Massachusetts: Extraordinary Times

Transcription

1 Massachusetts: Extraordinary Times Federal ACA and State Challenges/ League Priorities/ Health Policy/ Mergers and More! Meeting of the Assembly September 27, 2011 James W. Hunt, Jr. President & CEO

2 Massachusetts Community Heath Centers 50 community health centers Over 280 sites reflect medical, dental, behavioral health, school-based and social services 800,000 patients September 27, 2010

3 Massachusetts Community Health Centers Comprehensive and Responsive Care Quality of care continually exceeds national averages Model disease management programs National Medical Home Grant recipient Electronic Health Records 49 of Massachusetts 50 health centers have either purchased, implemented or are in the process of implementing EHRs League preparing for Meaningful Use and more under Health Reform Direct Economic Impact 2009 Health Center Expenditures $808,900,000 Payroll $566,000,000 Employees 12,200 Support Additional jobs 2,445 Total economic engine approaching $1.24 billion

4 ARRA, ACA & 2011 Re-Cap Increased Demand for Services ARRA Funds Nationally: $341 million ARRA Funds Massachusetts: $9 million Continuation of IDS et al in 2011 final federal budget New Access Points ARRA Funds Nationally: $160 million ARRA Funds Massachusetts: $1.3 million ACA Funds Massachusetts: 12 NAP applicants in 2011, including 3 FQHCs, with none funded to date

5 ARRA, ACA & 2011 Federal and State Capital Improvement Programs ARRA Funds Nationally: $852 million ARRA Funds Massachusetts: $27.7 million State M.O.B. law enacted and available Social Impact Bonds being considered Facility Investment Program/CDP FIP/CDP Funds Nationally:$508 million FIP/CDP Funds for Massachusetts: $123 million,16 sites HIT Funds for Massachusetts: $2.9 million ACA Funds: 2011 Large and Small Capital program proposal period announced by HRSA with $700 million available for federally-funded health centers

6 ACA Resources: A Question Mark $9.5 billion ACA appropriation for health center expansion in jeopardy FFY-11 Budget Reduction Act cut $600 million in operational support for health centers and back-filled the reduction with ACA funds intended for expansion IMPACT: $1 billion in 2011 resources for NAPs, and EMC re-directed to backfill base appropriations ?

7 ACA Resources: A Question Mark Future Concerns Additional $8.5 billion over next 4 years in question $1.5 billion in capital funding unchanged To date, 16 Massachusetts health centers have received large-scale construction & renovation FIP/CDP grants (first distribution under ARRA, second under ACA) Applications for next round of CDP grants under ACA ($700 million available) due 10/12/11 $1.5 expansion for NHSC - unchanged Workforce initiatives Residency and expanded provider training

8 Public Health and Medicaid ACA: $15 billion for Public Health Trust Fund IT initiatives CMS initiatives Some diversion of funds in FY-11for workforce 2012 State Budget Expect DPH level funding Continued HSN dental funding? Essential provider and capacity building funding? Provider payments

9 ACA Challenges In September, President Obama released a deficit reduction plan that includes structural reforms $1.5 trillion in tax increases $583 billion in spending cuts over 10 years $321 billion in health care cuts over a decade $248B from Medicare $73B from Medicaid $3.5 billion cut to ACA s Prevention and Public Health Trust Fund over 10 years Includes cuts to skilled nursing facilities, home health agencies, inpatient rehabilitation and long-term care facilities

10 Deficit Control Act of 2011 Debt Deal $900 billion in discretionary spending cuts over the next ten years in order to increase debt limit for the next few months (split between security and non-security spending) Super Committee - Joint, bipartisan committee charged with identifying and proposing a $1.2 trillion package of savings aimed at reducing the national deficit. All key committees must finalize and submit their plans to the Super Committee by October 14, which includes individual House and Senate Committees. The Super Committee must finalize and propose its package for Congressional consideration by November 23, at which time the plan will be scored by the Congressional Budget Office (CBO). May slip to December 2. By December 23, Congress must will take one 'yes' or 'no' vote to determine whether the proposed saving package will be accepted or rejected. If no action or partial cuts, significant across the board cuts will be triggered, referred to as sequestration Health center funding, Medicaid, Medicare, any and all Trust Funds authorized under health reform are vulnerable to potentially severe cuts and reductions.

11 Ongoing League Projects Support health center HIT to tackle biggest costdrivers in our health care system Implement EMR/EHR at remaining sites PCMH training, TA, and payments Prepare CHCs for ACO and ICO Opportunities

12 Opportunities Continue Dialogue and Knowledge-building around ACOs Promote community-based residency training programs to attract medical, dental, nursing graduates to pursue primary care CHC careers Prepare centers for expanded resources dedicated to recruiting primary care clinicians under NHSC, League/BOA LRP, Partners/Kraft Center Study and create MCO (NHP), ACO, and other CHCbased initiatives 9/27/2011

13 Opportunities Leverage CHC 800,000 patient base to demonstrate through data, the quality and effectiveness of health center care Work with NHP on Partners Affiliation Agreement Assist DentaQuest Foundation on expansion of dental advocacy nationally Seek CHC investments in Medicaid waivers

14 Strategic Threats Diminishing state funding and reduced rates for MCOs and coverage (Coalition letter) Lack of fair payment by the state and Connector for publicly-assisted patients Global payments, ACO Regulations, and Incentive payments Remaining uninsured and coverage issues, select networks Primary care reimbursement, increased patient responsibility

15 Strategic Threats National primary care provider shortage, short/long term Negotiated rule-making for HPSA/MUAs proposals being finalized Continuing infrastructure needs (facility, HIT) Recognition of social determinants of health, immigration issues Proliferation and impact of for-profit entities Sentiment: ACA attacks, constitutional challenges Medicaid Adult Dental cuts

16 2012 Action Plan Upgrade TA and training opportunities for members Expand website-based Training & Education Develop comprehensive 2012 state and federal health policy papers and budget requests Support NACHC, fellow PCAs and BPHC in maintaining ACA Increase advocacy and number of advocates Promote fairness to Massachusetts as HCR leader

17 2012 Action Plan Seek new resources and fees to sustain League Promote health centers as major partners in IT, ACO, and PCMH development with current and future health care entities and partners

18 9/27/2011

19 Definition Massachusetts -itis Wikipedia definition: A condition that presents itself after repeated exposure to Massachusetts long list of healthcare policy accomplishments, e.g.: MA. Miracle, MA. Best Practices, MA. Examples, MA. HCR stories. Cure: Listening to Michelle Bachmann or Rick Perry speak on any topic related to health care policy for more than 10 minutes.

20 Questions--Thank you James W. Hunt, Jr. President and CEO Massachusetts League of Community Health Centers 40 Court Street, 10th Floor Boston, MA