1 Primary Health Care Update November 18, 2008 Jim Macrae Associate Administrator U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care National Association of Community Health Centers 26 th Annual State/Regional Primary Care Association Conference

22 Primary Health Care Mission Improve the health of the Nation’s underserved communities and vulnerable populations by assuring access to comprehensive, culturally competent, quality primary health care services

Health Center Program Overview Calendar Year Million Patient Visits  1,076 Grantees - 53% rural  7,000+ Service Sites Over 100,000 Staff  8,000 Physicians  4,700 NPs, PA, & CNMs Source: Uniform Data System, Million Patients (1 in 20)  91% Below 200% poverty (1 in 7)  39% Uninsured (1 in 8)  930,589 Homeless Individuals  826,977 Migrant/Seasonal Farmworkers  133,518 Residents of Public Housing Health Centers Serve All Ages

Our Focus Primary Health Care/ Public Health Leadership Performance Improvement: - Outreach /Quality of Care - Health Outcomes/Disparities - Financial Viability/Costs Program Requirements: - Need - Services - Management and Finance - Governance

55 Key Health Center Program Requirements  Need Needs Assessment Shortage Area/Population Designation  Services Full Range of Primary Care/Enabling Services Core Staffing Accessible Hours/Location After Hours Coverage Hospital Admitting Privileges/Continuum of Care Sliding Fee Discounts Quality Improvement/Assurance Plan

66 Key Health Center Program Requirements  Management and Finance Key Management Staff Contractual/Affiliation Agreements Collaborative Relationships Financial Management and Control Policies Billing and Collections Systems Budget Program Data Reporting Systems Service Level – Scope of Project  Governance Board Authority Board Composition, including Patient Majority Conflict of Interest Policy

7 Forthcoming Policy Information Notices Target Population (Fall 2008) Specialty Care (Fall 2008) FQHC Look-Alike Application (Draft Out for Comment) Institutional Care (Draft for Comment: Fall 2008) Governance (Draft for Comment: Fall 2008) FTCA (Draft for Comment: Winter 2008)

88 FY 2009 Health Center Funding Opportunities  Behavioral Health Service Expansion  Oral Health Service Expansion  Pharmacy Service Expansion  Enabling Services for Special Populations  Planning Grants  Health Information Technology Grants

99 Key Health Center Program Performance Measures/Impact  Outreach/Quality of Care Entry into Prenatal Care Childhood Immunizations PAP Tests  Health Outcomes/Disparities Low Birth Weight Blood Pressure Control Diabetes Control  Financial Viability/Costs Total Cost per Patient Medical Cost per Medical Encounter Change in Net Assets to Expense Ratio Working Capital to Monthly Expense Ratio Long Term Debt to Equity Ratio

Health Center Trends

11 Program Effectiveness  Health Care Quality Studies  Patient Satisfaction Survey  Balanced Scorecard/Dashboard Grantee Satisfaction Staff Satisfaction Quality/Timeliness Impact/Assistance  Program Requirements  Performance Improvement  Primary Health Care/Public Health Leadership

12 Primary Health Care/Public Health Leadership  Workforce  Medical/Health Home  Health Disparities/Evidence-Based Care  Health Information Technology  Medicaid/SCHIP/Medicare  Patient Safety and Pharmacy Collaborative  Integration of Primary Care and Behavioral Health  Oral Health  HIV/AIDS  TB & Hepatitis C  Comprehensive Cancer Control  Veteran’s Care

13 Questions?

Jim Macrae Associate Administrator U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care 5600 Fishers Lane Rm Rockville, MD Telephone: