Bureau of Primary Health Care Update for the South Carolina Primary Health Care Association John Cafazza Division Director Central Southeast Division U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care October 12, 2012
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Bureau of Primary Health Care Update for the South Carolina Primary Health Care Association John Cafazza Division Director Central Southeast Division U.S.
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Bureau of Primary Health Care Updatefor the
South Carolina Primary Health Care Association
John CafazzaDivision DirectorCentral Southeast DivisionU.S. Department of Health and Human ServicesHealth Resources and Services AdministrationBureau of Primary Health Care
October 12, 2012
Primary Health Care 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
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Health Center Program Overview
Calendar Year 2011
80 Million Patient Visits 1,128 Grantees 8,500+ Service Sites
Over 138,000 Staff 9,937 Physicians 6,934 NPs, PA, & CNMs
Source: Uniform Data System, 2011, Service Sites: HRSA Electronic Handbooks
20.2 Million Patients 93% Below 200% Poverty 36% Uninsured 62% Racial/Ethnic Minorities 1,087,000 Homeless Individuals 863,000 Farmworkers 188,000 Residents of Public Housing
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Under 511%
5 to 1213%
13 to 178%
18 to 2410%
25 to 6451%
65 and up7%
Health Center Serve All Ages
Medicaid38%
Medicare6%
Other Public Insurance2%Other 3rd Party
7%
Self-Pay6%
State/Local/Other
17%
BPHC Grants17%
ARRA Grants5%
Other Federal Grants2%
Health Center Revenue Sources
Health Center Program National Presence – May
2012
4
Health Center Program Overview
National Impact
Source: Health Center Data: Uniform Data System, 2011. National Data: U.S. Census Bureau, 2010 Current Population Reports and Current Population Survey.
Jobs 113,059 123,012 131,660 138,403 25,344 (22.4%)
Source: Uniform Data System, 2008-2011 and HRSA Electronic Handbooks 6
Health Center Program Performance
Calendar Year 2011
Among Health Center Patients:
• 70% entered prenatal care in the first trimester
• 7.4% low birthweight rate continues to be lower than national estimates (8.2%)
• 44% of children received all recommended immunizations by 2nd birthday
• 63% of hypertensive patients with blood pressure ≤ 140/90
• 71% of diabetic patients with HbA1c ≤ 9
• $654 total cost per patient
• $144 cost per medical visit
For more information: http://www.bphc.hrsa.gov/policiesregulations/performancemeasures/index.html Source: Uniform Data System, 2011. National Birthweight Data: 2010. Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2010. National vital statistics reports web release; vol 60 no 2. Hyattsville, MD: National Center for Health Statistics. 2011.
o Over 80% reported the overall quality of services received at the health center were “excellent” or “very good.”
o Over 80% reported that they were “very likely” to refer friends and relatives to the health center.
o Over 75% reported the main reason for “going to the health center for healthcare instead of someplace else” was because it was convenient (28%), affordable (25%), and provided quality healthcare (22%).
