Preserving the Safety Net Presented by Zara Marselian, CEO at the Natinal Health Plicy Frum Sessin May 18, 2012 1
Abut La Maestra Missin: T prvide quality healthcare and educatin, imprve the verall well-being f the family, bringing the underserved, ethnically diverse cmmunities int the mainstream f ur sciety, thrugh a caring, effective, culturally and linguistically cmpetent manner, respecting the dignity f all patients. First Clinic, pened 1990 LEED Certified Gld Health Center, pened 2010 2
La Maestra Health Services Clinic frmed in 1990 under La Maestra Amnesty Center. The need fr culturally cmpetent healthcare was identified by cuncil representing ver 12,000 students at the Center. 4 Medical & 5 Dental Centers in San Dieg Cunty 4 schl-based medical/dental clinics Mbile Clinic Mental Health services nsite at main clinic, high schl clinic, and at ther sites thrugh telemedicine. All services and prgrams have elements fcusing n educatin, case management and scial services Integrated Apprach 3
Annual Number f Patients /Visits Ttal Unduplicated Patients Ttal Visits 45,000 40,000 35,000 30,000 40,288 37,782 35,524 32,121 29,811 27,459 200,000 180,000 160,000 140,000 120,000 122,564 138,070 165,872 174,430 25,000 20,000 15,000 23,879 18,680 15,870 13,487 100,000 80,000 60,000 56,192 88,948 82,492 102,843 10,000 40,000 39,881 41,420 5,000 20,000 0 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 0 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 91.2% f Patients were best served in a language ther than English in 2011 4
Innvative Mdels at La Maestra Circle f Care - Integrated Services Medically Trained Cultural Liaisn Mdel Telemedicine Schl-Based Health Mbile Health Imaging Services Residents f Public Husing - Outreach & Health Fairs (educatin/screening) at Husing - Eligibility & Enrllment Assistance Transprtatin 5
Well Being & the Circle f Care Netwrk ges beynd medicine t address scial determinants f health: bringing greater resurces t ur patients Circle f Care Mdel New Skills, Independence, Self-Esteem, Helping and Teaching Others, Wrking in Healing Envirnments Fd Pantry with nutritin educatin and besity preventin Urban Cmmunity Garden Micrcredit Prgram fr Wmen & Micrenterprise Assistance Jb Training and Placement Fd Pantry Cmmunity Garden Zumba classes 6
Well Being & the Circle f Care Scial Services & Legal Advcacy Transitinal Husing and help finding Affrdable Husing Culture and Healing thrugh Art Prgram Senir Emplyment Trainee Micrcredit Participants Micrcredit Meeting Micrenterprise Transitinal Husing 7
Serving the Culturally Diverse Cmmunity Mst culturally diverse health center in Califrnia 22 languages and dialects spken by staff 91% f patients prefer t cmmunicate in a language ther than English Staff represents (is frm) the cultures served, ensuring cultural and linguistic cmpetency. Medically Trained Cultural Liaisns prvide valuable, nging supprt and educatin t lcal residents and identify new needs. 8
Languages Spken by Staff Achli Arabic Burmese Cantnese Chaldean English French Italian Karen Latian Luganda Mandarin Nuer Plish Russian Sicilian Sign Language Smali Spanish Sudanese Swahili Tagalg Thai Vietnamese 9
Integratin f Prgrams Cmmunity Outreach Enabling Services Eligibility, Medi-Cal & Healthy Families Enrllment Transprtatin Interpreting/ Translatin Medically Trained Cultural Liaisns Primary Care Adult Health, Wmen s Health, Pediatric & Teen Health, Senir Health Affrdable Husing Mental Health Mentring Ethnic CBOs Husing & Cmmunity Develpment Financial Literacy Micrenterprise Assistance Jb Training & Placement Oral Health Optmetry Pharmacy Labratry Imaging Telemedicine Patient Educatin Cmmunity Develpment Legal Advcacy Services Dmestic Vilence Referral Cmmunity Member / Patient Behavir Mdificatin Referrals Cunseling & Linking t Prgrams Childcare Clthing & Fd Healthcare Training Scial Services Cntinuus Patient Fllw-up and Case Management 10
Medically Trained Cultural Liaisns & Prmtras Partnerships Outreach & Health Prmtin Mbile Outreach Prvide Guidance Case Management & Navigatin Patient Health Educatin Patient Supprt Preventin Screening at Health Fairs 11
Telemedicine Telemedicine started in 2005 at main clinic Began prviding Mental Health t satellites & rural sister health centers Cntinuing t expanded netwrk f specialists t bring specialty care t medical hme By 2010, equipment installed at all satellites grants & cllabratins 12
