2018 ANNUAL REPORT PREPARING FOR A VALUE-BASED WORLD · 2019. 4. 18. · CFO Steve Shelton, Advance Community Health, Raleigh Clinician Tammy Kiger, MD, Carolina Family Health Centers,

NORTH CAROLINA COMMUNITY HEALTH CENTER ASSOCIATION • www.ncchca.org 4917 Waters Edge Drive, Suite 165, Raleigh, NC 27606 • 919.469.5701

2018 ANNUAL REPORT

PREPARING FOR A VALUE-BASED WORLD

NC COMMUNITY HEALTH CENTER ASSOCIATION


The North Carolina Community Health Center Association (NCCHCA) was formed in 1978 by the leadership of community health centers. NCCHCA is comprised of membership from 40 health center grantees (including one migrant voucher program) and 2 Look-Alike organizations. These centers operated 240+ sites serving nearly 560,000 patients in 2017. NCCHCA is singularly focused on the success of health centers.

NCCHCA is the HRSA funded state Primary Care Association (PCA) and Health Center Controlled Network (HCCN). The non-profit, consumer-governed Federally Qualified Health Centers (FQHCs) we represent provide integrated medical, dental, pharmacy, behavioral health, and enabling services to over one-half million patients in North Carolina. FQHCs receive federal assistance for sliding-fee discounts to assure no one is denied access to care. NCCHCA represents FQHCs to state and federal officials and provides training and technical assistance on clinical, operational, financial, administrative, and governance issues.

Going forward, NCCHCA is positioning health centers as the state’s largest primary care provider network through Carolina Medical Home Network and its Independent Practice Assocaition (IPA) and Accountable Care Organization (ACO) subsidaries.

ABOUT NCCHCA

AppHealthCareBakersville

Bertie CountyBlue Ridge

Cabarrus RowanCarolina Family

First ChoiceGoshen

High CountryKinstonLincoln

MedNorthMERCE

OcracokeOIC

PersonRobeson

Rural Health GroupStedman Wade

TriadUnited

West CaldwellWestern NC

CW Williams CharlotteCraven

MetropolitanDHHS Farmworker

Anson CommWell

Greene County

IPA 32

HCCN 33

PCA 42

AdvanceCaswellGaston

Hot SpringsPiedmontNCCHCA

February 2018

PCA = Primary Care AssociationIPA = Independent Practice AssociationACO = Accountable Care OrganizationHCCN = Health Center Controlled Network


PRESIDENT’S REPORT

Supporters,

The North Carolina Community Health Center Association and its Carolina Medical Home Network focused FY 2017-18 efforts on payment transformation efforts. North Carolina Medicaid refined their 1115 demonstration waiver with a heavy emphasis on primary care, coordinated care management, and social drivers of health. Because of our experience in the Medicare Shared Savings Program through our network’s ACO, we are well positioned to spread strategies and lessons learned to Medicaid. The work of the 2017 NCCHCA board in unifying members to form a statewide primary care network laid the foundation for our strong position in Medicaid transformation. NCCHCA’s approach to organizing health centers through our network IPA has brought bidding managed care companies to the table on critical issues of patient care, access, and quality. The participation of health centers in the NACHC PRAPARE collaborative and the Blue Cross Blue Shield of NC funded Data Informed Outreach Project propelled health centers to the forefront of primary care inclusion in social determinants (drivers) of health screening. Historically, health centers in NC have filled the behavioral health void in communities. These efforts received a significant boost from BPHC grants for integrated behavioral health and substance abuse disorder services. As North Carolina’s groundbreaking Medicaid Transformation Plan unfolds in 2019, our health centers are poised to occupy the top tier of providers delivering accessible, high quality, and cost-effective services.

