Health Center History & NACHC Overviewchv-comms.s3.amazonaws.com/CHC-NACHC-ViP-Overview.pdfuninsured on a sliding fee scale. The higher the individuals’ income the greater the share

HealthCenterHistory&NACHCOverview

www.nachc.com|www.communityhealthventures.com

1965:Communityhealthcentersbeginasa“demonstra9onproject”(governmentspeakfor

“pilotphase”)inPresidentLyndonJohnson’sWaronPovertyeffort.Three“neighborhood”

healthcenters(astheywerecalledthen)arefundedinBoston,MA,MoundBayou,MSand

Denver,CO.

CHC History & Timeline

Tofirstunderstandwhocommunityhealthcentersareandwhatmakesthemunique,youmustfirstknowwheretheycamefrom:



1971:TheNa9onalAssocia9onofNeighborhoodHealthCentersisfoundedandlaterchanges

itsnametotheNa9onalAssocia9onofCommunityHealthCenter(NACHC).

1980-1987:Duringtheearlytomid-80’s,NACHC(pronounced“nak”)anditsmemberhealth

centersfoughtoffmul9pleeffortsbytheWhiteHousetoblockgrantthehealthcenter

program(effec9velydissolvingthefederal-localpartnershipmodelthatisatthecenterofthe

program).StateandRegionalPrimaryCareAssocia9ons(PCA)wereformedtomonitorstate

policydevelopments.



1989-1992:GeorgeH.W.Bushincreasesfederalfundingforhealthcenters

bymorethan$150million.TheWhiteHouseandCongresscreatespecial

designa9onforhealthcentersasFederallyQualifiedHealthCenters

(FQHC).ThisFQHCdesigna9on–amongotherthings–reimburseshealth

centersatcostforservicesprovidedtoMedicaidandMedicare

beneficiaries.Addi9onally,thePresidentandCongressexpandtheFederal

TortClaimsAct(FTCA)tohealthcenterswhichprovidesformalprac9ce

coverageforanyclinicianworkingatanFQHC.Lastly,Congresscreatesa

newpharmacydiscountprogramwhichrequirespharmaceu9cal

manufacturerstosellmedica9onstohealthcenters(andothersafetynet

providers)atdeepdiscounts.



2001-2002:GeorgeW.Bushcallsfor5yearini9a9vetoincreasehealth

centerfundingby$700million.

2002-2004:Federalfundingforhealthcentersreaches$1.6billion(60%

increasesince2000).

2009-present:AmericanRecoveryandReinvestmentActprovides

healthcenterswithover$13billioninexpansionandopera9onal

funding.


CommunityHealthCenterQualiDes

ConsumerDrivenBoard:Toensurethathealthcenters’services

reflecttheneedsofthepa9entsandcommunity,51%ofallhealth

centerboardmembersmustbeusersoftheclinic.

LocatedinHigh-NeedAreas:Healthcentersmustbelocatedinan

areaiden9fiedbyfederalagenciesinconjunc9onwithstatesas

havingelevatedpoverty,higherthanaverageinfantmortalityand

wherefewphysiciansprac9ce.

Sohowdohealthcentersdiffer“opera=onally”fromothergroupprac=cesorclinics?



OpenDoorPolicy:Healthcentersmustseeanyoneregardlessoftheir

insurancestatus.Healthcentersmustoffertheirservicestothe

uninsuredonaslidingfeescale.Thehighertheindividuals’incomethe

greaterthesharetheymustpayforthecostofprovidingapersons’health

care.Slidingfeescalesarebasedupontheannuallyupdatedpoverty

guidelinesgeneratedbytheDepartmentofHealthandHumanServices.

EnablingServices:Healthcentersarerequiredtoofferservicesthat

enableaccesstohealthcarefortheirpa9ents.Someoftheseenabling

servicesincludetransporta9on,interpreta9onservices,healtheduca9on,

casemanagement,etc.



