An Introduction to MPCA and Federally Qualified Health Centers~ Partners for Quality Care

Transcription

1 An Introduction to MPCA and Federally Qualified Health Centers~ Partners for Quality Care AIM Partnership Forum June 5, 2014 Lynda C. Meade, MPA Director of Clinical Services Michigan Primary Care Association

2 Overview Michigan Primary Care Association Michigan Health Centers Clinical services Health status of health center patients The Affordable Care Act and Health Centers

3 Who Is MPCA? Michigan Primary Care Association Membership Association Governed by a Board of Directors Receives grants and contracts from state and federal agencies Supports and advocates for expansion of primary care in underserved communities Provided technical assistance and services across a full spectrum of topics/interests 54 Primary Care Associations nationwide

4 Who are the FQHCs? Federally Qualified Health Centers (FQHC) is used as an umbrella term for a number of safety-net programs and refers to how they are reimbursed by Medicaid HRSA s Primary Health Care Programs have their roots in the Migrant Health Act of 1962 and the Economic Opportunity Act of 1964, Program began in 1965 under President Johnson s War on Poverty First Michigan Health Center: Baldwin Family Health Care has been in operation since 1967 Located in medically underserved communities and/or underserved population

5 38 Health Centers provide care for more than 600,000 residents at over 230 delivery sites across Michigan

6 Specialty Care in Michigan Migrant/Seasonal Farmworkers Health 5 designated agencies 94,167 MSWF and nonworkers (2013) 16,112 served in M/CHC in 2012 Homeless Health 12 designated agencies 93,982 Homeless in Michigan (2011) 21,545 served in CHCs in 2012 (increase of 38 % from 2011) Public Housing 2 designated agencies Indian Health Services (2 sites/12 tribes) Schoolbased 21,623 served Veterans 9,952+ served HIV/AIDS (2 Ryan White Clinics)

7 Health Centers are âç Öâx The fundamental principles on which they were established over 45 years ago set them apart from other providers of health care: Located in or serve medically underserved areas or populations Provide comprehensive primary health care services as well as support services that promote access to health care Provide services available to all with fees adjusted based on ability to pay Governed by a community board composed of 51 percent or more of Health Center patients who represent the population served Meet strict performance and accountability requirements regarding administrative, clinical, and financial operations as established by the federal government

8 Michigan Health Center Patients 550, , , , , ,31 450, Michigan UDS 2011

9 Patients by Age - Statewide 65 and Older, 6.3% Under 5, 10.9% 5 to 12, 16.6% 25 to 64, 48.3% 13 to 17, 8.3% 18 to 24, 9.6%

10 Patients by Insurance Status - Statewide Percentage of Total Medicaid/CHIP 45.4% Uninsured 31.8% Private 13.4% Medicare 9.2% Other Public 0.2% Michigan UDS 2012

11 Patients by Ethnicity- Statewide Percentage of Total Non-Hispanic/Latino 85.6% Hispanic/Latino 14.4%

12 Health Center Staffing Practitioner Type Number of FTEs Physician 230 Mid-Level 190 Nurse 305 Dentist 107 Mental Health 80 Enabling Physician Mid-Level Nurse Dentist Mental Health Enabling * Total does not include FQHC Look- Alikes.

13 Health Center Patients* 13,000 With Asthma Nearly 30,000 With Diabetes Over 48,000 With Hypertension Additional 7,000 with Heart Disease Additional 6,500 with Chronic Bronchitis and Emphysema 20,000 Diagnosed With Depression, 12,000 With Anxiety Disorder 45,000 Required Restorative Dental, Nearly 40,000 Oral Surgery * 2012

14 Increased Access [xtäà{ to vtüx Today more than 600,000 Michigan residents rely on a Health Center as their health care home including individuals who are low income, uninsured, underinsured, elderly, minority, migrant and seasonal farmworkers, homeless, and those living with HIV/AIDS.

