Federally Qualified Health Centers (FQHCs) & Medicaid: Increasing Access, Reducing Cost, Sustaining Quality and Improving Health Outcomes Regan Crump,

Federally Qualified Health Centers (FQHCs) & Medicaid:

Increasing Access, Reducing Cost, Sustaining Quality

and Improving Health Outcomes

Regan Crump, MSN, DrPHU.S. Department of Health and Human ServicesHealth Resources and Services Administration Office of Planning and EvaluationHealth Systems and Financing Group

Fall 2004 Annual MeetingNational Association of State Medicaid Directors

November 18, 2004

2

The FQHC & Medicaid Partnership

Working together to provide health care for vulnerable populations!

A partnership that generates an outstanding return for State Medicaid Agencies (SMAs)!

3

The FQHC & Medicaid Shared Mission

Improve access to cost effective services for vulnerable populations.

Improve quality of care and health outcomes for Medicaid beneficiaries, including the elimination of health disparities.

4

Eight Facts Supporting the Outstanding Return from FQHCs

Health Centers*…

1. Are a major source of care for Medicaid beneficiaries;

2. Are cost efficient;

*All Section 330-funded health centers are FQHCs.

5

Health Centers*…3. Tailor services to the needs

of the populations and communities you serve;

4. Coordinate care with other providers in the community;

Eight Facts Supporting the Outstanding Return from FQHCs

6

Health Centers…5. Reduce risk and improve

health outcomes for vulnerable populations;

6. Provide high quality care for patients with multiple chronic conditions;

Eight Facts Supporting the Outstanding Return from FQHCs

7

Health Centers*…7. Are strengthened by

technical assistance from linkages at the National, State and local levels;

8. Stand ready to serve Medicaid beneficiaries as your provider of choice.

*All Section 330-funded health centers are FQHCs.

Eight Facts Supporting the Outstanding Return from FQHCs

Health CentersFact #1

Health centers are a major source of care for Medicaid beneficiaries,

serving 4.4 million beneficiaries.

9

12.4 Million served 50.0 Million patient encounters 3,600 service delivery sites 89.7% below 200% poverty 39.3% uninsured 63.8% racial/ethnic minority Serve all ages

–

12.5 % 4 and under–

14.2 5-12 years–

20.0 13-24 years–

46.4 25-64–

7.1 65 and over

Health Center Program – CY03

Source: BPHC UDS, 2003

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Health Centers serve:

1 out of 10 Medicaid beneficiaries

1 out of 20 SCHIP beneficiaries

1 out of 7 migrant farmworkers

1 out of 5 homeless persons

Source: BPHC UDS, 2003

11

Medicaid Beneficiaries in Health Centers

Medicaid beneficiaries seen in health centers tripled between 1980 and 2001.1

4.4 million Medicaid beneficiaries were seen in health centers in 2003.2

The number of Medicaid beneficiaries seen in health centers continues to grow.Sources: 1Kaiser Family Foundation

2 BPHC UDS Data, 2003

Health CentersFact #2

Health centers are cost-efficient providers of

care.

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Health Center Services

Comprehensive primary care Preventive services & screenings Chronic disease management Enabling services (e.g., translation) Quality Assurance/Improvement Prenatal and post partum care Dental and mental health

14

Health Centers Provide High Quality Cost-Efficient Care

Cost of treating Health Center Medicaid patients is 30-34% less than cost for those receiving care elsewhere; 26-40% lower for prescription costs; 35% lower for diabetics; 20% lower for asthmatics. Center for Health Policy Studies. Final Report; November 1994.

Health Center Medicaid patients are 22% less likely to be hospitalized for potentially avoidable conditions than those obtaining care elsewhere. Health Center Medicaid patients are less likely to use the ER and less likely to be hospitalized for potentially avoidable conditions than those with a usual source of care who obtained care elsewhere. Falik et al. Medical Care Vol. 39, No 6; 2001.

15

Health Center Medicaid Savings, 2002

1Health Center Medicaid

PatientsIf They Had Gone Elsewhere

$2.4 B

$1.8 B

$600 M

Source: Center for Health Policy Studies, 1994

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Medicaid Savings through Health Centers

Lower prescription drug costs (340B Drug Pricing Program)

Lower medical costs due to effective chronic disease management

Avoidable hospitalizations prevented

Health CentersFact #3

Health centers tailor services to the needs of

the populations and communities you serve.

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Tailoring Services to the Community

51% user-majority governing board directs the center.

Services are based on community needs assessment, including prevalent diseases.