Respectfully yours,

E. Benjamin Money, MPHPresident & CEO

Other 8%

Lobbying 2%

Development 14%

Administrative 11%

Programs 65%

Expenditures 2017-2018

GPO 4%

Membership Dues 5%

Sponsor-ship 9%

Other Grants 14%

Federal Grant(PCA/HCCN) 67%

Revenues 2017-2018


BOARD OF DIRECTORS 2018-2019OFFICERSChair Brian Toomey, Piedmont Health Services, CarrboroVice-Chair LaShun Huntley, United Health Centers, Winston SalemSecretary Carolyn Allison, Charlotte Community Health Clinic, CharlotteTreasurer Margaret Covington, Stedman-Wade Health Services, WadePast Chair Kim Schwartz, Roanoke Chowan Community Health Center, Ahoskie

AT-LARGECFO Steve Shelton, Advance Community Health, Raleigh Clinician Tammy Kiger, MD, Carolina Family Health Centers, Inc., WilsonHR Angela Martin, Caswell Family Medical Center, YanceyvilleMember Philip Harewood, Lincoln Community Health Center, DurhamMember Robert Spencer, Gaston Family Health Services, Gastonia

BOARD OF DIRECTORSAlice Salthouse, High Country Community Health, BooneAlthea Johnson, MedNorth Health, WilmingtonAnn Absher, Wilkes County Health DepartmentCarlos Gomez, Western NC Community Health Services, AshevilleCheryl Ballance, Ocracoke Health Center, OcracokeChuck Shelton, Bakersville Community Health Center, BakersvilleDarlene Ennett, Kinston Community Health Center, KinstonDavid Moore, Metropolitan Community Health Services, WashingtonDebra Weeks, C.W. Williams Community Health Center, CharlotteDelvin McAllister, South Central Community Health Center, RaefordDon Holloman, Cabarrus Rowan CHC, Concord Doug Smith, Greene County Health Care, Inc., Snow HillGlenn Martin, Interim CEO, Person Family Medical Center, RoxboroGreg Bounds, PhD, Goshen Medical Center, Inc., FaisonGwendolyn Reed, Anson Regional Medical Services, WadesboroJennifer Greene, Appalachian District Health Department, BooneLaura Owens, Carolina Family Health Centers, Inc., WilsonLee Ann Amann, Black River Health Services, BurgawMichelle Lewis, Triad Adult and Pediatric Medicine, Inc., GreensboroPamela Tripp, CommWell Health, Newton GrovePenella Washington, Advance Community Health, RaleighReuben Blackwell, OIC Family Medical Center, Rocky MountReuben Pettiford, Appalachian Mountain Community Health Center, AshevilleRichard Hudspeth, MD, Blue Ridge Community Health Services, HendersonvilleRose Turner, Gateway Community Health Centers, Inc., Elizabeth CityScott Harrelson, Craven County Health Department, New BernShavonda Pugh, Bertie County Rural Health Association, WindsorSheila Simmons, First Choice Community Health Centers, MamersTeresa Shackleford, MERCE Family Healthcare, Asheboro Teresa Strom, Hot Springs Health Program, MarshallThomas McRary, West Caldwell Health Council, LenoirTim Hall, Robeson Health Care Corporation, PembrokeWilliam Crumpton, Caswell Family Medical Center, YanceyvilleYvonne Long-Gee, Rural Health Group, Roanoke Rapids


QUALITY

HRSA Quality Awards # CHCs Awarded

Electronic Health Record (EHR) Reporters 24Clinical Quality Improvers 33Health Center Quality Leaders 13Enhancing Access to Care 15Delivering High Value Health Care 3

Addressing Health Disparities 8Advancing Health Information Technology 37

Achieving PCMH Recognition 28

HRSA’s Quality Improvement grant awards promote continued community health center improvements. HRSA Administrator George Sigounas, MS, PhD states: “Quality, value-based care is a priority of the U.S. Department of Health and Human Services and HRSA-funded health centers serve as leaders in quality healthcare in the U.S.”

The North Carolina Formerly Incarcerated Transition (FIT) program is establishing patient-centered primary care medical homes for returning inmates with chronic medical conditions, mental illness and/or substance use disorder.

The NC FIT program builds on investments being made by the NC Department of Public Safety (DPPS) to improve reentry. In coordination with DPS, the FIT Program extends the work of local reentry councils and community-based organizations to link recently released prisoners with essential healthcare services. NCCHCA has been an important partner in establishing partnerships with FQHCs which are uniquely positioned to care for these complex patients, addressing physical and mental health as well as treatment for addiction.

