Oklahoma s Safety Net : Collaborative Opportunities to Improve Access to Care PRESENTATION FOR THE OKLAHOMA RURAL HEALTH CONFERENCE MAY 22, 2015
Participants will be able to: L e a r n i n g O b j e c t i v e s o Recognize and catalog the reach of health care safety net providers across the state Oklahoma s Safety Net and Collaborative Opportunities to Improve Access to Care o Acquire knowledge as to collaborative initiatives with public health and health care state agencies o Examine strategic partnerships utilized in other states that could serve as possible pilots in Oklahoma
What is a Health Care Safety Net Provider? Institute of Medicine 1. Either by legal mandate or explicitly adopted mission, care is offered to patients regardless of the ability to pay for those services 2. that organize and deliver a significant level of health care and other health-related services to uninsured, Medicaid, and other vulnerable patients 3
43 84 5 8 Public Hospitals Free Clinics School-Based Health Clinics Homeless Clinics 70 107 51 70 Federally Qualified Health Centers Community Mental Health Centers Rural Health Clinics Local Health Departments 4
PUBLIC HOSPITALS, 2015 PSYCHIATRIC SPECIALTY HOSPITAL REHABILITATION HOSPITAL CRITICAL ACCESS HOSPITAL GENERAL MEDICAL SURGICAL HOSPITAL COUNTIES Total Public Hospitals: 43 Data Source: American Hospital Association, AHA Guide 2015 Edition
FREE & CHARITABLE CLINICS IN OKLAHOMA, 2015 Total Free Clinics: 84 Data Source: Oklahoma State Department of Health, Office of Primary Care and Rural Health Development
RURAL HEALTH CLINICS RURAL HEALTH CLINICS COUNTIES Total Rural Health Clinics: 51 Data Source: Center for Medicare and Medicaid Services, 2015
SCHOOL-BASED HEALTH CENTERS SCHOOL-BASED HEALTH CENTERS COUNTIES Total: 5 Data Source: Oklahoma State Department of Health, Office of Primary Care and Rural Health Development
FEDERALLY QUALIFIED HEALTH CENTERS (FQHCs), 2015 FEDERALLY QUALIFIED HEALTH CENTERS COUNTIES Total FQHCs: 70 (3 new NAPs) Population Characteristics, 2013* Percent Rural: 72% Percent Under 200% of Poverty: 89% Percent Uninsured: 40% Percent Medicaid: 35% Percent Medicare: 9% *Oklahoma Health Center Fact Sheet, 2015 National Association of Community Health Centers Data Source: Oklahoma State Department of Health, Office of Primary Care and Rural Health Development
COMMUNITY MENTAL HEALTH CENTERS (CMHCs) COMMUNITY MENTAL HEALTH CENTERS COUNTIES Total CMHCs: 107 Data Source: Oklahoma Department of Mental Health and Substance Abuse Services
OKLAHOMA COUNTY HEALTH DEPARTMENTS (CHDs) COUNTY HEALTH DEPARTMENT SITES COUNTIES WITH HEALTH DEPARTMENTS* COUNTIES WITHOUT HEALTH DEPARTMENTS Total CHDs: 70 (89 sites) Data Source: Oklahoma State Department of Health
HOMELESS SHELTER-BASED HEALTH CENTERS, 2015 HOMELESS SHELTER HEALTH CENTERS COUNTIES Total: 8 Data Source: Oklahoma State Department of Health, Office of Primary Care and Rural Health Development
PRIMARY CARE HEALTH PROFESSIONAL SHORTAGE AREAS (HPSAs) GEOGRAPHICAL AREA HPSAs POPULATION GROUP HPSAs NOT HPSAs
POPULATION OF OKLAHOMA: 3,878,051 Source: U.S. Census Bureau, Population Division, Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2014 PERCENT UNINSURED All Oklahomans: 17.7% U.S. Census Bureau, Current Population Reports P60-250, Health Insurance Coverage in the US: 2013, U.S Government Printing Office, Washington, DC, 2014. PERCENT WITH DISABILITY 15.6% of Oklahomans Source: U.S. Census Bureau, 2009-2013 5-Year American Community Survey. DEMAND FOR SAFETY NET SERVICES PERCENT BELOW THE FEDERAL POVERTY LEVEL All Oklahomans: 16.9% Source: U.S. Census Bureau: State and County QuickFacts. Last Revised: 3 1-Mar-2015 15:14:14 EDT Children in Poverty: 24.1% Source: Oklahoma Institute for Child Advocacy, The State of Children in Oklahoma Fact Sheet, 2014. HIV/AIDS PREVALENCE 139.6 cases per 100,000 population, 2013 Oklahoma State Department of Health HIV/STD Service, Surveillance and Analysis Living HIV/AIDS Cases in 2013. Federal Poverty Level Individual: $11,770 Family of Four: $24,250 14
COUNTY RANKINGS FOR HEALTH OUTCOMES RANK 1-19 RANK 20-38 RANK 39-58 RANK 59-77 COUNTIES Source: University of Wisconsin Population Health Institute, County Health Rankings 2015
COUNTY RANKINGS FOR HEALTH FACTORS RANK 1-19 RANK 20-38 RANK 39-58 RANK 59-77 COUNTIES Source: University of Wisconsin Population Health Institute, County Health Rankings 2015
