An Introduction to MPCA and Federally Qualified Health Centers~ - PowerPoint PPT Presentation

An Introduction to MPCA and Federally Qualified Health Centers~ Partners for Quality Care AIM Partnership Forum June 5, 2014 Lynda C. Meade, MPA Director of Clinical Services Michigan Primary Care Association www.mpca.net

Overview  Michigan Primary Care Association  Michigan Health Centers  Clinical services  Health status of health center patients  The Affordable Care Act and Health Centers

Who Is MPCA ?  Michigan Primary Care Association  Membership Association  Governed by a Board of Directors  Receives grants and contracts from state and federal agencies  Supports and advocates for expansion of primary care in underserved communities  Provided technical assistance and services across a full spectrum of topics/interests 54 Primary Care Associations nationwide

Who are the FQHCs?  Federally Qualified Health Centers (FQHC) is used as an umbrella term for a number of safety-net programs and refers to how they are reimbursed by Medicaid ◦ HRSA’s Primary Health Care Programs have their roots in the Migrant Health Act of 1962 and the Economic Opportunity Act of 1964, ◦ Program began in 1965 under President Johnson’s War on Poverty ◦ First Michigan Health Center: Baldwin Family Health Care has been in operation since 1967 ◦ Located in medically underserved communities and/or underserved population

38 Health Centers provide care for more than 600 ,000 residents at over 230 delivery sites across Michigan

Specialty Care in Michigan  Migrant/Seasonal Farmworkers Health ◦ 5 designated agencies ◦ 94,167 MSWF and nonworkers (2013) ◦ 16,112 served in M/CHC in 2012  Homeless Health ◦ 12 designated agencies ◦ 93,982 Homeless in Michigan (2011) ◦ 21,545 served in CHCs in 2012 (increase of 38 % from 2011)  Public Housing ◦ 2 designated agencies  Indian Health Services (2 sites/12 tribes)  Schoolbased 21,623 served  Veterans 9,952+ served  HIV/AIDS (2 Ryan White Clinics)

âÇ|Öâx Health Centers are Health Centers are The fundamental principles on which they were established over 45 years ago set them apart from other providers of health care: Located in or serve medically Located in or serve medically underserved areas or populations underserved areas or populations Provide comprehensive primary health care Provide comprehensive primary health care services as well as support services that services as well as support services that promote access to health care promote access to health care Provide services available to all with fees Provide services available to all with fees adjusted based on ability to pay adjusted based on ability to pay Governed by a community board composed of Governed by a community board composed of 51 percent or more of Health Center patients 51 percent or more of Health Center patients who represent the population served who represent the population served Meet strict performance and accountability Meet strict performance and accountability requirements regarding administrative, requirements regarding administrative, clinical, and financial operations as clinical, and financial operations as established by the federal government established by the federal government

Michigan Health Center Patients 550,000 546,245 525,000 500,000 475,000 462,31 450,000 2007 2008 2009 2010 2011 Michigan UDS 2011

Patients by Age - Statewide 65 and Under 5, Older, 6.3% 10.9% 5 to 12, 16.6% 25 to 64, 13 to 17, 48.3% 8.3% 18 to 24, 9.6%

Patients by Insurance Status - Statewide Percentage of T otal Medicaid/CHIP 45.4% Uninsured 31.8% Private 13.4% Medicare 9.2% Other Public 0.2% Michigan UDS 2012

Patients by Ethnicity- Statewide Percentage of T otal Non-Hispanic/Latino 85.6% Hispanic/Latino 14.4%

Health Center Staffing Practitioner Type Number of FTEs Physician 230 Mid-Level 190 Nurse 305 Dentist 107 Mental Health 80 Enabling 272 230 272 Physician Mid-Level Nurse 80 190 Dentist Mental Health 107 Enabling 305 * Total does not include FQHC Look- Alikes.

Health Center Patients *  13,000 With Asthma  Nearly 30,000 With Diabetes  Over 48,000 With Hypertension  Additional 7,000 with Heart Disease  Additional 6,500 with Chronic Bronchitis and Emphysema  20,000 Diagnosed With Depression, 12,000 With Anxiety Disorder  45,000 Required Restorative Dental, Nearly 40,000 Oral Surgery * 2012

[xtÄà{ vtÜx Increased Access to Increased Access to Today more than 600,000 Michigan residents rely on a Health Center as their health care home—including individuals who are low income, uninsured, underinsured, elderly, minority, migrant and seasonal farmworkers, homeless, and those living with HIV/AIDS.