HRSA RECOGNITION

NORTH CAROLINA FORMERLY INCARCERATED TRANSITION (FIT) PROGRAM

450000

475000

500000

525000

550000

575000

600000

20172016

520,743

559,115

NC CHCS SAW 40,000 MORE PATIENTS


MEDICAID TRANSFORMATIONIn 2019, NC Medicaid will transition its program from a state-based medical home model to insurance networks with person-centered, coordinated care networks that address beneficiary health and social needs.

Since the 2015 legislation that began this process, NCCHCA has been involved in:• Providing input to NC Medicaid’s program development • Partnering in the development of a unique network for NC Medicaid managed care• Preparing Community Health Center members for the transition• Program development input

NCCHCA staff have participated on a number of NC Medicaid committees focused on developing the new Medicaid program, including:

• Social Determinants of Health Technical Advisory Committee • Beneficiary Engagement MCAC Subcommittee • NC Institute of Medicine Task Force on Accountable Care Communities • NCCHCA staff have provided written comments regarding policy papers & proposals:

• March 2018 comments on policy papers including: Prepaid Health Plan Network Adequacy and Accessibility Standards; Beneficiaries in Medicaid Managed Care; NC’s Care Management Strategy; Provider Health Plan Quality Performance and Accountability; and Centralized Credentialing and Provider Enrollment

• December 2017 comments on Actuarial and Operations Request for Information• September 2017 comments on NC Medicaid Managed Care Program Design• June 2017 comments on NC 1115 Waiver submitted to the Centers for Medicare and Medicaid

Services (CMS)

Partnering in the development of a unique joint venture for NC Medicaid managed care

• In partnership with the NC Medicaid Society and Centene Corporation, to develop Carolina Complete Health.

Preparing Community Health Center Members for Medicaid Transformation including:

• Delivered four regional Medicaid Transformation Regional Trainings (June 2018)

• A Medicaid FQHC PPS change in scope training (June 2018)

• Monthly Medicaid transformation training (July 2018 – ongoing)

Since 2015, NCCHCA has been working with NC Medicaid to make corrections to NC FQHC PPS rates, which have inappropriately limited Medicaid payment to FQHCs since 2001.

NC Community Health Centers experienced the following return on investment for these corrections:

• $1.6 million/year from removing Medicare caps and screens from Medicaid rates

• $2.9 million/year from instituting unique rates for newer health centers


INNOVATIVE

HEALTH CENTER CONTROLLED NETWORK

NCCHCA is a HRSA Health Center Controlled Network (HCCN) grantee. Participating in the HCCN - Carolina Medical Home Network (CMHN) -health centers have the opportunity to work together on quality improvement and operational system redesign initiatives and engage in payment reform models through the Independent Practice Association (IPA) and Accountable Care Organization (ACO) initiatives.

In the current round of funding, 33 health centers are HCCN members. The 2016-2019 HCCN grant focuses on

• Meaningful use for providers• Connecting to HIE • Achieving PCMH • Achieving healthy people 2020 quality

metrics• Transition to team based models of care

Blue Cross BQPP Program

Blue Quality Physician Program (BQPP) is a primary care quality improvement incentive program through Blue Cross Blue Shield of NC. PCMH recognition is a core eligibility requirement and practices can apply for BQPP once per year and are scored on several elements, including quality, cost, access and provider education.

BQPP evolves yearly to drive accountability and improvement based on national trends and utilizes Provider Quality Reports (PQRs) for closing member care gaps. Of the 21 health centers participating in the CMHN agreement with BCBSN, 6 are currently participating in BQPP and an additional 3 have submitted Fall 2018 applications.


ACCOUNTABLE CARE ORGANIZATION

Carolina Medical Home Network (CMHN) saved Medicare $3.1 million dollars in 2017

CMHN did this by implementing value-based care strategies to control cost and utilization. Recently released CMS Accountable Care Organization (ACO) results show that CMHN has been on an upward trajectory on controlling cost since their inception in 2015. Our ACO health centers spent 16% less per patient per year than the National Fee-for-Service peer group and outperformed the All Medicare Shared Savings ACO peer group.

