The Health Center Program MassLeague of Community Health Centers Community Health Institute, 2017 May 3, 2017 Judith Steinberg, MD, MPH Chief Medical Officer Bureau of Primary Health Care (BPHC) Health Resources and Services Administration (HRSA) 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 1
Key Strategies Increase access to primary health care services Modernize primary care infrastructure and systems Improve health outcomes Promote performancedriven, innovative organizations Increase Impact of Health Center Program 3 Increase Access National Impact Source: Uniform Data System, 2015. National Data: U.S. Census Bureau, 2015 Population Estimates 4 2
Millions 5/2/2017 Increase Access National Impact Source: Uniform Data System, 2015. National Data: U.S. Census Bureau, 2015 Population Estimates 5 Increase Access Program Growth 26 Patients 25 24 23 22 21 20 19 18 17 2008 2010 2013 2015 Patients 17,122,535 19,469,467 21,726,965 24,295,946 Growth from 2008-2015 (% Increase) 7,173,411 (41.9%) Source: Uniform Data System, 2008-2015. HRSA Electronic Handbooks, 2008-2015. 6 3
Increase Access Program Growth 1500 1450 1400 1350 1300 1250 1200 1150 1100 1050 1000 Grantees 2008 2010 2013 2015 Grantees 1,080 1,124 1,202 1,375 Growth from 2008-2015 (% Increase) 295 (27.3%) Source: Uniform Data System, 2008-2015. HRSA Electronic Handbooks, 2008-2015. 7 Modernize and Improve Primary Care Delivery EHR Adoption Patient Centered Medical Home 2015 No EHR 2% Some Sites 6% 2016 No PCMH Recognition 32% All Sites 92% PCMH Recognized 68% Over 1,020 (74%) of health centers are participating in Health Center Controlled Networks Source: Uniform Data System, 2010 and 2015. AIU = Adoption, Implementation, Upgrade. 8 4
Improve Health Outcomes and Reduce Health Disparities 10.0% 9.0% 8.0% 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% Low Birth Weight Babies 8.0% 1 7.6% National Estimates Perinatal Measures UDS 2015 80.0% 75.0% 70.0% 65.0% 60.0% Patients Entering Prenatal Care in the First Trimester 71.0% 2 73.0% National Estimates UDS 2015 Source: 1 National Vital Statistics Report. Birth: Final Data for 2014. Vol. 64, No 12, December 23, 2015. 2 National Vital Statistics Report. Expanded Data from the New Birth Certificate, 2008. Vol. 59, No.7, July 27, 2011. 9 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Improve Health Outcomes and Reduce Health Disparities Adults with Hypertension whose Blood Pressure is Under Control 53.0% 1 63.8% National Average UDS 2015 Chronic Disease Management 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Diabetic Patients whose Diabetes is Under Control 54.4% 2 70.2% National Average UDS 2015 Source: 1 NCHS Data Brief. Hypertension Prevalence and Control Among Adults. No. 220, November 2015. 2 National Committee on Quality Assurance. The State of Health Care Quality 2014. 10 5
Improve Health Outcomes and Reduce Health Disparities Preventive Services 80.0% 78.0% 76.0% 74.0% 72.0% 70.0% 68.0% 66.0% 64.0% 62.0% Percentage of Children Ages 19-35 Months who Receive Immunizations 68.4% 1 71.6% 2 77.5% HP2020 Baseline National Average UDS 2015 Source: 1 National Immunization Survey (NIS), CDC/NCIRD and CDC/NCHS, 2012. 2 National Immunization Survey (NIS), CDC/NCIRD and CDC/NCHS, 2014. 11 Colorectal Cancer (CRC) Screening: 80% by 2018 Public Health Campaign CRC Screening by PCMH 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 38.7% 32.4% CRC Screening Rates PCMH No PCMH National Partnerships National Colorectal Cancer Roundtable TA resources 1. EHR Best Practice Workflow and Documentation Guide 2. 80% by 2018 Communications Guidebook to reach the unscreened 3. American Cancer Society CRC Health Center Learning Collaborative in New England and West Virginia 12 6
