north carolina’s community health centers vitalto a ... · cmhn accountable care organization...

Community health centers are not-for-profit health care practices that provide comprehensive, patient-centered primary care. Community health centers:

Serving federally-designated medically underserved areas and populations, Community health centers (CHCs)provide coordinated primary and preventive services that promote reductions in health disparities forlow-income individuals, racial and ethnic minorities, rural communities and other underserved populations.CHCs help people overcome barriers to care by providing a comprehensive array of enabling services that atypical private practice physician would not, facilitating access to health care.

THE COMMUNITY HEALTH CENTER DIFFERENCE

NORTH CAROLINA’S COMMUNITY HEALTH CENTERSVITAL TO A HEALTHY NORTH CAROLINA

WHAT ARE COMMUNITY HEALTH CENTERS?

Serve medically underserved populations,Provide appropriate, necessary services with fees adjusted based on patients’ ability to pay,Demonstrate sound clinical and financial management, and Are governed by a board, a majority of which must include health center patients.

Primary medical careDental care*Behavioral/mental health care*Prescription drugsHealth insurance outreach and enrollmentEnabling services: case management, health education, translation, WIC programs, transportation, etc..**SERVICE AVAILABILITY VARIES BY HEALTH CENTER.

North Carolina CHC Patient Visits by Type of Service1

1Bureau of Primary Care, HRSA, DHHS, 2014 Uniform Data System (UDS).

NORTH CAROLINA COMMUNITY HEALTH CENTER ASSOCIATION | 4917 WATERS EDGE DR., STE. 165, RALEIGH, NORTH CAROLINA 27606 | 919.469.5701 | NCCHCA.ORG

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N.C. health centers serve significantly more uninsured patients than health centers nationally.

Health center patients spend 62% less.

Total annual health expenditures were62% less for patients served in NorthCarolina’s community health centersthan for patients receiving care in otherambulatory care settings.

In dollars, NC CHC patients experiencedan average savings of approximately$3,400 dollars.3 That is money in NorthCarolinians’ pockets.

$1,233Median cost

per hospital ED visit2

$141Medical cost

per medical visit1

$192Dental cost

per dental visit1

$644Total annual cost

per patient1

1.BPHC, HRSA, DHHS, 2014 Uniform Data System (UDS).2.Median charge for 10 most common outpatient conditions in ED. Caldwell N., Srebotnjak T., Wang T., Hsia R. (2013) “How Much Will I Get Charged for

This?” Patient Charges for Top Ten Diagnoses in the Emergency Department. PLoS ONE 8(2): e55491. Available: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0055491.

3.Richard P., Shin P., Vasilkovska K., Rosenbaum S. (2011). Bending the health care cost curve in North Carolina: The Experience of Community Health Centers. http://www.rchnfoundation.org/wp-content/uploads/2013/01/GeigerGibson_NCAug92011-final.pdf

More than 7 in 10 N.C. health center patients live at or below 200% of the poverty line, an annual income less than $23,850 for a family of four (in 2014).1

Health Centers Are a Vital Part of the Healthcare SystemCONTINUITY OF CARE FOR NORTH CAROLINA’S UNINSURED

THE RIGHT CARE AT THE RIGHT TIME FOR THE RIGHT COST


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Community Health Centers Create Jobs

NC HEALTH CENTER FTES IN 20144

Health centers help make communities healthier and more economically viable by creating jobs in underservedcommunities. Health sector jobs withstand economic downturns and are expected to be one of the fastest growing jobsectors in the next decade.2

1.The Economic Impact of North Carolina’s Federally Qualified Health Centers (2011). Capital Link, Inc. 2.Aging America creates demand for health-care workers. Feb 1, 2012. Reuters: http://www.reuters.com/article/2012/02/01/us-usa-economy-jobs-outlook-

idUSTRE8102FT20120201. 3.Kotelchuck R., Lowenstein D. & Tobin J. (2011.) Community health centers and community development financial institutions: Joining forces to address

determinants of health. Health Affairs 30(11): 2090-2097.4.BPHC, HRSA, 2014 Uniform Data System (UDS).5.Bazemore A et al. Graduates of Teaching Health Centers are More Likely to Enter Practice in the Primary Care Safety Net. American Family Physician. 2015;94(4),

November 15, 2015.

