America s Voice for Community Health Care The NACHC Mission To promote the provision of high quality, To promote the provision of high quality, comprehensive and affordable health care that is coordinated, culturally and linguistically competent, and community directed for all medically underserved people.
Thriving Among the Best - Sustainability& Improved Patient Outcomes HIV-Medical Home June 9, 2012 Kathy McNamara Asst. Director of Clinical Affairs National Association of Community Health Centers
Today s Discussion. Background & Context Health Center Strategy for Health Reform Putting it Together: Public Health and Primary Care
Community Health Centers 2012 Environment Patient Protection and Affordable Care Act Medical Home (PCMH) Demonstrations Legislation Certification Accountable Care Organizations Meaningful Use Federal Focus on Health Centers National Prevention and Health Promotion Strategy National HIV/AIDS Strategy National Quality Strategy Hepatitis Action Plan
Health Reform 101 It is about transformation of both primary care & public health Managing health of a population through time and across all settings Performance measurement & improvement Documenting costs and generating improved savings and quality
Health Reform: Health Center Payer Mix in 2015 Current (2009) Patients by Payer Source (National Averages) Post-Reform (2015) Patients By Payer Source (Averages) Private 16% Uninsured 39% Medicaid 34% Exchange 7% Uninsured 26% Private 12% Medicaid 42% Other Public 1% CHIP 2% Medicare 8% Other Public 1% Medicare 8% CHIP 4% NOTE: Medicare patients will grow significantly over the next 10 years
Health Centers and HIV/AIDS The Data Over 758,801 HIV/AIDS tests performed 94,972 HIV positive patients More than 427,797 HIV/AIDS patient encounters 30,791 of 94,972 HIV positive patients (32%) were seen by non-part C funded health centers
More Data: The New Story Number of CHCs with at least 50 HIV patients Number of CHCs with at least 50 Hep patients Number of CHCs with any Ryan White Part C Funds 258 325 158 Total HIV Encounters Total HIV Patients Total Hep B and C Encounters Total Hep B and C Patients Total HIV Test Encounters Total HIV Test Patients HIV Test Encounters Per Patient Hep B and C Test Encounters HepB and C Test Patients Median 5 4 29 20 127 118 1.01 26 24.5 Average 361.16 80.57 131.65 63.06 765.35 695.51 0.84 430.30 371.98
Today s Discussion. Background & Context Health Center Strategy for Health Reform: PCMH Putting it Together: Public Health and Primary Care
Quality Journey: Health Centers as Part of the Transformation Patient Centered Medical Home Health Disparities. Collaborative
HRSA/BPHC PCMH Goal Medical home accreditation and/or recognition for all health centers by 2016. PCMH RECOGNITION (# SITES) 8000 7000 6000 Number of Sites 5000 4000 3000 2000 Number of Sites 600 500 400 300 200 100 Inset 1000 0 Years 0 Years
NACHC Health Center Triple Aim Population Health Reducing disparities Growth Patient Centered Medical Home Engagement Patient and community Advocacy Transformation Value Improve quality; reduce cost
Patient Centered Medical Home: Health Center Vision Health Center engagement in local health system and local community health improvement Meaningful Use & HIT Infrastructure Health Homes recognition accreditation programs Effective Teams & Care Integration: Behavioral & Mental Health, HIV/AIDS, Oral Health
Thirty-Seven States Advancing Medical Homes in Medicaid and/or CHIP Programs 3 Federal Demos: 1. CMS Medicare MH 2. CMS Advanced Primary Care Pilot w/ state Medicaid 3. Medicare FQHC MH pilot program = Identified to have a medical home initiative Source: National Academy for State Health Policy State Scan, May 2010. http://www.nashp.org/md-home-map
What Are Key Design Features of a PCMH: Commonwealth Fund Safety Net Medical Home Initiative Engaged Leadership Quality Improvement Strategy Empanelment (provider/team accountability for specific population of patients) Enhanced access Interdisciplinary team-based healing relationships with patients Patient centered interactions (e.g. self-management support) Organized evidence based care Care coordination
Performance Measurement and Transparency
Today s Discussion. Background & Context Health Center Strategy for Health Reform and PCMH Putting it Together: Public Health and Primary Care
Healing the Schism Today, the two cultures medicine and public health seem to live in different, often unfriendly, worlds. This was not always the case. Experiences with universities, health departments, and governments during four decades have convinced me that continued separation of the two enterprises greatly diminishes their combined scientific, organizational and institutional potentials Kerr L. White, Healing the Schism: Epidemiology, Medicine, and the Public s Health, 1991
Synergies: Health Centers & Public Health Collaboration Adapted from: Medicine & Public Health: the power of collaboration. R.D. Lasker & Committee on Medicine & Public Health, NY Academy of Medicine, 1997 Synergy Examples ACA Examples 1. Coordination of services Disease Intervention Specialist (DIS) interface with patients in the health center setting; ACOs, Health Center Networks, MU, PCMH 2. Improved access to care Coordination of referrals and linkage to care Expansion CHCs, Medicaid, CAHPS, Clin. Prevention, PCMH 3. Population Partner notification services and prevention of National Quality perspective new infections Strategy metrics; HRSA metrics 4. Identify and address community health problems 5. Strengthen health promotion through community strategies 6. Shaping the future: policy, training & research Outreach into the community; CHC user majority boards and community needs assessments Education and information around STD testing and prevention Creating a model for health center and public health collaboration; CHC data warehouses, research networks, workforce development Community Health Assessments, CHC needs assessments, PCMH, ACO Prevention & PH Fund, Transformation Grants Prevention/ PH Fund; CHC teaching health centers
What Health Centers Need from Health Departments Transfer of Information Data extent of the problem (prevalence) Community Assessment Coordination and Sharing of Benefits and Resources Test kits or conventional testing support Screening tools Data charts, training etc DIS coordination Partner notification and Expedited Therapy Facilitate care coordination & access to specialists* Support for integration of HIV,HEP, STD into primary care medical home model
NACHC Tool and Resources Partnerships between Federally Qualified Health Centers and Local Health Departments for Engaging in the Development of a Community-Based System of Care The guide includes information about different partnership models and agreements, and considerations for patient privacy and health information exchanges. The Quality Management Plan: A Practical, Patient Centered Template This monograph provides a detailed process for health centers how to build HIV and PCMH into their QI plans. Includes meaningful use metrics. Sexual Health in the Primary Care Visit Developed for health centers to incorporate sexual history taking into primary care; Board Member, and LGBT Routine HIV Testing in Primary Care Model http://www.nachc.com/clinicalhiv.cfm
Lessons Learned and Needs of the Future PCMH Model and Triple Aim Access, quality of care and cost/value Capacity building Innovation Public Health, Primary Care,and Public Safety Partnerships with Medicaid Vitality is state-based
Contact Information Thank You! Kathy McNamara NACHC 301 347 0400 Kmcnamara@NACHC.com