In 2015, the NC Community Health Care Association created an Accountable Care Organization (ACO) under the umbrella of Carolina Medical Home Network (CMHN). In 2017 the CMHN ACO was comprised of eight health centers: Advance CHC, Caswell Family Medical Center, Gaston Family Health Services, Goshen Medical Center, Hot Springs Health Program, Piedmont Health Services, Roanoke-Chowan CHC, and Rural Health Group. The ACO is in a Medicare Shared Savings (MSSP) Track 1 model, which is a no-risk model that allows for potential shared savings of up to 50% after surpassing a minimum savings threshold.

HEALTH CENTER CONTROLLED NETWORK In calendar year 2017-18 the HCCN ensured that 100% of health centers were in line to be connected to the state HIE; 85% of HCCN members

• Received HRSA award for delivering High Value Healthcare & Enhancing Access to Care• Reducing Total Cost per Total Patient between 2016 & 2017• Expanded PCMH recognition

Going forward, the HCCN will be focused on optimizing health information technology around things like increasing patient engagement, reducing provider burden, absorbing unaffiliated provider data, all with the goal of performing well in value-based contracts.


COLLABORATION

The NC primary care conference is a collaboration of safety net providers in the state of North Carolina, including the NC association of free & charitable clinics. What started as an annual conference just for Community Health Centers is now a gathering meeting for primary care safety net providers from all over NC.

Behavioral Health Chief Financial OfficersClinical NetworkCommunications/ Consumer EducationDental DirectorsDiabetes Emergency PreparednessHealth Insurance Outreach & Enrollment Human Resources

Medical Directors Outreach and Enrollment Patient Centered Medical HomePharmacy DirectorsPractice Managers QUICHE: Quality Use Improve Change EvaluateSpecial Populations Health

NCCHCA WORKGROUPSEast Coast

Migrant Stream Forum

East Coast Migrant Stream Forum

1978 2018

40 Years of Service


NCCHCA’s support helps health centers

build and sustain effective Outreach

& Enrollment programs.

OUTREACH AND ENROLLMENT

COVERAGE TO CARE

The assistance that Outreach & Enrollment staff provide helps people get covered, stay covered, and access care. Staff also connect people to other needed health and social resources and promote access to primary care.

NCCHCA and our member community health centers have played a leading role in helping North Carolinians understand their health insurance options and enrolling them in affordable coverage that best meets their needs.

Community health centers have dedicated, expert staff who educate their communities about health insurance options and help people enroll in coverage through Medicaid, NC Health Choice, Health Insurance Marketplace, and Medicare (through partnership with the NC Senior Health Insurance Information Program).

Each year, community health centers in North Carolina train more than 100 staff and volunteers to help consumers and patients enroll in coverage. Since 2013, NC FQHCs have seen more patients get covered, increasing their access to care.

0%

10%

20%

30%

40%

50%2017

2013

Third Party InsuranceUninsured

Insurance Status of NC Community Health Center Patients

Awareness & Knowledge

Application & Eligibility

Enrollment Coverage Maintaining Coverage

Access to approproiate

care


EMERGENCY PREPAREDNESSHurricane Matthew:

Recovering in Partnership with Kate B. Reynolds Foundation

Readying Health Centers for the Next DisasterNCCHCA continued its regular Emergency Preparedness training in 2017-2018.

• Intensive workshops to prepare member Community Health Centers for the new CMS Emergency Preparedness rule

• Active Shooter Training (free for members)• Regular EP phone calls and in person meetings• Full scale drills in partnership with Regional Advisory Committees

Preparedness In Partnership: Collaborating with HRSA and NC’s Office of Rural Health

After Hurricane Matthew hit North Carolina in October of 2016, NCCHCA worked closely with the Kate B. Reynolds foundation to regrant about $400,000 to member health centers for costs not covered by FEMA or other state & national disaster assistance programs. Four health centers received grants up to $150,000 to help them get back on their feet. NCCHCA also used this experience to inform our reporting practices to HRSA and other interested parties during the 2018 Hurricane season, when the state was hit by two storms in one month.

