Bureau of Primary Health Care Update February 6, 2014 Angela R. Powell, MPH, CPH Director, Southwest Division U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care
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 2
Health Center Program Grantee Overview-Calendar Year 2012 21.1 Million Patients 93% Below 200% Poverty 36% Uninsured 62% Racial/Ethnic Minorities 1,121,037 Homeless Individuals 903,089 Agricultural Workers 219,220 Residents of Public Housing Grantees Revenue Sources ARRA Grants 2% Other Federal Grants 3% Grantees Serve All Ages 25 to 64 51% 65 & up 7% Under 5 11% 5 to 12 13% 13 to 17 8% 18 to 24 10% Self-Pay 6% BPHC Grants 18% State / Local/Other 17% Other 3rd Party 7% Medicaid 38% Other Public Insurance 3% Medicare 6% Source: Uniform Data System, 2012, Service Sites: HRSA Electronic Handbooks 1,198 Grantees with 8,900+ Service Sites 83.8 Million Patient Visits Over 148,000 Staff 10,400+ Physicians 7,500+ NPs, PA, & CNMs 3
Health Center Program Look-Alike Overview-Calendar Year 2012 951,000 Patients 91% Below 200% Poverty 32% Uninsured 71% Racial/Ethnic Minorities 24,412 Homeless Individuals 17,946 Agricultural Workers Look-Alikes Serve All Ages 65 & up 7% Under 5 11% 5 to 12 13% Look-Alike Revenue Sources Other Federal Grants 4% 25 to 64 51% 13 to 17 8% 18 to 24 10% Self-Pay 4% Other 3rd Party 7% State / Local/Other 32% Other Public Insurance 1% Medicaid 44% Medicare 8% Source: Uniform Data System, 2012, Service Sites: HRSA Electronic Handbooks 93 Look-Alikes with 270+ Service Sites 3.4 Million Patient Visits Over 5,707 Staff 566 Physicians 276 NPs, PA, & CNMs 4
Health Center Program National Presence July 2013 5
Millions Health Center Program Growth: National Impact 2008-2012 Thousands Thousands Patients Sites Jobs 22 10 160 21 9.5 150 20 9 140 8.5 130 19 8 120 18 7.5 110 17 2008 2009 2010 2011 2012 7 2008 2009 2010 2011 2012 100 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012 Growth from 2008-2012 (% Increase) Patients 17,122,535 18,753,858 19,469,467 20,224,757 21,102,391 3,979,856 (23.2%) Sites 7,518 7,892 8,156 8,501 8,979 1,461 (19.4%) Jobs 113,059 123,012 131,660 138,403 148,245 35,186 (31.1%) Source: Uniform Data System, 2008-2012 and HRSA Electronic Handbooks 6
Health Center Performance Calendar Year 2012 Among Health Center Patients: 70.2% entered prenatal care in the first trimester Rate of low birthweight babies (7.14%) continues to be lower than national estimates (7.99%) 63.6% Hypertensive Patients with Blood Pressure <= 140/90 70% Diabetic Patients with HbA1c <= 9 $686 Total Cost per Patient $150 per Medical Visit For more information: http://www.bphc.hrsa.gov/policiesregulations/performancemeasures/index.html Source: Uniform Data System, 2012. National Birthweight Data: 2012. Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2012. National vital statistics reports; vol 62 no 3. Hyattsville, MD: National Center for Health Statistics. 7
Health Center Performance Health Center Patient Survey 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%). 8
AZ State Health Centers Calendar Year 2012 Map and Data to be inserted, include both grantees and lookalikes on map. Source: Uniform Data System, 2012 AZ State Health Centers 16 Grantees 2 Look Alikes In 2012, 16 Health Center Grantees Served 423,160 patients: 27% were uninsured 52% were at or below 200% of poverty 59% Female 59% nationally 33% Children < age 18 32% nationally 9% Seniors age 65+ 7% nationally Served by (FTEs): 235.6 Physicians 144.9 Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives 9
AZ State Health Centers Calendar Year 2012 - Fiscal Year 2013 PERFORMANCE Among AZ State Health Center Patients: 68.9% entered prenatal care in the 1 st trimester Rate of low birth rate 5.1% 33.4% of children have received all recommended immunizations by second birthday 65.3% Diabetic Patients with HbA1c <= 9 61.8% Hypertensive Patients with Blood Pressure <= 140/90 $767 Cost per Patient; $206 per Visit FUNDING $44.7 M base operational grants (FY 13) $23.6 M H80 Total $21.1 M New ACA grants $2.27M Outreach and Enrollment $0.81M Base Adjustments $2.23 M School Based Health Source: Uniform Data System, 2012, 2013 and HRSA Electronic Handbooks 10
Bureau of Primary Health Care (BPHC) Organizational Structure Office of the Associate Administrator Office of National Assistance and Special Populations Office of Administrative Management Office of Quality and Data Office of Policy and Program Development Northeast Division Central Southeast Division North Central Division Southwest Division 11
BPHC Organizational Structure: Primary Health Care Divisions Southwest Division North Central Division Central Southeast Division Northeast Division Data as of February 2013 Regions 6 & 9 Regions 5, 8, & 10 Regions 4 & 7 Regions 1, 2, & 3 309 Grantees 313 Grantees 270 Grantees 308 Grantees 10 PCAs 17 PCAs 12 PCAs 13 PCAs 43 FQHC-LAs 25 FQHC-LAs 13 FQHC-LAs 21 FQHC-LAs 12
