strategy · 2012. 5. 14. · information and services among hcs and other...

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