NCCHCA has built a strong relationship with many national and state partners, as we frequently experience major weather events. NCCHCA coordinates damage and closings assessments with the state’s office of rural health. We collaborate with HRSA to optimize reporting after natural disasters, and are also partnering with other PCAs in mastering best practices for helping our health centers prepare for, then recover from, major events each year.


INNOVATING WITH ACCESS

NC Safety Net Health System

We are organizing the safety net to efficiently coordinate our efforts in caring for the uninsured. This collaboration includes:

• The NC School Health Alliance• NC Office of Rural Health• North Carolina Asociation of Free and

Charitable Clinics • North Carolina Association of Local Health

Directors • NC Foundation for Health Leadership and

Innovation• Care Share Health Alliance • NC Rural Health Leadership Alliance

• Provider loan repayment strengthens recruitment and retention among Safety Net providers. • The debt load of graduating medical residents in 2016 was $190,000, and that will only increase in

subsequent years. • Safety net providers are often the only primary care provider in a rural area willing to see patients

regardless of insurance status and rural communities have high numbers of uninsured. • National competition for providers makes it difficult for rural communities to compete on salary

and community/quality of life measures. But, in a survey of those receiving loan repayment assistance from state and federal programs, reasons providers stayed included “my spouse is happy in the community,” “My children are happy in the community,” and “We feel safe in the community.”

The North Carolina Office of Rural Health’s analysis found the annual, rural economic impact by provider type. The economic impact includes money the provider spends, money spent on businesses the provider employs to do their job, and spending by those businesses as a result of the provider employing them.

Rural Provider TypeAnnual Economic

Impact on Rural Community

Physician $615,282OBGYN $725,668

Pediatrician $600,190Physician Assistant $298,238Nurse Practitioner $317,377Psychiatrist $652,037

Social Worker $211,188Licensed Professional Counselor

$137, 924

Psychologist $413,462Dentist $794,077

ORH disclaimer: Specific results will vary by county

Loan Repayment Makes NC Stronger

Safety Net


ACCOUNTABILITY TO WASHINGTON, DC

Community Health Centers are accountable to the Federal Government and citizens for the HRSA grant investment. Health Centers submit annual Universal Data System (UDS) reports, documenting their services, quality, and use of federal funds. Health Center reports are publically available on the Bureau of Primary Health Care website.

Health Centers regularly invite elected officials to tour their facilities and learn more about the high quality services and health outcomes they deliver to their constituents.

HRSA Administrator Dr. George Sigounas, who keynoted our 2017-2018 Primary Care Conference, is pictured here with Piedmont

Health CEO Brian Toomey, NCCHCA CEO Ben Money, and Tom Irons, MD.

Left: Senator Richard Burr checks out telehealth equipment at Roanoke Chowan CHC’s Creswell Primary Care with CEO Kim Schwartz and CMO Claudia Richardson


FULL TIME AND CONTRACT STAFFHCCNPETER FREEMAN, MPHVice President & Executive Director of Carolina Medical Home Network

MARK MASSING, MD, PhD, MPHDirector of Data & Analytics

CAREY O’REILLY, RD, LDN, CDEClinical Integration Manager

LAUREN LOWERY, MPHNetwork Development Manager

ELIZABETH KASPER, MPH Special Projects Coordinator (Contract)

KATHLEEN EVANS ACO Program Manager (Contract)

PCA E. BENJAMIN MONEY, JR., MPHPresident and Chief Executive Officer CHRIS SHANKVice President of Operations & Business Development

MARTI WOLF, RN, MPHClinical Programs Director

ROSA NAVARRO, MADirector of Training and Technical Assistance

SHARON BROWN-SINGLETON, MSM, LPNDirector of Health Center Services & Support

ALICE POLLARD, MSW, MSPHHealth Care Access Coordinator

APRIL MORGAN, MAOutreach and Enrollment Coordinator

DIANE HOBGOODOffice Manager JOSIE LANE, MPA, MALSTraining Coordinator

KRISTEN DUBAY, MPPSenior Policy Advisor

LESLIE WOLCOTT, MA Communications Coordinator

MEL GOODWIN, JDCommunity Development & Special Populations Coordinator

PATRICIA BLACKExecutive Assistant & Board Liason

RONAK PATELFinance Manager

This project is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) under the North Carolina State Primary Care Association Cooperative Agreement, number 5 U58CS06835-13-00, valued at $1,415,574. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.