15 FQHC Growth Strategies New Access Points Expanded Medical Capacity Service Expansion Change in Scope Facility Expansion Enabling Services Collaboration & Partnerships

16 THE AFFORDABLE CARE ACT AND HEALTH CENTERS

17 The Need for Health Centers Post- ACA Today, approximately 1,200 Health Centers operate nearly 9,000 service delivery sites across the country More than 22 million people access comprehensive health care services at Health Centers, regardless of income level or insurance status Projected 30 million individuals will gain insurance through the Marketplace and Medicaid under ACA

18 Health Centers and the ACA Having an insurance card does NOT ensure access to care Despite passage of the ACA and Medicaid expansion, many individuals will remain uninsured Health Centers will continue to play an important role as safety net providers for those remaining uninsured

19 CHC Expansion $11 billion for new Health Center Program Expansion FY $9.5 billion to expand operational capacity $1.5 billion in funding to begin to meet capital needs Michigan received 9 New Access Point Awards (NAP) in 2013 that will serve 42,000 new patients Funding opportunities for service expansion available now

20 Coverage Expansion Medicaid Expansion through the Healthy Michigan Plan: Potential 500K new Medicaid patients of which over 100K are Health Center patients Insurance Marketplace: Requires that health centers receive fair reimbursement from insurers offering plans through the new health insurance exchanges

21 Health Centers and the ACA Health Centers are economic engines in the communities they operate Source of stable employment and job training for residents Engage in capital development projects that often act as catalysts for economic revitalization Proven track record of educating community members about overall health, health care services, and insurance

22 Comprehensive care Patient Centered Coordinated Care Accessible Services Quality and Safety

23 Health Information Technology Electronic Health Records Patient Registry Patient Management System Meaningful Use Telemedicine/mobile health Outreach and enrollment (CMS Innovation) 33 of 36 (92%) health centers have EHR Nationally 90% of Health Centers have EHRs (Others 72%) 12 of 36 refer dental services out 66% of agency have EDR if offering oral health services HIT Critical to cost, experience and quality in truly transformed health care!!

24 Quality, Cost, Patient Experience Health care triple aim Healthy People 2020 driven goals Payment based on health status and outcomes is here now! Management of data critical Health status is a team sport and everyone plays a role Innovation is a must..

25 What is the PCMH? A PCMH puts patients at the center of the health care system, and provides primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective. (American Academy of Pediatrics)

26 Joint Principles of the PCMH Adopted by AAFP, ACP, AAP, AOA: Personal Physician Physician Directed Medical Practice Whole Person Orientation Care is Coordinated and Integrated Quality and Safety are Hallmarks Enhanced Access Payment Reform

27 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Status of PCMH in Michigan Health Centers 100% HRSA Goal by % All Health Centers Status in U.S. Note: Based on 36 Health centers (excluded New starts) 50% Health Centers Status in Michigan

28 Measurement Alignment: Healthy People 2020 HEDIS HRSA Clinical Core Measures Guidelines MQIC

29 Uniform Data System & HP2020 Percent Low Birth Weight Babies Percent Patients with controlled Hypertension Percent Patients with Controlled Diabetes Percent Patients with Prenatal Care in 1st Trimester Percent Immunized Children Percent Females Screened for Cervical Cancer Percent Patients Assessed for Tobacco Use Percent Patients Who Received Tobacco Cessation Intervention Percent of Adult Patients with BMI Charted and Follow Up Percent of Adolescent Patients with weight counseling and BMI Documented Percent of Patients with Acceptable Asthma Treatment Plan Percent of Patients with Appropriate Sceening for Colorectal Cancer 74.00% 72.00% 70.00% 68.00% 66.00% MICHIGAN FQHC AVERAGE NATIONAL FQHC AVERAGE 64.00% 62.00% 60.00% Percent of Patients with Acceptable Asthma Treatment Plan

30 Asthma Data Asthma Patients 27,182* 13,130 14,141 13,445 Asthma Visits 46,695* 20,529 22,280 21,944 *From the 2012 UDS Manual: Table 6A has been significantly revised for data submitted for CY 2012 and years thereafter. In the past focus exclusively on PRIMARY DIAGNOSES. Beginning with 2012 report on all VISITS with the designated diagnoses and all patients who received this diagnoses, regardless of whether it was a primary diagnosis, a secondary diagnosis, a tertiary diagnosis, or any other level.

31 Recent MDCH Program/Project Partnerships Cervical, Colorectal, Ovarian Cancer Immunizations HIV Hep C Oral Health Perinatal 4X4 Task Force Developmental screening Emergency management Diabetes STD

32 Opportunities Communication Education Resources Alignment Data sharing Advocacy Other..

33 Questions? For further information, please contact: Lynda Meade, MPA Director of Clinical Services (direct)