Primary Health Care Our Focus Primary Health Care/ Public Health Leadership Performance Improvement: - Outreach/Quality of Care - Health Outcomes/Disparities - Cost/Financial Viability Program Requirements: - Need - Services - Management and Finance - Governance 13
Primary Health Care Measures of Success Grantee Satisfaction Employee Satisfaction Quality/Timeliness (Internal Operations) Program Analysis (Application) Reviews Change in Scope Reviews Look-Alike Reviews FTCA Reviews Operational Site Visits Travel Vouchers Correspondence * Impact Healthy People 2020 National Quality Recognition EHR Implementation Financially Strong Cost Per Patient Increase Program Requirement Compliance 14
Impact-BPHC Quality Strategy Better Care Healthy People & Communities Affordable Care Strategy Implementation 1. Programs/Policies 2. Funding 3. Technical Assistance 4. Data/Information 5. Partnerships/Collaboration INTEGRATED HEALTH SYSTEM INTEGRATED SERVICES COMPREHENSIVE SERVICES ACCESS Priorities & Goals 1. Implementation of QI/QA Systems Health Centers fully implement their QI/QA plans 2. Adoption and Meaningful Use of EHRs Health Centers implement EHRs across all sites & providers 3. Patient-Centered Medical Home Recognition Health Centers receive PCMH recognition 4. Improving Clinical Outcomes Health Centers meet/exceed HP2020 goals on at least one UDS clinical measure 5. Workforce/Team-Based Care Health Centers are employers/providers of choice and support team-based care 15
Current Program Impact: Key National Indicators % of Health Centers with EHR Implementation (2012) 79% have EHRs at all sites used by all providers 11% have EHRs at some sites used by some providers % of Health Centers Achieving Patient-Centered Medical Home Recognition (as of August 2013) 80% of all health centers are participating in Patient-Centered Medical Health Home Initiatives (PCMHHI) and nearly 29% have achieved Patient-Centered Medical Home (PCMH) recognition % of Health Center Meeting/Exceeding Healthy People 2020 Goals (2012): 59% Meet/Exceed Hypertension Control Goal of 61% 11% Meet/Exceed Diabetes Control (HbA1c 9) Goal of 84% 37% Meet/Exceed Early Entry into Prenatal Care Goal of 78% 61% Meet/Exceed Low Birthweight Goal of 7.8% Individual and State health center profiles with performance and compliance data are now available to the public on the HRSA web site. See: http://bphc.hrsa.gov/uds/datacenter.aspx?q=d&year=2012 16
2012 AZ State Range of Clinical Performance High Low AZ State Average National Average Diabetes Control 81% 34% 65% 70% Timely entry into Prenatal Care 100% 53% 69% 70% Hypertension Control 72% 43% 62% 64% Low Birth Weight 10% 0% 5% 7% Childhood Immunizations 58% 9% 33% 42% Cervical Cancer Screening 80% 21% 60% 57% Asthma Therapy 96% 47% 87% 73% Source: Uniform Data System, 2012. 17
Program and Policy Updates 18
BPHC Program Oversight Approach Compliance assistance and support on Clinical/Financial Performance Measures occurs throughout the project period 19
Operational Site Visits All health centers will receive an Operational Site Visit (OSV) at least once every three years conducted using the Health Center Site Visit Guide Goal: 400 OSVs completed at the end of CY 2013. Over 500 OSVs planned for CY 2014. Additional Questions? Listen to the National Health Center TA Call on the OSV process from Spring 2013: http://services.choruscall.com/links/hrsa130514.html BPHC is requesting feedback from health centers about their OSV experience through a follow up evaluation 3 months post site visit. Please share your experience! 20
2014 Anticipated Policy Topics FINAL Governance PIN FINAL Sliding Fee Discount Program PIN FINAL Total Budget PIN UPDATED Progressive Action PAL DRAFT Financial Recovery Plan PAL DRAFT Subrecipients/Contracts PAL DRAFT Quality Improvement/Assurance PIN Draft policies open for comment will be posted at: http://www.bphc.hrsa.gov/policiesregulations/policies/draftsforcomment.html. 21
FY 2014 Funding Summary FY 2014 $150 million for 236 New Access Points $ 58 million in Outreach and Enrollment to Health Centers Upcoming $ 35 million for PCMH Facility grants $ 50 million for Mental Health Service Expansion and Integration $ 110 million Base Adjustments $ 300 million Service Expansion or NAP decisions pending 22
