Insure the Uninsured Project 19 th Annual Conference Sacramento Convention Center February 17, 2015 James W. Hunt, Jr., PhD President & CEO Changing Our Stripes: Health Centers & Health Care Reform

49 Community Health Centers 300+ sites reflect medical, dental, behavioral health, school-based and social services 889,000 patients (MA population: 6.6 million) Provide a broad range of primary & preventive care, including dental, eye and mental health care and other community-based services All 49 health centers have either purchased, implemented or are in the process of implementing a certified EHR; all preparing for Meaningful Use Support more than 18,000 jobs and generate a total economic impact exceeding $2 billion Viewed as Savings Generators not Cost Drivers 37 FQHCs have adopted a class- based rate for Medicaid & a negotiated class-based rate for subsidized plans (ConnectorCare) 2 Massachusetts Community Health Centers

Early Growth Under State Health Reform An Archives of Internal Medicine study found that Massachusetts’ federally-funded health centers saw a 31% increase (134,000) in patients between 2005 and 2009, even as growing numbers of residents obtained coverage under Chapter 58, our state’s health reform law. Reasons cited by patients: Convenience Affordability Non-medical services Multilingual providers Welcome all regardless of payment source

ALL CENTERS Total Increase Total Percentage Increase Patients 594,000889,000295, % Massachusetts Health Centers Growth in Patients, Continued Growth Under State & Federal

Uninsured: As Percentage of Total Patients MA Health Centers Uninsured Patients 32.7%18.7% Caveat: Although the percentage of health center patients who are uninsured has declined, the total number of uninsured patients at health centers has increased. What’s more, the highest concentration of Massachusetts’ uninsured residents continue to receive care through the state’s community health centers.

Patients By Coverage * Massachusetts Community Health Centers Coverage TypePercentage of Total Patients Medicaid41.4% (40% pre-reform) Subsidized10.5% ( new coverage ) Medicare9.7% Private19.6% Uninsured18.7% (32.7% pre-reform) 90% of Massachusetts health center patients fall below 200% of the federal poverty guidelines, with 36.7% better served in another language * Based on 2013 UDS

Patients By Race, Ethnicity * Massachusetts Community Health Centers Patient Race, EthnicityPercentage of Total Patients By Race White48.6% Black, African-American16.9% Asian9.4% More than one4.6% By Ethnicity Hispanic32.1% * Based on 2013 UDS

National Health Care Reform “ Health care must be a right for all rather than the privilege of a few.”

What Are the Issues? Fair payment Disruptive policy Workforce P ublic-private partnerships Continuing uninsured Readiness…

Risk Readiness Readiness What is it? How is it measured? What is the “secret sauce” that gets you to the table?

Quality What about value-based incentives? Is the Primary Care Medical Home THE ANSWER? Retail health care anyone? How important is customer service?

Influencers of Payment Reform What constituencies wield the most influence in California? Providers? Insurers? Consumers? Employers? Labor? Government?

Reflections from Massachusetts Complexity of managing vulnerable patients Need for real-time medical expense & claims data MCO participation, Alternative Payment & PCPRI ACO & integrated system needs Fair Rates Promotion of PCMH Value over Volume