Income

72%ofhealthcenterpa9entsare100%ofthefederalpovertylevel(FPL)

andbelow.Comparably,only21%ofpa9entsseekingcareatothernon-

FQHCprovidersare100%ofFPLorbelowna9onally.(NOTE:An

individualat100%ofFPLin2013isearning$11,490annually.Afamily

offourat100%ofFPLhasahouseholdincomeof$23,550).

Race

•  66%ofhealthcenterpa9entsarewhite.

•  24%areblack.

•  5%areAsianorPacificIslander.

Youknowthehistory.Youknowtheopera=onaldifferences.Howaboutthepa=ents?



InsuranceStatus

•  36%ofhealthcenterpa9entsareuninsured.Comparably,only4%ofpa9entsseekingcareata

privatephysicianprac9ceareuninsured.

•  40%arebeneficiariesofMedicaidorStateChildHealthInsurancePrograms(CHIP).Comparably,

only13%ofpa9entsseekingcareatprivatephysicianprac9ceareMedicaidbeneficiaries

na9onally.

•  14%areprivatelyinsured.

•  8%areMedicarebeneficiaries.



AnEmphasisonEducaDonandPersonalResponsibility

•  Ifyou’reasmokerthere’sa74%greaterchancethatyou’llreceive

smokingcessa9oneduca9onatahealthcenterversusaprivate

provider.

•  Ifyou’reanasthma9cthere’sa60%greaterchancethatyou’llreceive

educa9ononhowtopersonallycontrolyourasthmaatahealth

centerversusaprivateprovider.

Howarehealthcentersmakingadifference?



AnEmphasisonIncreasedAccesstoPrevenDveCareandReducedDispariDes

•  88%ofHispanicwomenreceiveamammogramathealthcenters;thena9onalaveragefor

Hispanicwomenis66%.

•  63%ofuninsuredwomenreceiveamammogramathealthcenters;thena9onalaveragefor

uninsuredwomenis45%.

•  62%ofAfricanAmericanmenreceivecolorectalcancerscreeningsathealthcenters;thena9onal

averageforAfricanAmericanmenis44%.

•  60%ofmenonMedicaidreceivecolorectalcancerscreeningsathealthcenters;thena9onal

averageformenonMedicaid35%.

Howarehealthcentersmakingadifference?



…savingtaxpayerdollars.

•  $24billionannuallyinhealthcaresystemssavingsaccordingto

over20independentstudies.

•  Nearly$7billioninMedicaidsavingsaccordingtomul9ple

independentstudies.

…sDmulaDngeconomicgrowthintheircommuniDes.

•  In2009healthcentersgenerated$20billionineconomic

ac9vityintheirlocalcommuni9esandproducedmorethan

189,000jobs.

Anemphasisonpreven=vecareresultsinhealthcenters…


WhatDoesNACHCdoforHealthCenters?

NACHC Advocates for Health Center Interest:

NACHC has one of the most well respected and

successful legislative advocacy operations in

Washington, DC. Having built one of the strongest and

bi-partisan coalitions of legislators, NACHC enjoys

great support on Capitol Hill and in the White House

from both sides of the aisle. Following are some of

NACHC’s legislative achievements.

Andwhynotsupporttheorganiza3onthatsupportshealthcenters?



NACHCachievements:

Opera=ngGrant:Everyyear,NACHCsecuresfundingforhealthcentersthatamounts(onaverage)

to20%ofahealthcenters’overallopera9ngbudget.Withouttheseopera9ngdollars,mosthealth

centerswouldfindthemselvesindirefinancialstraits.

ExpansionoftheHealthCenterProgram:DuringtheBushadministra9oninthe1990’s,thehealth

centermovementwentthroughanunprecedentedexpansion(including$150millioninnew

opera9nggrantdollars).DuringtheObamaadministra9on,healthcenterssawanother

unprecedentedexpansionwithaone9me$15billiondollarappropria9onforsiteexpansionand

capitalimprovements.




