Meeting New Challenges in Health Center Board Governance Tess - PowerPoint PPT Presentation

Meeting New Challenges in Health Center Board Governance Tess Kuenning, CSN, MS, RN President and Chief Executive Officer Bi-State Primary Care Association David Reynolds, DrPH Health Policy Analyst and Founder of Vermont’s First Federally Qualified Health Center

Session Description and Learning Objectives Community boards need to be well informed in order to oversee and  make key decisions as state and national health care reform efforts continue to unfold It is imperative boards have knowledge of these emerging changes  Session learning objectives  Understand key state and national reform efforts that affect your role as a – board member Understand where to find resources that will support your understanding of – the legal, administrative, financial and clinical requirements of the Community Health Center program Understand the emerging trends in board responsibilities within the context – of health care reform Bi- State Primary Care Association’s 2014 Primary Care Conference ~ May 13, 2014

Agenda Session description and learning objectives  Overview of the Bureau of Primary Health Care (BPHC) and National  Association of Community Health Center (NACHC) resources and updates as it relates to Health Center boards Overview of national health care reform  Overview of VT and NH state health care reform and its relationship  to primary care and the board’s role Putting the pieces together and meeting the challenges for both  states Conversation about what you have heard: Q&A  Wrap up and session evaluation  Bi- State Primary Care Association’s 2014 Primary Care Conference ~ May 13, 2014

Primary Care Delivery: Vehicle for Services Bi- State Primary Care Association’s 2014 Primary Care Conference ~ May 13, 2014

BPHC: Board Governance Expectations  PIN 2014-01: Health Center Program Governance  Governance requirements (PIN 2014-01) – Governance requirements for Health Centers have been set forth in statute, regulations and through various HRSA policies – PIN 2014- 01 clarifies HRSA’s policies in implementing the statutory and regulatory governance requirements of the Health Center program – Must demonstrate the establishment of an independent governing board that assumes full authority and oversight responsibility for the Health Center Bi- State Primary Care Association’s 2014 Primary Care Conference ~ May 13, 2014

BPHC: Board Governance Expectations  Statutory governance (PIN 2014-01) – Governing board size – Board composition – Organization/corporate bylaws – Board authority, functions and responsibilities  General board oversight – Duty of care – Duty of loyalty (conflict of interest) – Duty of obedience Bi- State Primary Care Association’s 2014 Primary Care Conference ~ May 13, 2014

BPHC: Board Governance Expectations  Additional considerations for Health Center governance All Health Centers with existing affiliation agreements or considering new – affiliation agreements should examine their arrangements to assure their governing board remains in compliance with all governance requirements described in the PIN  Examples include: Mergers – Acquisitions – Parent-subsidiary arrangements – Subrecipient arrangements – Contracts for a substantial portion of the project – Bi- State Primary Care Association’s 2014 Primary Care Conference ~ May 13, 2014

BPHC: 19 Program Requirements Services: Need:   Required and additional services Needs assessment – – Staffing requirements – Management and Finance:  Accessible hours of – Key management staff – operation/locations Contractual/affiliation agreements – After hours coverage – Collaborative relationships – Hospital admitting privileges and – Financial management and control – continuum of care policies Sliding fee discounts – Billing and collections – Quality improvement/assurance plan – Budget – Governance:  Program data reporting systems – Board authority – Scope of project – Board composition – Conflict of interest policy – Bi- State Primary Care Association’s 2014 Primary Care Conference ~ May 13, 2014

BPHC: Operational Site Visit (OSV)  Objective assessment and verification of Health Center compliance with statutory and regulatory requirements  Review of administration, governance, fiscal and clinical programs  Review of progress on clinical and financial performance  Assistance with areas of non-compliance  Assistance with identification and implementation of best practices  At least once per project period or at least once every 3 years Bi- State Primary Care Association’s 2014 Primary Care Conference ~ May 13, 2014