Promote Innovative Organizations Integrate with Primary Care: Focus Area Behavioral Health Substance Use Oral Health HIV/Public Health Funding Opportunity Mental Health Service Expansion Substance Abuse Service Expansion Oral Health Service Expansion Partnerships for Care Awards Amount 433 $105.8 M 271 $94 M 420 $155.9 M 22 $30 M 13 13 Behavioral Health Integration Successes: Hiring BH staff Staff training/education Policies/procedures Huddles for team based care Integrating EHR Expanding into addiction services Challenges: Recruitment/retention BHCs Lack of desired competencies for BHI Lack of bilingual staff Partnering with professional schools Mental health stigma Lack of resources re: autism RESOURCE: The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) Health Center Depression Screening Innovation Community Monthly roundtable discussions Resources, webinars, direct TA 14 7
Substance Abuse Service Expansion (SASE) Progress at 9 months: 92% have at least one provider with Drug Addiction Treatment Act (DATA) Waiver 50% have increased the number of providers with DATA Waiver 67% increase in DATA Waivers 15,000 patients received MAT Resources: Opioid Addiction Treatment ECHO Substance Abuse Warmlines 15 Substance Abuse Service Expansion Facilitators Language interpretation SBIRT integrated in EHR Shared medical appointments for transitional age youth Support groups for young adults Use of telemedicine Challenges Recruitment/retention DATA waiver training not widely available for NPs and PAs State regulatory restrictions on MAT Coordinating and managing workflow for MAT Coordinating with internal and external partners Confidentiality and release of records from external treatment facilities 16 8
Number of Patients 5/2/2017 Behavioral Health and Substance Abuse Services Integration Mental health patients increased by 19% from 2014 to 2015 Mental health personnel increased by 22% from 2014 (6,372 FTEs) to 2015 (7,780 FTEs) Depression screenings and follow up for patients increased by nearly 12% from 2014 (38.8%) to 2015 (50.6%) 2,000,000 1,500,000 1,000,000 500,000 Health Center Mental Health and Substance Use Patients 2007-2015 (UDS) 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 Years 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 38.8% 50.6% 2014 2015 Depression Screening 17 Oral Health Integration Investments to Increase Access to Oral Health: Oral Health Services Expansion (OHSE) $156 Million supporting 420 Health Centers 1,600 new dentists, dental hygienists, assistants, technicians to serve nearly 785,000 new patients Increase access to oral health care services and improve oral health outcomes Oral Health T/TA National Cooperative Agreement (NCA) National Network for Oral Health Access (NNOHA) T/TA for health centers to provide new high quality oral health services, enhance quality of oral health services, report on oral health care quality 18 9
Million 5/2/2017 Oral Health Integration Health Center Dental Patients and Visits from 2010-2015 14 12 10 8 # of Patients 6 # of Visits 4 2 0 2010 2011 2012 2013 2014 2015 Source: HRSA Uniform Data System (UDS) 90% health centers provide preventive dental services either directly or via contract In 2015, 13.2M dental visits were provided with an increase of 42% since 2010 5.2M dental patients were served in 2015 with an increase of 38% since 2010 4,108 dentists and 1,921 dental hygienists work at health centers HRSA UDS Dental Sealant Measure in 2015, achieved 42.4%, exceeding HP2020 goal of 28.1% 19 UDS 2015 Dental Sealants Measure 45 40 35 30 25 20 15 10 5 0 Dental Sealants Measure, % 42.5 25.5 HP2020 Baseline UDS 2015 HP2020 Goal 28.1 Numerator 121,312 Denominator 285,799 % 42.5% Percentage of children, age 6-9 years of age, at moderate to high caries risk, who received a dental sealant on a first permanent molar during the measurement period. 20 10