Respects the local language, values and culture.

Services designed for homeless and migrant users as appropriate.

Conveniently located in underserved areas.

19Sources: BPHC UDS, 2003

U.S. Census, 2000

Health CentersFact #4

Health centers coordinate with other providers in the

community.

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Health Centers are in Networks

Integrated Service Delivery Initiative (ISDI) Shared, Integrated Management Information

System (SIMIS) Information and Communication

Technology (ICT) Programs Electronic Health Record (EHR) Networks

22

Healthy Communities Access Program (HCAP) networks include Health Centers

Coordinates horizontal and vertical integration

Improves chronic care coordination

Builds information technology systems

Strengthen local safety net infrastructure Strengthen local emphasis on health care for

underserved

23Source: BPHC, KDay June, 2003

Health CentersFact #5

Health centers reduce risk and improve health

outcomes for vulnerable populations.

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Health Center Plans Outperform Nationin Most Medicaid Preventive Services

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Childh

ood im

muniz

ation

com

binatio

n 1

Adoles

cent

well c

are

visits

Cervic

al ca

ncer s

cree

ning

Check

ups

afte

r del

ivery

Well-c

hild

visits

, 3-6

yea

r old

s.

Prena

tal c

are in

the fir

st tri

mes

ter

Eye e

xam

s fo

r per

sons

with

dia

bete

s

Childr

en's

acce

ss to

car

e - 1

2-24

mon

ths

Childr

en's

acce

ss to

car

e - 2

5 m

onth

s-6

years

Childr

en's

acce

ss to

car

e - 7

-11 ye

ars

Measures

Per

cen

tag

e

National Medicaid Mean Health Center Mean

Source: 1999 Health Plan Employer Data and Information Set (HEDIS), Partridge, et. al. Based on Performance of Nine Health Center-Based Plans

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Low Birth Weight: Health Centers Better

Sources: Uniform Data System, 1999 – 2003National Center for Health Statistics (NCHS) - Health U.S. 2002* 2003 NCHS data available Dec 2004

7.80

7.05

7.707.60

7.60

7.00

7.40

7.10

7.10

6.80

7.00

7.20

7.40

7.60

7.80

1999 2000 2001 2002 2003

Ra

te U.S.*Health Centers

27

79

6773

85

55

46

6266

0102030405060708090

Medicaid Uninsured AfricanAmerican

Hispanic

Pro

portio

n o

f P

atie

nts

Scr

eened

Health Center

U.S. Population

Mammography: Health Centers Better

Mammography Screenings Among Health Center Females Remain Higher Than Females Below 200% FPL in the Nation

HP2010 Goal: 70%

For age 40 and over

Sources: 2002 User Visit Survey2000 National Health Interview Survey

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92

83

9291

84

78

84

78

40

50

60

70

80

90

100

Medicaid Uninsured African American Hispanic

Pro

portio

n of

Fem

ales

Scr

eene

d

Health Center

U.S. Population

Pap Smears: Health Centers Better

Pap Tests Among Health Center Females Remain Higher Than Females Below 200% FLP in the Nation

HP2010 Goal: 90%

For age 18 and over

Sources: 2002 User Visit Survey2000 National Health Interview Survey

Health CentersFact #6

Health centers provide high quality care for patients

with multiple chronic conditions.

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Treating Chronic Illnesses

Source: 15 Illnesses Drive Up Costs. Connolly C. The Washington Post. Wednesday, August 25, 2004

31

Health Centers Provide Leadership in Evidence-based Disease Management

More than half of health centers have participated in at least one Chronic Disease Management Collaborative: Cancer Diabetes Depression Asthma Prevention Perinatal

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Health Center Chronic Disease Management

3.3

1

0

0.5

1

1.5

2

2.5

3

3.5

Od

ds

Ra

tio

Health CenterPatients

Comparable Group

African Americans & Hispanics with Hypertension at Health Centers are 3 Times as Likely to Report Blood Pressure Under Control as NHIS

Comparable Group

Source: National Health Interview Survey - Measure is 140/90 and hypertension control is self-reported.

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Collaboratives: A Success in Health Centers

“With federally funded health centers having fully embraced the (Disease Management Collaborative) model…this has become arguably the largest, most important health care quality improvement initiative in the country.

It’s exactly what the health care system needs right now – a demonstration that it is possible both to improve care dramatically and even reduce health care costs.”