Health Center Performance2009 Health Center Patient
Survey
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South Carolina Health CentersCalendar Year 2011
South Carolina
Health Center Grantees
In 2011, 20 Health Centers served 326,829 patients: • 39.7% were uninsured• 93.9% were at or below 200% of
poverty• 61.2% Female
• 58.7% nationally
• 30.6% Children < age 18• 32% nationally
• 9.1% Seniors age 65+ • 6.9% nationally
• Served by (FTEs): – 170.31 Physicians
– 108.99 Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives
9Source: Uniform Data System, 2011
South Carolina Health CentersCalendar Year 2011 - Fiscal Year 2012
PERFORMANCE
Among South Carolina Health Center Patients:• 59.0% entered prenatal care in
the 1st trimester• 8.2% rate of low birth weight • 49.5% of children have received
all recommended immunizations by second birthday
• 71.2% of diabetic patients with HbA1c ≤ 9
• 62.5% of hypertensive patients with blood pressure ≤ 140/90
• $570 total cost per patient• $159 cost per visit
FUNDING
10Source: Uniform Data System, 2011 and HRSA Electronic Handbooks
• $51.3 M base operational grants (FY ‘12)
• $19.6 M New ACA grants• $ 2.9 M – New Access Points• $ 0.2 M – HIV Supplemental
Funding • $14.4 M – Capital
Development – Building Capacity Grant
• $ 1.6 M – Capital Development – Immediate Facility Improvement Grant
• $ 0.5 M – School Based Health
Center Capital Grant
Primary Health CareOur Focus
Primary Health Care/
Public Health Leadership
Performance Improvement:- Outreach/Quality of Care
- Health Outcomes/Disparities - Cost/Financial Viability
Program Requirements:- Need
- Services - Management and Finance
- Governance11
Primary Health Care 2012 Strategic Priorities
– Grantee Satisfaction• BPHC External Technical Assistance & Training Strategy
– Employee Satisfaction• BPHC Internal Staff Training & Development
– Timeliness/Quality• Service Area Definition & Program Collaboration
– Impact• Quality Strategy (includes Meaningful Use & Patient-
Centered Medical Home)• Recovery Act Projects Close-Out
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National Priority Training and Technical
Assistance Support Areas
Note: Multi-select. Percents will not add to 100.
What additional TA resources or tools would enhance the performance of your organization?
2011 2010
60%
52%
50%
39%
39%
39%
35%
35%
34%
34%
31%
28%
28%
24%
22%
19%
18%
13%
2%
3%
53%
52%
50%
46%
33%
41%
38%
44%
N/A
38%
37%
32%
34%
27%
27%
30%
18%
15%
4%
4%
Patient-Centered Medical Home
Quality Improvement
Risk Management
Behavioral Health Service Integration with Primary Care
FTCA
Governing Board Training
Billing
HIT
Capital/Growth Planning
Needs Assessments
Strategic Planning
Fiscal
Staff Retention and Recruitment
School-Based Health Centers
EHR
Teaching Health Centers
Outreach to Special Populations
Patient Safety
Other TA resource or tool
None
Current Program Impact: Key National Indicators
% of Health Centers with EHR Implementation (UDS 2011) 65% have EHRs at all sites used by all providers 15% have EHRs at some sites used by some providers
% of Health Centers Achieving Patient-Centered Medical Home Recognition (as of Septebmer 1, 2012) 28% of all health centers are participating in Patient-Centered
Medical Health Home Initiatives (PCMHHI) 11% have achieved Patient-Centered Medical Home (PCMH)
recognition
% of Health Center Meeting/Exceeding Healthy People 2020 Goals (UDS 2011) 57% Meet/Exceed Hypertension Control Goal of 61% 10% Meet/Exceed Diabetes Control (HbA1c ≤9) Goal of 85% 36% Meet/Exceed Early Entry into Prenatal Care Goal of 78% 61% Meet/Exceed Low Birthweight Goal of 7.8% 14
Current Program Impact: Key South Carolina
Indicators% of Health Centers with EHR Implementation (UDS 2011)
47% have EHRs at all sites used by all providers 16% have EHRs at some sites used by some providers
% of Health Centers Achieving Patient-Centered Medical Home Recognition (as of September 1, 2012) 47% of South Carolina State health centers are participating in
Patient-Centered Medical Health Home Initiatives (PCMHHI) 0% have achieved Patient-Centered Medical Home (PCMH)
recognition
% of Health Centers Meeting/Exceeding Healthy People 2020 Goals (UDS 2011) 50% meet/exceed hypertension control goal of 61% 0% meet/exceed diabetes control (HbA1c ≤9) goal of 85% 8% meet/exceed early entry into prenatal care goal of 78% 42% meet/exceed low birthweight goal of 7.8%
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Source: Uniform Data System, 2011
Percentage of EHR Adoption by State UDS 2011
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Health Center EHR Adoption National and South Carolina, UDS
2011
National South Carolina0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
65%
47%
14%
16%
EHR at Some Sites
EHR at All Sites
2015 Goal: 100% of Health Centers use EHR at All Sites
Source: Uniform Data System, 2011
2012 Goal: 50% of Health Centers use EHR at All Sites
All Sites/Providers Some Sites/Providers No EHR
South Carolina Health Centers have not met the 2012 HRSA EHR goal based on UDS 2011 data.