Board Resource Guide National Association of Community US DHHS/HRSA/BPHC/Resources   Health Centers Resources Health Center Program Board – Governance (PIN 2014-01) Health Center Program Governance – 19 Program Requirements Requirements: Governing Board – Responsibilities and How to Do Them Operational Site Visit Guide – Health Center Board Education Video – Governing Board Handbook – Series: Discussion and Resource Guide Other Resources  Health Center Advocacy: Legal Do’s and – Supercircular (OMB condensed Circulars) – Don’ts Federally Qualified Health Center (FQHC) – Health Center Program Governance – Frequently Asked Questions Series: Information Bulletins #1-19 Community Health Centers: A Movement – Managed Care Handbook: A Practical – and the People Who Made It Happen Guide for Health Centers Community Health Forum: Moving – Collaborative Arrangements: A Guide for – Behavioral Health into the Mainstream of Health Centers and Their Partners Primary Care Bi- State Primary Care Association’s 2014 Primary Care Conference ~ May 13, 2014

We Know the Health Care “ System ” Is Not Monolithic It’s MANY M A It’s not N MANY Y THE HEALTH CARE HEALTH CARE SYSTEM SYSTEMS Bi- State Primary Care Association’s 2014 Primary Care Conference ~ May 13, 2014

Actually, It ’ s Worse: It ’ s Many Overlapping Systems It’s MANY MANY M A N MANY MANY Y HEALTH CARE SYSTEMS Bi- State Primary Care Association’s 2014 Primary Care Conference ~ May 13, 2014

The Health Care Conundrum  Abundant need for change: – National uninsured rates ranging 45-55 million – Exploding health care costs – US GDP 17% vs. 8-10% major industrialized nations – Insurance premiums too expensive/rising faster than earnings – Employer sponsored insurance: Most insurance is from employer; loss of job=loss of insurance – Lack of affordability of premiums, deductibles, co-pays, co- insurance, out-of-pocket expenses Bi- State Primary Care Association’s 2014 Primary Care Conference ~ May 13, 2014

The Health Care Conundrum: What Needs to Change? Invest in primary and preventive health care  Assure affordability to see a provider  Coordinate care (primary care, dental, nutrition, transportation,  translation; one-stop shopping; get the right care at the right prices at the right time) Avoid unnecessary treatment or hospitalization; avoid unnecessary  emergency room use Pay for value/outcomes instead of volume/visits  Use technologies (Electronic Health Record (EHR); analytics to evaluate  claims and EHR) Affordable, low-cost prescription drugs  Assure carriers increase resources for patient care vs. high profits  Bi- State Primary Care Association’s 2014 Primary Care Conference ~ May 13, 2014

Affordable Care Act (ACA): Timeline Overview 2011: Patient Bill of Rights and Medicare free preventive services and receive 50%  discount on brand name drugs in the Medicare “donut hole” 2011: New Center for Medicare and Medicaid Innovation to improve health care  quality and efficiency 2012: Accountable Care Organization (ACO) providers work together in integrated  health care systems 2012: Standardize billing and use of EHR and Meaningful Use  2013: Pay Medicaid at parity with Medicare (2 years; primary care only)  2013: Expand Medicaid to 138% FPL  2013: Open enrollment in Health Insurance Marketplace began October 1; offer tax  credits 100-400% FPL and small business tax credit 2014: Access to affordable health insurance options on Marketplace; individual  mandate/shared responsibility or pay penalty 2015: Pay physicians based on value, not volume; pay for quality  Bi- State Primary Care Association’s 2014 Primary Care Conference ~ May 13, 2014

ACA: Investments in the National Health Service Corps National Health Service Corps Funding, 2011-2015 LOSS ANTICIPATED from LOSS/GAIN ACTUAL Fiscal Year Trust Fund Discretionary Funding Total Annual Anticipated from FY to Received Funding (est.) to Actual FY (+/-) (+/-) FY2010 NA $142 million NA $142 million NA NA FY2011 $290 million $142 million $25 million $432 million $315 million ($117 $173 million million) FY2012 $295 million $142 million $5 million $437 million $300 million ($137 ($15 million) million) FY2013 $300 million $142 million $0 $442 million $300 million ($158 ($16 million) $284 million million) 1 FY2014 $305 million $142 million $0 $447 million $289 million ($158 $5 million 2 million) FY2015 $310 million $142 million $452 million Bi- State Primary Care Association’s 2014 Primary Care Conference ~ May 13, 2014