Alamance | Piedmont Health ServicesAlleghany | AppHealthCareAnson | Anson Regional Medical ServicesAshe | AppHealthCareAvery | High Country Community HealthBeaufort | Metropolitan Community Health ServicesBertie | Bertie County Rural Health Association | Roanoke Chowan Community Health CenterBladen | CommWell HealthBrunswick | CommWell Health | Goshen CHC Buncombe | Western NC Community Health ServicesCabarrus | Cabarrus Rowan CHC Caldwell | West Caldwell Health CouncilCaswell | Caswell Family Medical Center | Piedmont Health ServicesCatawba | Gaston Family Health ServicesChatham | Piedmont Health ServicesCherokee | Appalachian Mountain Health Center Chowan | Gateway Community Health CentersColumbus | Goshen Medical Center | Robeson Health Care CorporationCraven | Goshen Medical Center | Craven County CHCCumberland | Stedman-Wade Health Services | Community Health InterventionsDavidson | Gaston Family Health ServicesDuplin | Goshen Medical CenterDurham | Lincoln CHC Edgecombe | Carolina Family Health Centers | OIC Family Medical Center | Rural Health GroupForsyth | United Health Center Southside Franklin | Advance Community Health Gaston | Gaston Family Health ServicesGates | Gateway CHCGraham | Appalachian Mountain Health CenterGreene | Greene County Health CareGuilford | Triad Adult and Pediatric MedicineHalifax | Rural Health GroupHarnett | First Choice Community Health Center Haywood | Appalachian Mountain Health CenterHenderson | Blue Ridge Community Health ServicesHertford | Roanoke Chowan CHC Hoke | South Central CHCHyde | Ocracoke Health Center

Iredell | Gaston Family Health ServicesJackson | Appalachian Mountain Health CenterJohnston | CommWell HealthJones | Goshen Medical CenterLenoir | Kinston CHC Lincoln | Gaston Family Health ServicesMacon | Appalachian Mountain Health CenterMadison | Hot Springs Health ProgramMcDowell | Appalachian MountainMecklenburg | C.W. Williams CHC | Charlotte Community HealthMitchell | Mountain Community Health Partnership Montgomery | Robeson Health Care CorporationNash | Carolina Family Health CentersNew Hanover | MedNorth Health CenterNorthampton | Rural Health GroupOnslow | Goshen Medical CenterOrange | Piedmont Health ServicesPamlico | Greene County Health CarePasquotank | Gateway Community Health CentersPender | CommWell Health | Black River Health ServicesPerson | Person Family Medical CenterPolk | Blue Ridge Community Health ServicesPitt | Greene County Health CareRandolph | Randolph Family Health Care at MERCERichmond | Anson Regional Medical ServicesRobeson | Robeson Health Care CorporationRockingham | Triad Adult and Pediatric MedicineRowan | Cabarrus Rowan Community Health CentersRutherford | Blue Ridge Community Health ServicesSampson | CommWell Health | Goshen Medical CenterScotland | Robeson Health Care CorporationTransylvania | Blue Ridge Community Health ServicesUnion | Anson Regional Medical ServicesVance | Rural Health GroupWake | Advance Community Health Warren | Rural Health GroupWashington | Roanoke Chowan CHC | Metropolitan CHC Watauga | High Country Community HealthWayne | Goshen Medical Center Wilkes | Wilkes County Health DepartmentWilson | Carolina Family Health CentersYancey | Mountain Community Health Partnership

NC COMMUNITY HEALTH CENTER SITE LIST

2018 ANNUAL REPORT PREPARING FOR A VALUE-BASED WORLD · 2019. 4. 18. · CFO Steve Shelton, Advance Community Health, Raleigh Clinician Tammy Kiger, MD, Carolina Family Health Centers,

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