“[Community health] centers create good jobs,with career ladders, at all levels of capabilityand educational attainment, which in itselfpromotes the health of the community.”3

$1.00 $4.00

Analysis of North Carolina Community Health Centers showed for every grant dollar CHCs receive, they generate four dollars in economic activity.1

1,110 Medical FTEs

208 Dental FTEs

70 Mental Health/Substance Abuse FTEs

329 Enabling Services FTEs

178 Pharmacy FTEs

Total FTEs — 3,165 includes:

In 2014, North Carolina Community Health Centers brought $110 million in federal and private grants to communities across the state, leading to a potential economic impact of approximately $440 million in underserved communities

$110 Million

$440 Million

HEALTH CENTER ECONOMIC IMPACT

N.C. Education Programs Attract Providers

The three Teaching Health Center Graduate Medical Education programs in North Carolina are a valuable investment for the long-term viability of the safety net and access to care in underserved communities.

Graduates from these programs are almost twice as likely as residents from other family medicine residency programs to practice in settings primarily associated with underserved populations.5


Health Centers Innovate and Lead in Healthcare Delivery

Recognizing the complex needs of their patient population, CHCs have to be on the cutting edge ofcare delivery in order to provide the range of services their patients need without regard to ability topay.

Health centers led efforts to connect to the NC HIE, bringing in safety-net partners like rural health centers andschool-based health centers, as well as other providers and health systems. All CHCs have Electronic HealthRecords and will be able to communicate with other community providers and their patients to improve healthand reduce unnecessary testing.

Improving Patient Experience

CMHN Health Center Controlled Network (HCCN)

Carolina Medical Home Network’s Health Center Controlled Network is providing health information technology support to more than 30 Community Health Center members. Through this program, Community Health Centers are providing more targeted care and identifying ways to lower cost, while improving care.

Six NC Community Health Centers are participating in a Medicare Shared Savings Program ACO. CMHN ACO is leveraging enhanced access to clinical and claims data to drive population health management and improve health outcomes for Medicare beneficiaries. Receiving ACO Investment Model funding from the CMS Innovation Center in 2016, CMHN ACO is expanding its care management infrastructure to better meet the needs of NC Medicare patients.

CMHN Accountable Care Organization (ACO)

27 NC Community Health Centers participate in this partnership, created in in 2012, to contract with commercial payers and progress toward clinical and financial integration, leading the way to success in value-centric reimbursement models across multiple healthcare payers.

CMHN Independent Practice Association (IPA)

HEALTH CENTERS LEAD INNOVATIVE, COST-SAVINGS MODELS

LEADING CONNECTIVITY TO THE NC HEALTH INFORMATION EXCHANGE


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The High Quality Healthcare Option

Health centers will continue to be an integral part of the healthcare system because they provide high-qualityservices to an ever-growing segment of the population. Today, Community Health Centers serve 24 millionpatients nationally. In North Carolina, they serve 8% of all Medicaid beneficiaries.

HEALTH CENTERS OUTPERFORM OTHER PRIMARY CARE PROVIDERS

Health centers have been reporting data to the federal government on an annual basis since 1998, allowing forthe analysis and tracking of health center performance.

CHCs provided recommended care more frequently for 14/18 quality measures, including management ofheart disease, asthma treatment, smoking cessation counseling, diet and exercise counseling, appropriatescreening for chronic diseases, and medication management in the elderly.1

1.Goldman L.E., Chu P.W., Tran H., and Stafford R. Federally qualified health centers and private practice performance on ambulatory care measures. American Journal of Preventive Medicine 2012 Aug;43(2):142-9.

2.BPHC, HRSA, DHHS, 2014 Uniform Data System (UDS); Healthy People 2020 data available online: https://www.healthypeople.gov/2020/data-search/Search-the-Data

HEALTH CENTERS ARE ON TRACK TO MEET OR EXCEED HEALTHY PEOPLE 2020 GOALS2

North Carolina Community Health Centers already exceed or are on track to meet important HealthyPeople 2020 goals in these areas:

83% of patients receive tobacco use screening and counseling

71% of pregnant patients begin prenatal care in 1st trimester

71% of diabetic patients have their disease under control

61% of patients have blood pressure under control

80% of all child patients receive appropriate immunizations

In 2015, North Carolina Community Health Centers received 29 Quality Improvement Awards from HRSA totaling $1,383,436.

2015 COMMUNITY HEALTH CENTER QUALITY IMPROVEMENT AWARD


Community health centers receive funding to support populations with unique barriers to or need for health care access. These populations include individuals experiencing homelessness, public housing residents, migrant farmworkers, and veterans.

To serve these populations, North Carolina has 11 migrant health centers, 10 healthcare for the homeless grantees, and 3 public housing primary care grantees.