Schl Based and Mbile Health 2009: Opened Medical and Dental Clinic at Hver High 2010: Opened Central Elementary Medical Clinic 2011: Opened Mnre Clark Middle Medical Clinic 2012: Opened Rsa Parks Elementary Medical Clinic 2012: Mbile Clinic with 2 dental peratries, 1 medical exam rm Bringing Oral Health t at least 9,000 students and their families per year N cnstructin cst f building n campus Health screenings, mental health, health educatin, telemedicine and teledentistry cnsults 13
Quality Imprvement Patient Centered Medical Hme pursuing accreditatin -Facilitates partnerships between patient and persnal physicians/care team, and patient s family t prvide cmprehensive preventive care -Care crdinated with utside prviders via Health Infrmatin Exchange, registries -Aligns with State Health Insurance Exchange plan requirements. 14
Quality Imprvement Electrnic Health Recrds/Practice Management NextGen: Primary Enterprise Practice Management System and EHR. Used fr all patient registratin, billing, electrnic prescriptin requests, and medical dcumentatin. -Streamlines prcess fr imprved patient care -Prviders can care fr mre patients -Imprves accessibility f patient infrmatin -Integrates all relevant clinical infrmatin abut a patient within a single, integrated electrnic recrd, allwing clinicians t make evidenced based clinical decisins, reducing errrs 15
Quality Imprvement Electrnic Health Recrds/Practice Management -Reduces billing and cllectins csts -Reduces claim denials -Imprves revenue thrugh autmated recall plans -Autmated task management and prductivity reprting imprves verall prductivity -Reduced cst/labr assciated with paper recrds 16
Revenue Surces Payr Surce by # f Patients - 2011 1,444 3% 5,984 14% 280 1% 1,564 4% 7,609 17% 631 1% 26,066 60% Medi-Cal Healthy Families Self-Pay Cunty Indigent Medicare Private Insurance Episdic: State/Cunty/Grant 17
Current Scenari fr Califrnia FQHCs Prspective Payment System (PPS): PPS cvers minimum cst f care fr Medicaid patients Des nt cver case management, care crdinatin, health educatin, health navigatrs, health screenings, enabling services, translatin, transprtatin, eligibility Same-day visits nt reimbursed Within the Fur Walls challenge 18
Current Scenari fr Califrnia FQHCs Healthy Families: State finally starting t pay wraparund in May 2012, fr visits since Octber 2009 $1.9 millin due t La Maestra frm State f CA fr adjustment t interim rate, which we applied fr 5 years ag. State wes La Maestra ver $2 millin frm recnciliatin reprts fr past 5 years 19
Current Scenari fr Califrnia FQHCs Effects f Ecnmic Dwnturn and Challenges: Unemplyment - Mre Uninsured Mre hmeless Veterans Release f drug related ffenders Brder Zne Challenge frm ICE Public Health Issues Human Trafficking Fundatins have less $ fr grants because stck lst value Budget cuts n cverage fr adult dental, little fr mental health 20
Current Scenari fr Califrnia FQHCs N Cunty Hspital, nly Safety Net and Emergency Rm Cunty Funds have strict eligibility mandates NEW: San Dieg Cunty Selected fr the Dual Demnstratin Prject Grwth (Medi-Medis) 21
Future Scenaris/Implicatins 1. Health Insurance Exchange 2. Medicaid expansin f childless adults 3. Basic Health Plan fr Califrnia 4. Increase desperately needed fr FQHCs t cntinue serving as the Safety Net fr 19 millin peple natinwide 5. Since 1960s, cmmunity health centers have been taking care f uninsured ppulatins. 22
Future Scenaris/Implicatins Accuntable Care Organizatins (ACO) Perceptins/Miscnceptins: Risk factrs will impede success f ACOs. ACO mdel resembles managed care plans. Facts: Mdel mandating inclusin f an FQHC wuld wrk. Califrnia FQHCs are already experienced with managed care: high vlumes f managed care members 23
Future Scenaris/Implicatins Refrm What has cmmunity seen as benefits s far? Increased cverage fr children up t 26 years ld under cmmercial plans. Eliminatin f prir cnditins under cmmercial plans 24
Suggestins fr FQHC Sustainability 1. Mre direct funding frm Federal gvernment 2. Supprt the Safety Nets/FQHCs by hlding firm n PPS rates r imprved alternative reimbursement rates. 3. Encurage ACOs t include FQHCs with their PPS rates as FQHCs prvide mre cmprehensive patient care vs. private prvider practices/grups 4. Direct grants t health centers are always best: Earmark funding is abslutely essential fr safety net FQHCs 25
Mdels that Sustain FQHCs 1. Medical Imaging Services 2. Pharmacy 3. Nn-medical: diversificatin f revenue streams 26