HRSA, BPHC, Central Southeast Division (June 2012)
South Carolina EHR AdoptionUDS 2011 Data
Impact-BPHC Quality Strategy
1. Implementation of QI/QA SystemsAll Health Centers fully implement their QI/QA plans
2. Adoption and Meaningful Use of EHRs
All Health Centers implement EHRs across all sites & providers
3. Patient-Centered Medical Home Recognition
All Health Centers receive PCMH recognition
4. Improving Clinical OutcomesAll Health Centers meet/exceed HP2020 goals on at least one UDS clinical measure
5. Workforce/Team-Based CareAll Health Centers are employers/providers of choice and support team-based care
Priorities & Goals
ACCESS
COMPREHENSIVE SERVICES
INTEGRATED SERVICES
INTEGRATED HEALTH SYSTEM
Better Care Healthy People & Communities Affordable ⃘� ⃘�Care
1. Programs/Policies
2. Funding
3. Technical Assistance
4. Data/Information
5. Partnerships/Collaboration
Strategy Implementation
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• Patient-Centered Medical Health Home Initiative
• Accreditation Initiative
• PCMH supplemental grant funds
• Partnership with the CMS Primary Care Demonstration
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HRSA’s PCMH Investments
• Demonstrates the quality of care provided in health centers and provides opportunity for continuous quality improvement.
• Positions health centers at an advantage for the changing health care landscape.
• Invests in the health center workforce resulting in reduced staff turnover and improved recruitment.
• Transforms patient care to help health centers achieve the three part aim of: Better care, Better health and communities, and Affordable care.
• Federal DHHS Priority
o Goal: 13% of health centers PCMH recognized by 9/30/2012
o Goal: 25% of health centers PCMH recognized by 9/30/2013
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Why PCMH?
Patient-Centered Medical/Health Home Initiative
(PCMHHI) • Encourages and supports health centers to transform their
practices and participate in the PCMHH recognition process to:– improve the quality of care and outcomes for health center
populations;– increase access; and – provide care in a cost effective manner.
• HRSA/BPHC will cover recognition process fees and provide technical assistance resources for practice transformation.
• Participation is strongly encouraged and provides an opportunity for health centers to achieve PCMH recognition.
For further information on the PCMHH Initiative:• PCMHH Initiative PAL:
Initiating and Maintaining Medicare FQHC Reimbursement
CMS requires ALL permanent and seasonal sites within a health center’s approved scope of project to be enrolled INDIVIDUALLY in Medicare.
• Each site must also indicate its unique Medicare Billing Number (also known as a PTAN or CCN) on claims for all services rendered at that site.
• Please ensure that your health center has all of its correct Medicare Billings Numbers listed in EHB as soon as possible, for each of their permanent and seasonal sites.
For more information about the requirements and process for enrolling sites in Medicare,
review PAL 2011-04http://www.bphc.hrsa.gov/policiesregulations/policies/pal201104.html
Meet/Exceed Healthy People 2020 Goals on One or More Clinical Performance Measures
• % of Health Centers with PCMH Recognition
• % of Health Centers with Cost Increase Less than National Average
• % of Health Centers Financially Strong (No Going Concern Issues)
T/TA Focus Areas:• Clinical Performance Measures
• Financial Performance Measures
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Fiscal Year 2012 Primary Care Association
Requirements
Statewide/Regional Program Assistance Workplan
o Information on Available Resourceso Annual T/TA Needs Assessmento Special Populationso Collaborationo Emergency Preparednesso Regional/Statewide Surveillance Analysis o Newly Funded Health Centers
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Quality and Data Updates
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FTCA Program
• FTCA Health Center Policy Manualo Primary source for information on FTCA
grantees and related stakeholderso Consolidates, clarifies and synthesizes existing
FTCA policy documents and statutory languageAvailable at: http://bphc.hrsa.gov/policiesregulations/policies/pin201101.html
• Application Review/Deeming in EHBo 2013 Requirements for FTCA Deeming available in