FQHC Growth Strategies  New Access Points  Expanded Medical Capacity  Service Expansion  Change in Scope  Facility Expansion  Enabling Services  Collaboration & Partnerships

THE AFFORDABLE CARE ACT AND HEALTH CENTERS

The Need for Health Centers Post- ACA  Today, approximately 1,200 Health Centers operate nearly 9,000 service delivery sites across the country ◦ More than 22 million people access comprehensive health care services at Health Centers, regardless of income level or insurance status  Projected 30 million individuals will gain insurance through the Marketplace and Medicaid under ACA

Health Centers and the ACA  Having an insurance card does NOT ensure access to care  Despite passage of the ACA and Medicaid expansion, many individuals will remain uninsured ◦ Health Centers will continue to play an important role as safety net providers for those remaining uninsured

CHC Expansion  $11 billion for new Health Center Program Expansion FY2011-2015 ◦ $9.5 billion to expand operational capacity ◦ $1.5 billion in funding to begin to meet capital needs  Michigan received 9 New Access Point Awards (NAP) in 2013 that will serve 42,000 new patients ◦ Funding opportunities for service expansion available now

Coverage Expansion Medicaid Expansion through the Healthy Michigan Plan: Potential 500K new Medicaid patients of which over 100K are Health Center patients Insurance Marketplace: Requires that health centers receive fair reimbursement from insurers offering plans through the new health insurance exchanges

Health Centers and the ACA  Health Centers are economic engines in the communities they operate ◦ Source of stable employment and job training for residents ◦ Engage in capital development projects that often act as catalysts for economic revitalization  Proven track record of educating community members about overall health, health care services, and insurance

Comprehensive care • Patient Centered • Coordinated Care • Accessible Services • Quality and Safety •

Health Information Technology  Electronic Health Records  Patient Registry  Patient Management System  Meaningful Use  T elemedicine/mobile health  Outreach and enrollment (CMS Innovation) 33 of 36 (92%) health centers have EHR  Nationally 90% of Health Centers have EHRs (Others 72%)  12 of 36 refer dental services out  66% of agency have EDR if offering oral health services  HIT Critical to cost, experience and quality in truly transformed health care!!

Quality, Cost, Patient Experience  Health care triple aim  Healthy People 2020 driven goals  Payment based on health status and outcomes is here now!  Management of data critical  Health status is a team sport and everyone plays a role  Innovation is a must…..

What is the PCMH?  A PCMH puts patients at the center of the health care system, and provides primary care that is “accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.” (American Academy of Pediatrics)

Joint Principles of the PCMH  Adopted by AAFP, ACP, AAP, AOA: ◦ Personal Physician ◦ Physician Directed Medical Practice ◦ Whole Person Orientation ◦ Care is Coordinated and Integrated ◦ Quality and Safety are Hallmarks ◦ Enhanced Access ◦ Payment Reform

Status of PCMH in Michigan Health Centers 100% 100% 90% 80% 70% 60% 50% 50% 40% 40% 30% 20% 10% 0% HRSA Goal by 2017 All Health Centers Status Health Centers Status in in U.S. Michigan Note: Based on 36 Health centers (excluded New starts)

Measurement  Alignment:  Healthy People 2020  HEDIS  HRSA Clinical Core Measures  Guidelines  MQIC

Uniform Data System & HP2020 Percent of Percent Percent of Percent of Percent of Percent Percent Adolescent Percent Percent Percent Patients Who Adult Patients with Patients with Percent Low Patients with Percent Females Patients with Patients with Patients with Patients Received Patients with Acceptable Appropriate Birth Weight Prenatal Care Immunized Screened for weight controlled Controlled Assessed for Tobacco BMI Charted Asthma Sceening for Babies in 1st Children Cervical counseling Hypertension Diabetes Tobacco Use Cessation and Follow Treatment Colorectal Trimester Cancer and BMI Intervention Up Plan Cancer Documented 74.00% 72.00% 70.00% 68.00% MICHIGAN FQHC AVERAGE NATIONAL FQHC AVERAGE 66.00% 64.00% 62.00% 60.00% Percent of Patients with Acceptable Asthma Treatment Plan