NACHCachievements(con3nued):

FQHCDesigna=on:InsecuringtheFQHCdesigna9on,healthcentersareeligibleforenhanced

MedicaidandMedicarepaymentsinrecogni9onofthepersistentandchallengingchronichealth

condi9onsthatexistinthecommuni9estheyserveandtheenablingservicestheyprovideto

adequatelycareforthesedifficulttocareforpopula9ons.

340BDiscountPrescrip=onDrugProgram:Thisdiscountpharmacyprogramwasextendedto

includehealthcentersintheearly90s.Discountstohealthcentersare–onaverage–55%offof

wholesaleprice.




NACHCachievements(con3nued):

FederalTortClaimsAct(FTCA):ByhavingFTCAmalprac9cecoverageextendedtohealthcenters,

NACHCwasabletoeliminateamajorcostcentertohealthcenteropera9ons.

Na=onalHealthServiceCorp:Thelargestna9onalloanrepaymentprograminopera9ontoday

rewardsnewlygraduatedmedicalstudentswithfullorpar9alloanforgivenessinexchangeforthat

student’scommitmenttoworkatacommunityhealthcenter.NACHCadvocatesforrenewedand

expandedfundingforthisprogrameveryyear.

.




OtherNACHCbenefits:

ProvidesTrainingandTechnicalAssistance:

NACHCprovideshealthcentersongoing

educa9ononanyruleorregulatorychangesthat

effecttheiropera9on.Whetherthroughclass

roomtraining,conferences,webinarsorissue/

opera9onalbriefs,NACHCdeliverseduca9onina

varietyofways..


KeyWords/Phrases

The“movement”:Howmanyhealthcenterleadersdescribethehealthcenterindustry.Health

centerswereborneoutofsocialmovementthatwasPresidentLyndonJohnson’sGreatSociety.The

WaronPovertysocialmovementwasoneaspectofhisvisionofaGreatSociety.

FQHC(FederallyQualifiedHealthCenter):Itisthespecialdesigna9onawardedclinicswhosepurpose

itistoserveAmerica’sunderserved.FQHCsreceivegrantfundingandenhancedMedicaidand

Medicarepaymentsasaresultofthisdesigna9on.

Tobesuccessful,youhavetotalktheCHCTalk…


KeyWords/Phrases

PCA(PrimaryCareAssociaDon):Astateorregionalassocia9onrepresen9nghealthcenterinterestsat

thestateorregionlevel.Thereare52state/regionalprimarycareassocia9onsinopera9ontoday(i.e.,

CaliforniaPrimaryCareAssocia9on,NorthwestRegionalPrimaryCareAssocia9on,Washington

Associa9onofCommunityandMigrantHealthCenters,etc.).

BPHC(BureauofPrimaryHealthCare):Theagencyresponsibleforawardinghealthcentergrants,

providinghealthcenterleaderswithdirec9onrelatedtogovernmentregula9onandgenerally

responsibleforallthingsFQHCrelated.“TheBureau”(asit’salsoknowninthehealthcenterworld),is

adivisionoftheHealthResourcesandServicesAdministra9on(HRSA)andHealthandHumanServices

(HHS).


KeyWords/Phrases

WiththesavingsahealthcentercanachievethroughtheValueinPurchasing(ViP)program,health

centerscanenhancethelevelofserviceprovidedintheircommunity.Withthemoneysavedthrough

ViPhealthcenterscandeveloppharmacyassistanceprogramsforimpoverishedclients,hireaddi9onal

outreachand/oradministra9vestafforhireclinicalstafftoseemorepa9ents.

Forexample:

$144,789saved=1FamilyPrac9cePhysicianFTE=3,781newvisitsperyear*

$141,015saved=1PediatricPhysicianFTE=3,781newvisitsperyear*

$81,788saved=1PhysicianAssistant/NursePrac99onerFTE=2,870newvisitsperyear*

$40,000saved=1RegisteredNurseFTE=383newvisitsperyear*

*Source:NACHCHealthCenterSalary&BenefitsReport2010-2011,Na9onalDataAmerica’sHealthCentersFactSheet,2009

Savingstranslatesintoimprovedpa=entcare

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