Community Health Centers are more than just primary care providers. They provide a broad array of services to improve patient access to care, to address external impacts on the individuals’ health, and provide whole-person care. Some of the enabling services health centers provide to meet these needs include:

FQHCs have dedicated, expert staff who educate their communities about health insurance options and help people enroll in coverage. Their assistance goes beyond enrollment – including helping people understand their options, access care, and get connected to other needed health and social resourcesIn some counties, especially rural ones, FQHCs are one of the only sources of free in-person enrollment help.

Since 2013, North Carolina FQHCs have trained more than 300 staff to provide education to over 178,000 North Carolinians2.

Unique Services Improve Access to Care

SPECIAL POPULATIONS

ENABLING SERVICES

INSURANCE ENROLLMENT ASSISTANCE

“The strongest predictor of completing the application process was receiving help with enrollment from a navigator

or application assister, which increased the probability of obtaining coverage by nearly 10 percentage points.”1

1“The impact of state policies on ACA applications and enrollment among low-income adults in Arkansas, Kentucky, and Texas.” Sommers BD, Maylone B, Nguyen KH, et al. Health Aff. 2015 Jun;34(6):1010-8.2North Carolina Community Health Center Association

Interpretation servicesCase managementWIC programsMigrant outreach programsHealth education, including nutrition counselingInsurance enrollment assistance


CHCs have extensive experience caring for vulnerable patients and have developed a range of services to meet patients’ needs. They provide integrated behavioral health services and many have on-site dental and pharmacy services. CHCs’ also provide enabling services to facilitate access to care.CHCs continue to care for North Carolinians who cycle between Medicaid coverage and uninsurance. Providing continuity of care and ongoing case management reduces Medicaid costs when individuals cycle back onto Medicaid coverage.CHCs utilize the 340b Drug Pricing Program to provide significant prescription drug savings to both the Medicaid program and recipients.Medicaid patients in health centers are less likely to utilize expensive hospital care and more likely to receive recommended preventive services.5-6

1.Rhoades JA, Cohen SB. The Long-Term Uninsured in America:, 2008-2011: (Selected Intervals): Estimates for the U.S. Civilian Noninstitutionalized Population under Age 65. Statistical Brief #424. November 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov/mepsweb/data_files/publications/st424/stat424.pdf

2.Institute of Medicine, 2009. America’s Uninsured Crisis: Consequences for Health and Health Care. Washington, DC: National Academies Press. p. 60-63.

3.Ku, L., Bruen, B., Steinmetz, E., Steinmetz, E. (December 2014). The Economic and Employment Costs of Not Expanding Medicaid in North Carolina: A County-Level Analysis. Center for Health Policy Research, The George Washington University. Cone Health Foundation and Kate B. Reynolds CharitableTrust. Retrieved from: http://www.conehealthfoundation.com/foundation/initiatives/nc-medicaid-expansion/.

4.Rothkopf J., Brookler K., Wadhwa S. et al. Medicaid patients seen at federally qualified health centers use hospital services less than those seen by private providers. Health Aff July 2011 30:1335-1342.

5.Goldman L.E., Chu P.W., Tran H., and Stafford R. Federally qualified health centers and private practice performance on ambulatory care measures. American Journal of Preventive Medicine 2012 Aug;43(2):142-9.

Closing the Coverage Gap for North Carolina’s Uninsured

Adults without children (ages 19-64) with incomes below 100% of Federal Poverty Guidelines (FPG), or $11,670 annually for an individual, CANNOT access subsidized insurance or Medicaid in NC.Increasing insurance access to those below 100% FPG would create jobs in NC and increase personal income.4 Closing the insurance coverage gap for this population would create and 43,000 by 2020. N.C. could leverage federal dollars to help our current Medicaid program transition to value-based payment.Federal funding was set aside to increase insurance coverage for the Coverage Gap population. Choosing not to do so will mean North Carolina loses $21 billion in federal funds between 2016 and 2020.4

Choosing not to Close the Gap will greatly weaken NC’s safety-net system. Community health centers are facing a 70% cut in federal grant dollars starting October 1, 2018 due to the assumption that there would be fewer uninsured Americans.

HARD-WORKING , LOW-INCOME INDIVIDUALS NEED ACCESS TO INSURANCE

PAIR INSURANCE COVERAGE WITH COMMUNITY HEALTH CENTERS TO SAVE N.C. MONEY

People without health insurance are sicker and poorer1, making it more difficult for these individuals to contribute to the economy.More drastically, numerous studies show that people without health insurance are more likely to die in the course of a year than people with insurance.2

INCREASING ACCESS TO HEALTH INSURANCE IS GOOD FOR PUBLIC HEALTH ANDGOOD FOR NORTH CAROLINA’S ECONOMY.


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