Primary Care HIV Integration In 2015, HRSA-funded health centers continued working to increase access and improve health outcomes for patients living with HIV 1.3 million patients tested for HIV 155,000 HIV patients served at over 630,600 visits 74.7% of HIV patients linked to care Partnerships for Care (P4C) Health Centers have: Improved HIV testing and care capacity Established multidisciplinary HIV care teams Enhanced EHR and trained HIV care teams Developed partnerships with local and state entities for enabling services and linkage/ re-engagement in care 4 State Health Departments in FL, MA, MD, NY 22 Health Centers across the 4 states One Training and Technical Assistance Contractor Federal Partners across Department of Health and Human Services 21 PrEP Service Delivery by Health Centers Developed and disseminated HIV PrEP Health Center Technical Assistance Resource BPHC supports adopting PrEP into clinical practice for at risk patients as part of routine primary care Health Center Program/ Section 330 funding can be used for PrEP, including medication and health center visits for follow-up and related services Offered services must be provided in accordance with applicable clinical guidelines regardless of insurance status and/or ability to pay Working with partners to support PrEP training and technical assistance 22 11
Public Health and Primary Care Integration Health Centers Respond to their Community Emergent public health issues, examples: Zika virus infection Opioid epidemic Social Determinants of Health Academy Partnership for Care 23 Health Center Workforce Health Center Workforce Workgroup National Cooperative Agreements: CHC Inc Association of Clinicians for the Underserved Collaborations with Bureau of Health Workforce, Federal Office of Rural Health Policy FTCA coverage for health center volunteer health professionals Telehealth 24 12
Preparing for New Payment and Delivery Models BPHC Key Strategies Prepare Health Centers Demonstrate impact: Access Quality of care Cost-effectiveness Population management Getting there: QI, performance management Optimization of HIT/HIE Expertise with most complex populations Care integration Addressing social determinants of health 25 100 % 80 60 40 Health Center Controlled Network Accomplishments 99.0 98.8 83.8 81.9 63.2 73.4 54.7 68.1 74.0 97.3 81.2 20 28.8 0 ONC certified EHRs EPs using EHRs EPs attesting to MU HCCN Baseline EPs receiving HCs meeting MU payments at least one HP2020 goal YR 3 Closeout HCs with PCMH recognition status Source: FO HRSA-13-237, HCCN awardees, final report 26 13
Health Information Exchange and Patient Engagement 100% 80 86.4 60 40 57.7 51.3 68.0 75.7 59.3 57.3 67.3 20 0 2014 2015 2014 2015 Health Info Exchange Patient Engagement using HIT HCCN No Network Source: UDS 2014 and UDS 2015 27 Looking Ahead Priority areas Opioid epidemic/substance abuse treatment services Mental health Childhood Obesity HRSA/BPHC Care integration/social determinants of health Coordinated strategy to improve diabetes control Intimate partner violence strategy UDS Modernization New Compliance Manual, Change in Scope, Operational Site Visits Enhance bi-directional communication with health center clinicians 28 14
Role of State, Regional, and National Partners Local Health Centers State PCAs NCAs HCCNs Regional BPHC and Federal Partners Federal 29 Health Center Program Resources Website: www.bphc.hrsa.gov Includes many Technical Assistance (TA) resources Weekly E-Newsletter: Primary Health Care Digest Sign up online to receive up-to-date information BPHC Helpline: www.hrsa.gov/about/contact/bphc EHB questions/issues FTCA inquiries BPHC Project Officer: Address specific questions about your health center s grant or look-alike designation National Cooperative Agreements & Primary Care Associations: bphc.hrsa.gov/qualityimprovement/strategicpartnerships 30 15
Thank You! Judith Steinberg, MD, MPH Bureau of Primary Health Care (BPHC) Health Resources and Services Administration (HRSA) jsteinberg@hrsa.gov 301 594 4110 www.bphc.hrsa.gov @HRSAgov facebook.com/hhs.hrsa 31 16