Missouri Primary Care Association March 2011 Missouri Primary Care Association1

 Senate and House approved Continuing Resolution through April 8.  $6.1 billion in cuts ◦ $3.5 billion in program reductions ◦ $2.6 billion in earmark cuts  No funding cuts to CHCs in Continuing Resolution  Uncertainty regarding final budget and cuts – negotiations behind the scenes Missouri Primary Care Association2

 Dedicated Funding for CHCs  Total $9.5 billion for operations and expanded capacity (New Access Points, Expanded Medical Capacity, and Service Expansion)  $1.5 billion for capital improvement projects (new facilities, new equipment, renovation)  Primary Care Provider Capacity  $1.5 billion for National Health Service Corps to train, recruit and retain primary care providers to serve the underserved Missouri Primary Care Association3

 Medicaid Expansion for all individuals under 65 at or below 133% of FPL in 2014; many current sliding fee patients will be able to access Medicaid coverage  Private insurance plans in Health Insurance Exchanges will be required to contract with FQHCs and pay cost-based PPS rates. Premium and cost sharing assistance available to individuals between 133%-400% FPL Missouri Primary Care Association4

 Preventive services added to FQHC Medicare services and removal of cap on payment for Medicare visits  Funding for teaching FQHCs and FQHC-based residency programs Missouri Primary Care Association5

 Medical Home Demonstration: FQHCs become recognized as Patient-Centered Medical Homes. (BPHC Priority)  Accountable Care Organizations: Provider led organization whose members engage in joint decision making, that manages full continuum of care and is held accountable for overall costs and quality of care  FQHC providers receive Medicaid incentives for Meaningful Use of Health Information Technology Missouri Primary Care Association6

 Community Health Center model prominent – we must deliver  Focus on Becoming Providers of Choice  Anticipate increased demand for services  Patient Satisfaction with Care Experience is Critical as is Patient Retention and Outreach  Provider Recruitment and Retention is Critical Missouri Primary Care Association7

 CHCs should Pursue Patient Centered Medical Home (PCMH) Recognition  Focus on Operational Excellence, Effective and Efficient Operations  Fully Implement Electronic Medical Records (EMRs) and Participate in Health Information Exchanges (HIEs)  Improve Quality and Be Transparent  Enhance External Communications and Advocacy Missouri Primary Care Association8

 Bring Clinical, Quality, and HIT together ◦ Finish Data Warehouse to enable accurate, reliable, timely quality measures reporting ◦ Statewide Quality Improvement Effort ◦ Meaningful Use Incentives  Arcadia Solutions is consultant  Actively working with 16 of 23 FQHCs  17 measures reported for 7 FQHCs Missouri Primary Care Association9

 Operating Board Appointed by MPCA Board of Directors ◦ Clinical Provider Staff ◦ Quality Improvement Staff ◦ HIT Staff  Staffed by MPCA Center for Quality  Meets Quarterly  Determines Priorities for MOQuIN Missouri Primary Care Association10

Arcadia Solutions Proprietary & Client Confidential MPCA Strategic Vision 11 Stage 1 Stage 2 Stage 3 Adoption Quality of data equals quality of care Quality Improvement ACO/PCM H Own your data…Own your future. Meaningful Use may not achieve all of your organizational goals. Missouri Primary Care Association

 16 FQHCs participate at present  10 measures for diabetes and cardiovascular disease  Combination of reporting from patient registries, EMRs, and manual chart audits  Transitioning to use of MOQuIN data warehouse and reporting to satisfy state contract requirements Missouri Primary Care Association12

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 ARRA HITECH HIT Innovation and Implementation  Special Congressional Initiative  Missouri HIT Assistance Center Missouri Primary Care Association14

 MPCA is partner and contractor  Funding supports MPCA providing technical assistance to Health Centers to achieve Meaningful Use of HIT and receive incentive payments  No cost to Health Centers  Work is coordinated with Arcadia Solutions in tandem with MOQuIN Missouri Primary Care Association15

Arcadia Solutions Proprietary & Client Confidential 16 Meaningful Use Incentives Calendar Year First Calendar Year in which the EP Receives and Incentive Payment CY 2011CY 2012CY 2013CY 2014CY 2015CY $21, $8,500$21, $8,500 $21, $8,500 $21, $8,500 $21, *$8,500 $21, $8, $8, $8, $8, $8,500 TOTAL$63,750 Eligible professionals can receive up to $63,750 over six years. Missouri Primary Care Association

 Health Home Initiative  PRIMO Revamped  Health Insurance Exchange Legislation and Implementation Missouri Primary Care Association17

1. Ignorance is not Bliss: too many people don’t know who we are 2. Nearly 100 New Members of Congress and 80 members of the Missouri Legislature know little or nothing about Health Centers 3. State and Federal Deficit Reduction Efforts: we are now big enough to matter 4. The Appearance of Power is Power 5. Elected officials fear the voters more than ever (See #2) Missouri Primary Care Association18

◦ Grassroots advocacy is about one thing – building power. ◦ Power is not measured by the number of advocates we have on a list. ◦ Power is not measured by the number of small (or even large) victories we win every now and then. ◦ Power must be measured by our ability to successfully advance our own agenda and to make it unthinkable that any other political or special interest would ever want to take us on. Missouri Primary Care Association19

 Health Center Expectations (PIN 98-23)  FTCA (PIN 11-01)  Corporate Compliance (HIPAA)  Meaningful Use 20Missouri Primary Care Association

Community-Oriented Primary Care Foundation for CHC movement accessible first contact care, or serving as the entry point a continuous relationship with patients over time; comprehensive care coordination of care Care Model focuses on “system changes intended to guide quality improvement and disease management activities” for chronic illness. 21Missouri Primary Care Association

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Joint Principles of the Patient-Centered Medical Home Developed and Adopted March 2007  Personal Physician  Physician Directed Medical Practice  Whole Person Orientation  Care is Coordinated and/or Integrated  Quality and Safety  Enhanced Access  Payment Reform 23Missouri Primary Care Association

Centers for Medicare and Medicaid Health Resources and Services Administration: Bureau of Primary Health Care (HRSA-BPHC) All CHCs recognized by 2014 Awarded contract to National Committee for Quality Assurance (NCQA) to cover application costs Insurers-Private and Public Medical Societies Foundations 24Missouri Primary Care Association

 Provides an excellent review of the organization’s : ◦ Quality Improvement Programs ◦ Care Coordination- Both internal and external ◦ Community Linkages and access to specialty care ◦ Policies and procedures ◦ Corporate compliance ◦ Data extraction/reporting ◦ Meaningful Use of EMR 25Missouri Primary Care Association

NCQA developed a set of standards and a 3- tiered recognition process program) to assess the extent to which health care organizations are functioning as medical home Recognition requires completing an application and providing adequate documentation to show evidence that specific processes and policies are in place Recognition is offered at three levels: Level 1 – basic Level 2 – intermediate Level 3 – advanced 26Missouri Primary Care Association

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 National Committee for Quality Assurance:  The Joint Commission:  Primary Care Development Corporation of New York:  Patient-Centered Primary Care Collaborative:  Commonwealth Fund: Safety Net Medical Home Initiative:  Improving Chronic Illness Care:  American College of Physicians: 29Missouri Primary Care Association

 Susan Wilson-  Angela Herman-  Danny O’Neill- Missouri Primary Care Association 3325 Emerald Lane Jefferson City, MO (573) Missouri Primary Care Association30