Fiscal Year 2013-2014 Primary Care Association Requirements Statewide/Regional Health Center T/TA Activities A. Program Requirements Goal: % 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: % of Health Centers that Meet/Exceed Healthy People 2020 Goals on One or More Clinical Performance Measures % of Health Centers with PCMH Recognition % of Health Centers with Cost Increase Less than National Average % of Health Centers Financially Strong (No Going Concern Issues) T/TA Focus Areas: Clinical Performance Measures Financial Performance Measures 23
Fiscal Year 2013-2014 Primary Care Association Requirements Statewide/Regional Program Assistance Workplan o Information on Available Resources o Annual T/TA Needs Assessment o Special Populations o Collaboration o Emergency Preparedness o Regional/Statewide Surveillance Analysis o Newly Funded Health Centers o Newly Designated Look-Alikes 24
Quality and Data Updates 25
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: bphchelpline@hrsa.gov or 1-877-974-BPHC (2742) PCMHH email: PCMHHinitiative@hrsa.gov 26
Affordable Care Act (ACA): Health Center and Primary Care Association Roles 27
ACA Health Insurance Marketplaces 28
ACA Health Insurance Marketplace: Key Points and Resources Each State has created its own Health Insurance Marketplace: a new, more affordable way for Americans purchase private health insurance Open enrollment began October 1, 2013 nationwide Coverage starts as soon as January 1, 2014 Resources: Consumer Websites: HealthCare.gov / CuidadoDeSalud.gov Consumer Call Center: 1-800-318-2596 Available 24/7 in 150 languages Partner/Stakeholder Website: Marketplace.cms.gov (brochures, fact sheets, infographics, Q&As, presentations and other materials available for download) Social Media: Like HealthCare.gov / CuidadoDeSalud.gov on Facebook Follow HealthCare.gov / CuidadoDeSalud.gov on Twitter 29
ACA Outreach and Enrollment: Health Centers Outreach and Enrollment: Hire O/E assistance workers Certify your organization per requirements for your state Train O/E assistance workers Plan and conduct outreach and enrollment activities take advantage of PCA, HRSA, and CMS resources Report progress: # of staff trained; # assisted; # of applications submitted; estimated # enrolled 30
ACA Outreach and Enrollment: Primary Care Associations Provide training and related information to health centers Coordinate O/E efforts at the state level Provide technical assistance Share real-time information with HRSA Report state level successes and issues. 31
ACA Key PCA and Health Center Resources Outreach and Enrollment Inbox (for general O/E questions) bphc-oe@hrsa.gov PCA Outreach and Enrollment Inbox (for PCA questions and issues) bphc-pca-oe@hrsa.gov BPHC O/E supplemental funding TA web page http://bphc.hrsa.gov/outreachandenrollment/ Other important websites: https://www.healthcare.gov/ https://www.cuidadodesalud.gov/es/ http://marketplace.cms.gov/ http://www.hrsa.gov/affordablecareact/ 32
Technical Assistance Resources 33
Technical Assistance (TA) Resources National and state-based support for training and technical assistance: o National Cooperative Agreements o State/Regional Primary Care Associations o State Primary Care Offices Federal TA Support: o Project Officer o TA Calls/Trainings o Onsite Consultant Support o BPHC TA Website For more information visit the BPHC TA Website: http://www.bphc.hrsa.gov/technicalassistance/index.html 34
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: bphchelpline@hrsa.gov. Available Monday to Friday (excluding Federal holidays), from 8:30 AM 5:30 PM (ET), with extra hours available during high volume periods. 35
Risk Management and Patient Safety Web Resources 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. 36
Primary Health Care and Public Health Leadership All Health Center and Primary Care Associations are encouraged to explore and participate in the following key HHS public health initiatives: Affordable Care Act Key Resources https://www.healthcare.gov/ https://www.cuidadodesalud.gov/es/ http://marketplace.cms.gov/ Affordable Care Act and HRSA Programs http://www.hrsa.gov/affordablecareact/ Health Centers Hire Veterans Challenge http://www.bphc.hrsa.gov/veterans/index.html 37
Primary Health Care and Public Health Leadership National Quality Strategy http://www.ahrq.gov/workingforquality/nqs/ Tobacco Cessation http://betobaccofree.hhs.gov/index.html HHS Action Plan to Reduce Racial and Ethnic Health Disparities http://minorityhealth.hhs.gov/npa/files/plans/hhs/hhs_plan_comple te.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 38
Primary Health Care and Public Health Leadership 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 http://www.collaborateforhealthyweight.org/ 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 39
Thank You! Questions? 40
Angela R. Powell, MPH, CPH Director, Southwest Division U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care 5600 Fishers Lane Rm. 16-105 Rockville, MD 20857 Telephone: 301.480.1130 41