Disproportionate Needs of Patients Served by Safety Net Hospitals and System Characteristics to Address Needs Health-related needs Personal and social factors adversely affecting health Personal and social factors affecting health care access Disproportionate Needs Chronic conditions Disability Mental illness Substance abuse Reproductive health care Poor nutrition Chronic stress Shortage of personal time Illiteracy Low social support Homelessness Disability Dangerous work Unsafe and/or Unhealthy environments Health risk behaviors (smoking, substance abuse, inactivity) No sick leave Language barriers Cultural disparities Transportation Nontraditional work hours Transient residence Disability Safety-Net System Characteristics Team care Care management Care coordination/integration Patient Centered Medical Home Co-located services Integrated services Social services Patient education Outreach services Facilitated enrollment in public programs Wraparound services Extended hours of service Transportation services Language services Cultural sensitivity Home visits Electronic visits Electronic heath records Home health care Telephone advice lines Source: E. L. Schor, J. Berenson, A. Shih, S. R. Collins, C. Schoen, P. Riley, and C. Dermody, Ensuring Equity: A Post-Reform Framework to Achieve High Performance Health Care for Vulnerable Populations, The Commonwealth Fund, October 2011 17
Strength & Viability of Safety Net Oklahoma s health care safety net is heavily reliant on external funding and 40 50 60 Increased Demand for Services support 30 70 Increased scrutiny Uniquely vulnerable to shifting and adverse economic pressures and policy 20 SAFETY NET SPEEDOMETER 80 on health outcomes conditions 10 90 Decreased State/Local/etc. Of concern is safety net providers reliance on revenue from state and local 0 100 funds to assist with uncompensated care governments, which leaves them highly costs exposed to changes in public spending and priorities 18
OVERVIEW OF STATE APPROPRIATIONS TO FQHCs Uncompensated Care Fund $4,000,000 $3,500,000 $3,000,000 $3,500,000 $3,286,558 $3,122,230 $3,122,230 $3,122,230 $2,500,000 $2,552,477 $2,000,000 $1,500,000 $1,000,000 $500,000 SFY Appropriated Funds $0 2010 2011 2012 2013 2014 2015 19
Total Patients Served at Oklahoma FQHCs HRSA Uniform Data System Report: 2009-2013 (most current) 162,871 147,779 135,272 131,649 118,810 2013 2009 2010 2011 2012 20
COLLABORATIONS
Shared Goals 1 2 3 4 INCREASE Healthcare Quality and Access IMPROVE Population Health Outcomes BEND The Healthcare Cost Curve CREATE a State of Health OSDH/OHCA COLLABORATIONS 22
Current Collaborations Between Agencies and Safety Net Uncompensated Care Fund MOUs w/ Maternal & Child Health Partnerships w/ Volunteers Take Charge! Program County Health Departments & FQHCs to provide & FQHCs New Development Funds Oklahoma Volunteer Charitable Healthcare Provider Program primary care State Trauma Fund Health Homes and Community Mental Health Centers Joint Strategic QI Projects 23
Strategic Partnerships Among State Agencies & Safety Net Public Health Primary Care Safety Net Expansion TN MD Tri-County Health Improvement Plan Allow FQHCs to be Eligible KS MO FQHCs co-located in Medicaid Health Homes with local health agencies 24
Collaborative Opportunities to Improve Access to Care Co-location Arrangement Two distinct health systems, each remains as a separate entity. This arrangement allows a LHD staff to colocate in a CHC/Clinic, or vice-versa. The focus is on removing barriers and increasing access to health care. Cross-referral Arrangement Establish a cross-referral arrangement enabling Individuals to obtain primary care through the Safety Net Provider & other services through the CHD (immunizations, well-baby & adolescent health clinics, maternity education, etc.) Telehealth Technology Support long-distance clinical health care, patient and professional health-related education, and public health services to reduce the cost of health care, reduce travel times, and result in better management of chronic diseases. Enhancing Capacity of Safety Net Via resource sharing, leveraging technology, and the provision, evaluation, and communication of value to health system partners and other key stakeholders. 25
BENEFITS OF COLLABORATION Contribute to Community Assessments Eliminate Duplication of HC Services Better Coordination of Care and Hand-offs Increase Access to Higher Quality HC Establishing Trust & Transparency Gathering & Sharing of Data 26
? QUESTIONS?
THANK YOU! Becky Pasternik Ikard Deputy State Medicaid Director Oklahoma Health Care Authority Valorie Owens, Manager of Statewide Access to Care Planning Office of Primary Care & Rural Health Development Center for Health Innovation & Effectiveness Oklahoma State Department of Health