PCA/HCCN Health Center Program Update National Association of Community Health Centers Community Health Institute August 30, 2016 Tonya Bowers, MHS Acting Associate Administrator Bureau of Primary Health Care Health Resources and Services Administration U.S. Department of Health and Human Services
Primary Care Mission and Strategies Improving the health of the Nation s underserved communities and vulnerable populations by assuring access to comprehensive, culturally competent, quality primary health care services. Increase access to primary health care services Modernize primary care infrastructure and delivery system Improve health outcomes and health equity Promote performancedriven, innovative organizations Increase Value of Health Center Program
Increase Access Patients Source: Uniform Data System, 2008-2015. National Data: U.S. Census Bureau, 2015 Population Estimates 3
Primary Care: Key Strategy Accomplishments ACCESS 42% increase in patients served since 2008 295 new health centers since 2008 Over 1,100 New Access Points since 2008 Over 18 million assisted under Outreach and Enrollment 98% of health centers have installed Electronic Health Records (EHR) 89% of health centers are participating in Meaningful Use Modernized over 1,600 service delivery sites since 2008 Over 1,020 (74%) of health centers are participating in health center controlled networks MODERNIZE
Primary Care: Key Strategy Accomplishments 93% of health centers met or exceeded Healthy People 2020 goals for at least one clinical measure in 2015 100% of health centers improved in at least one clinical quality measure/2014-2015 212 health centers reduced disparities in low birth weight, blood sugar control and blood pressure control/2014-2015 IMPROVE PROMOTE 449 (33%) health centers increased patients overall by at least 5% and increased patients in at least 2 service categories 68% of health centers are Patient Centered Medical Home (PCMH) recognized/accredited 43% increase in enabling services staff/2012-2015 5 5
FY 2016 Funding Funding Approximate Amount Awards Outreach and Enrollment (New Starts November) $7 M 93 Substance Abuse Service Expansion (March) $94 M 271 Health Infrastructure Investment Program (Capital May) $263 M 290 Oral Health Service Expansion (July) $156 M 420 Health Center Controlled Networks (July) $36 M 50 PCMH Recognition for New Grantees (August) $8.6 M 246 Quality Improvement Awards (August) $100 M 1,304 Delivery System Health Infrastructure Investment (Sept) $90 M ~1,300 Zika: PR, AS, VI $5.7 M 23 6
FY 2017 President s Budget Request Includes $5.1 billion to: Support quality improvement and performance management activities Ensure that current health centers can continue to provide essential health care services to their patient populations Serve approximately 27 million patients Proposes to extend current mandatory funding at $3.6 billion annually for FY 2018 and FY 2019 7
Increase Access Program Growth Patients Grantees Jobs Millions 26 25 24 23 22 21 20 19 1500 1450 1400 1350 1300 1250 1200 1150 1100 Thousands 200 190 180 170 160 150 140 130 120 18 1050 110 17 1000 100 2008 2010 2013 2015 Growth from 2008-2015 (% Increase) Patients 17,122,535 19,469,467 21,726,965 24,295,946 7,173,411 (41.9%) Grantees 1,080 1,124 1,202 1,375 295 (27.3%) Jobs 113,059 131,660 156,817 188,852 75,793 (67.0%) Source: Uniform Data System, 2008-2015. HRSA Electronic Handbooks, 2008-2015. 8
Refine Roles Compliance Manual: Establishes a single reference for compliance Describes how a health center would demonstrate compliance Identifies related considerations/discretion Aligns FTCA deeming requirements Change in Scope: Streamlines assurance and checklist Reduces redundancy 9
Increasing Health Center Value Access Cost Quality VALUE Patients & Communities Providers Payers 10
Thank You 11
Contact Information Tonya Bowers Acting Associate Administrator Bureau of Primary Health Care (BPHC) Health Resources and Services Administration (HRSA) Email: Tbowers@HRSA.gov Phone: 301-594-4110 Web: bphc.hrsa.gov Twitter: twitter.com/hrsagov Facebook: facebook.com/hhs.hrsa
Strategic Partnerships to Improve Quality & Value August 26, 2016 Suma Nair Director, Office of Quality Improvement Bureau of Primary Health Care (BPHC) Health Resources and Services Administration (HRSA)
Increase Access to Health Care Services One in 7 people living at or below the poverty level relies on a HRSA-supported health center for primary medical care Over 24 million people receive primary medical, dental or behavioral health care from a health center Investments to Increase Access: Outreach and Enrollment New Access Points Expanded Services 14
Health Center Program Insurance Status Trends 50.0 40.0 49.4 47.3 41.5 34.9 2013 2014 2015 30.0 27.9 24.4 20.0 14.1 16.8 15.6 10.0 0.0 Uninsured Medicaid Medicare "Other" Public 8.4 8.6 8.9 2.0 1.3 1.0 Private 3.4 Dual Eligibles Source: HRSA Uniform Data System (UDS)
Health Center Program Patient Visit Trends 25,000,000 1,600,000 20,000,000 1,400,000 1,200,000 15,000,000 1,000,000 800,000 10,000,000 600,000 5,000,000 400,000 200,000 - Medical Visits Source: HRSA Uniform Data System (UDS) Dental Visits 2013 2014 2015 - MH Visits SUD Visits