Tracy Orleans, Ph.D., senior scientist at the Robert Wood Johnson Foundation Advances Online, Robert Wood Johnson Foundation Newsletter, October 2002

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Total Registry Size for All DM Collaboratives

0

20000

40000

60000

80000

100000

120000

numb

er of

ptsRegistry Growth – Diabetes Collaboratives

Feb 1999-October 2003

Source: HRSA/BPHC/IHI Contact: Jerry Langley

Email: [email protected]

1,685 PatientsMarch 1999

139,295 PatientsOctober 2003

35

Source: HRSA/BPHC/IHI Contact: Jerry Langley

Email: [email protected]

Summary Measures: Diabetes CollaborativesFeb 2000-Oct 2003

Average HbA1c for DM Patients

8.0

8.1

8.2

8.3

8.4

8.5

8.6

8.7

8.8

aver

age

DM1 teams did not submit until Jun 2000

92,472 PatientsOctober 2003

21,561 Patients

4,343 Patients

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Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Accreditation

30% of health centers are accredited by the JCAHO.*

HRSA is providing support to help health centers achieve accreditation.

Goal is for 90% of health centers to be accredited.

*Based on data as of 9/1/2004

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Federal Tort Claims Act (FTCA) Covers Most Health Centers

69% of health centers are “deemed” (covered) under the Federal Torts Claim Act.*

Deeming indicates they have met patient safety and quality criteria:

e.g., peer review & quality assurance program e.g., primary source credentialing of providers

Health centers save the cost of malpractice insurance when covered by FTCA.

*Based on data as of 10/25/2004

Health CentersFact #7

Health center operations are strengthened by technical assistance from linkages at

National, State and local levels.

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National Linkages for FQHCs HRSA Bureau of Primary Health Care (BPHC)

National Association of Community Health Centers (NACHC)

National Health Care for the Homeless Council (NHCHC)

National Center for Farmworker Health (NCFH)

National Rural Health Association (NRHA)

White House – President’s Health Center Growth Initiative

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State-Level Linkages for FQHCs

Primary Care Associations (PCAs) Workforce Recruitment Statewide Strategic Planning Emergency Preparedness

Primary Care Offices (PCOs)*

Shortage Area Designations

*Located in State Health Departments

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Local Linkages for FQHCs

Local health departments

Local hospitals Other primary

care providers

Managed Care Organizations

Specialists Pharmacies

Collaborating with local providers:

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Local Linkages for FQHCs

Schools & universities

Community-based programs

Medical society

Business groups Employers Faith-based

institutions

Health CentersFact #8

HRSA-funded health centers stand ready to

serve Medicaid beneficiaries as your provider of choice.

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As Medicaid Providers of Choice, Health Centers…

help SMAs assure access and quality in local provider networks.

accept new Medicaid patients when other providers do not.

are opening new access points in areas of greatest need.

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Why should SMAs partner with health centers?

They already serve a large number of Medicaid beneficiaries.

They have demonstrated cost-efficiency with drug purchasing, preventing avoidable hospitalizations, and managing chronic disease.

46

They tailor services to the beneficiaries you serve.

They coordinate with other providers in the community.

The quality of care they provide for Medicaid beneficiaries is very high.

Why should SMAs partner with health centers?

47

They improve the health of high risk and high cost populations using state of the art chronic disease management techniques.

The system of support for the health center system is strong – funded by HRSA and others at the national, state and local levels.

Why should SMAs partner with health centers?

48

They share and spread their quality improvement, disease management and cost saving strategies.

They can help you get the kind of return that your State needs.

Why should SMAs partner with health centers?

49

Next Steps to Improve the Value of Partnership with FQHCs

SMAs, health centers and PCAs address issues jointly.

SMAs partner with PCAs in developing Medicaid waiver applications.

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HRSA, CMS and SMAs exchange pertinent data and information.

Share “best practices” in Medicaid-FQHC partnerships; in writing and in meetings.

Next Steps to Improve the Value of Partnership with FQHCs

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AMERICA’S HEALTH CENTERSAMERICA’S HEALTH CENTERS

THETHE MODEL FOR PRIMARY HEALTH CARE IN THE UNITED STATES

Increasing Access, Reducing Cost, Sustaining Quality

and Improving Health Outcomes

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Contact InformationRegan Crump, MSN, DrPH

U.S. Department of Health and Human ServicesHealth Resources and Services AdministrationOffice of Planning and EvaluationDirector, Health Systems and Financing Group5600 Fishers LaneParklawn Building, Room 10-29Rockville, Maryland 20857

Telephone: 301.443.1550Fax: 301.480.0773Email: [email protected]