Modernize Infrastructure & Delivery Systems 98% of health centers have adopted EHRs 68% of health centers have received PCMH recognition Invested in the modernization of over 1,600 service delivery sites Investments to Modernize Delivery System: Awards to expand/enhance PCMH model Awards to increase meaningful use of Health IT and facilitate HIE
Modernize Care: EHR Adoption Health Centers by Meaningful Use Progress Stage 3, 0.36% Not Sure, 2.18% 60% Health Center Meaningful Use Progress by HCCN Participation Stage 2, 27.35% AIU, 14.18% 50% Stage 1, 44.80% 40% 30% Additional Accomplishments: Over 50% of HCs used their EHR to report UDS clinical quality measures Many HCs are updating/enhancing HIT systems to support care integration An increase in HCs collecting social determinants data in their EHRs 20% 10% 0% AIU Stage 1 Stage 2 Stage 3 Not Sure HC with an HCCN HC with no HCCN Source: HRSA 2015 Uniform Data System (UDS) 18
19 Modernize Care: PCMH Recognition Goal: All health centers are PCMH recognized Next steps on your journey: Optimize/enhance your PCMH Team based care Integration of care Patient engagement Engage with the Medical Neighborhood Care coordination Build Community Partnerships to address social determinants of health Housing Nutrition Education Social Services Aging & Disability Supports Transportation PCMH & Quality Health centers that receive PCMH recognition generally performed better on clinical measures than health centers without PCMH recognition. http://www.ncbi.nlm.nih.gov/pubmed/27324440
Improve Health Outcomes & Health Equity 100% of health centers demonstrated improvement on one or more clinical quality measures 93% of health centers met/exceeded HP2020 goals on at least one clinical quality measure 212 health centers reduced disparities in low birth weight, blood sugar control and blood pressure control 226 health centers met or exceeded the Million Hearts goals on aspirin therapy, blood pressure control and smoking/tobacco cessation Investments to Improve Outcomes: Quality Improvement Awards Awards to support integrated care and care coordination 20
21 2014 Health Center Patient Survey 94% of health center patients rated the overall quality of their provider very good or excellent 84% of health center patients reported they would definitely refer friends and relatives to a health center for care Top 3 reasons for choosing a health center for care included convenience, quality of care, and affordability
2015 UDS Clinical Quality Measures Child/Adolescent BMI & Follow-up Adult BMI & Follow-up Childhood Immunization Tobacco Screening & Cessation Asthma & Meds Ischemic Vascular Disease: Therapy Colorectal Screening Cervical Screening Coronary Artery Disease: Lipid Therapy Early Entry into Prenatal Care Low Birthweight Hypertension Control Diabetes Control Depression Screening HIV Linkage to Care Dental Sealants (NEW) 22
23 2015 Quality Improvement Awards: $100.2 million Award Amounts by Category
Promote Performance-Driven, Innovative Organizations Nearly 35 percent of health centers increased access to integrated care (at least 5 percent increase in medical and at least one other type of patient) in 2015 Support health centers that employ multi-disciplinary teams 11,800+ physicians and 10,300+ nurse practitioners, physician assistants, and certified nurse midwives Provide linguistically appropriate enabling services (e.g., housing, food, and job support) to more than 2.38 million patients through health centers. Investments to Promote Performance and Innovation: Awards to increase data capacity and operational quality improvement Awards to support collaborative learning and best practice dissemination 24
25 UDS Modernization Project Area #1: UDS Content Goal: Ensure UDS reflects improvements in care delivery model Identify data elements to add or update Conduct an impact analysis and pilot Share findings and plan for rolling out changes Area #2: UDS Submission Process Goal: Streamline reporting burden by automating data submission Scan of current health center reporting processes and challenges Development of potential solutions Build prototype and pilot Share findings and plan for rolling out changes Timeline CY2016-2018
26 Increasing Health Center Value Access Cost Quality VALUE Patients & Communities Providers Payers
27 Shifting Focus to Strategic Enhance Partnerships Quality and Increase Value Vision: Create a Continuously Learning and Improving Health Center System PCAs Health Centers NCAs HCCNs BPHC and Federal Partners Opportunities to accelerate performance: Improve data and analytics capacity Identify and disseminate best/evidencebased practices Support practice transformation and quality improvement activities Advance operational performance and business acumen (including governance) Participate in delivery system reform Ideal TA support: Data-driven, results focused Focuses on performance improvement Facilitates/encourages collaboration Utilizes practice coaching/facilitation Customer-centric, responsive to changing needs based on health care landscape Multi-modal, based on educational and knowledge management best practices
28 Contact Information Suma Nair Director, Office of Quality Improvement Bureau of Primary Health Care (BPHC) Health Resources and Services Administration (HRSA) Email: snair1@hrsa.gov Phone: 301 594-0818 Web: http://bphc.hrsa.gov/index.html Twitter: twitter.com/hrsagov Facebook: facebook.com/hhs.hrsa