Bureau of Primary Health Care Update for the South Carolina Primary Health Care Association John Cafazza Division Director Central Southeast Division U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care October 12, 2012

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 2

Health Center Program Overview Calendar Year Million Patient Visits  1,128 Grantees  8,500+ Service Sites Over 138,000 Staff  9,937 Physicians  6,934 NPs, PA, & CNMs Source: Uniform Data System, 2011, Service Sites: HRSA Electronic Handbooks 20.2 Million Patients  93% Below 200% Poverty  36% Uninsured  62% Racial/Ethnic Minorities  1,087,000 Homeless Individuals  863,000 Farmworkers  188,000 Residents of Public Housing 3

Health Center Program National Presence – May

Health Center Program Overview National Impact Source: Health Center Data: Uniform Data System, National Data: U.S. Census Bureau, 2010 Current Population Reports and Current Population Survey. 5

Health Center Program Growth: National Impact Growth from (% Increase) Patients17,122,53518,753,85819,469,46720,224,7573,102,222 (18.1%) Sites7,5187,8928,1568, (13.1%) Jobs113,059123,012131,660138,40325,344 (22.4%) Source: Uniform Data System, and HRSA Electronic Handbooks 6

Health Center Program Performance Calendar Year 2011 Among Health Center Patients: 70% entered prenatal care in the first trimester 7.4% low birthweight rate continues to be lower than national estimates (8.2%) 44% of children received all recommended immunizations by 2 nd birthday 63% of hypertensive patients with blood pressure ≤ 140/90 71% of diabetic patients with HbA1c ≤ 9 $654 total cost per patient $144 cost per medical visit For more information: Source: Uniform Data System, National Birthweight Data: Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for National vital statistics reports web release; vol 60 no 2. Hyattsville, MD: National Center for Health Statistics

o Over 80% reported the overall quality of services received at the health center were “excellent” or “very good.” o Over 80% reported that they were “very likely” to refer friends and relatives to the health center. o Over 75% reported the main reason for “going to the health center for healthcare instead of someplace else” was because it was convenient (28%), affordable (25%), and provided quality healthcare (22%). Health Center Performance 2009 Health Center Patient Survey 8

South Carolina Health Centers Calendar Year 2011 South Carolina Health Center Grantees In 2011, 20 Health Centers served 326,829 patients: 39.7% were uninsured 93.9% were at or below 200% of poverty 61.2% Female 58.7% nationally 30.6% Children < age 18 32% nationally 9.1% Seniors age % nationally Served by (FTEs): – Physicians – Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives 9 Source: Uniform Data System, 2011

South Carolina Health Centers Calendar Year Fiscal Year 2012 PERFORMANCE Among South Carolina Health Center Patients: 59.0% entered prenatal care in the 1 st trimester 8.2% rate of low birth weight 49.5% of children have received all recommended immunizations by second birthday 71.2% of diabetic patients with HbA1c ≤ % of hypertensive patients with blood pressure ≤ 140/90 $570 total cost per patient $159 cost per visit FUNDING 10 Source: Uniform Data System, 2011 and HRSA Electronic Handbooks $51.3 M base operational grants (FY ‘12) $19.6 M New ACA grants $ 2.9 M – New Access Points $ 0.2 M – HIV Supplemental Funding $14.4 M – Capital Development – Building Capacity Grant $ 1.6 M – Capital Development – Immediate Facility Improvement Grant $ 0.5 M – School Based Health Center Capital Grant

Primary Health Care Our Focus Primary Health Care/ Public Health Leadership Performance Improvement: - Outreach/Quality of Care - Health Outcomes/Disparities - Cost/Financial Viability Program Requirements: - Need - Services - Management and Finance - Governance 11

Primary Health Care 2012 Strategic Priorities –Grantee Satisfaction BPHC External Technical Assistance & Training Strategy –Employee Satisfaction BPHC Internal Staff Training & Development –Timeliness/Quality Service Area Definition & Program Collaboration –Impact Quality Strategy (includes Meaningful Use & Patient-Centered Medical Home) Recovery Act Projects Close-Out 12

13 National Priority Training and Technical Assistance Support Areas Note: Multi-select. Percents will not add to 100. What additional TA resources or tools would enhance the performance of your organization?

Current Program Impact: Key National Indicators % of Health Centers with EHR Implementation (UDS 2011)  65% have EHRs at all sites used by all providers  15% have EHRs at some sites used by some providers % of Health Centers Achieving Patient-Centered Medical Home Recognition (as of Septebmer 1, 2012)  28% of all health centers are participating in Patient-Centered Medical Health Home Initiatives (PCMHHI)  11% have achieved Patient-Centered Medical Home (PCMH) recognition % of Health Center Meeting/Exceeding Healthy People 2020 Goals (UDS 2011)  57% Meet/Exceed Hypertension Control Goal of 61%  10% Meet/Exceed Diabetes Control (HbA1c ≤9) Goal of 85%  36% Meet/Exceed Early Entry into Prenatal Care Goal of 78%  61% Meet/Exceed Low Birthweight Goal of 7.8% 14

Current Program Impact: Key South Carolina Indicators % of Health Centers with EHR Implementation (UDS 2011)  47% have EHRs at all sites used by all providers  16% have EHRs at some sites used by some providers % of Health Centers Achieving Patient-Centered Medical Home Recognition (as of September 1, 2012)  47% of South Carolina State health centers are participating in Patient- Centered Medical Health Home Initiatives (PCMHHI)  0% have achieved Patient-Centered Medical Home (PCMH) recognition % of Health Centers Meeting/Exceeding Healthy People 2020 Goals (UDS 2011)  50% meet/exceed hypertension control goal of 61%  0% meet/exceed diabetes control (HbA1c ≤9) goal of 85%  8% meet/exceed early entry into prenatal care goal of 78%  42% meet/exceed low birthweight goal of 7.8% 15

Source: Uniform Data System, 2011 Percentage of EHR Adoption by State UDS

Health Center EHR Adoption National and South Carolina, UDS 2011 Source: Uniform Data System, Goal: 50% of Health Centers use EHR at All Sites

HRSA, BPHC, Central Southeast Division (June 2012) South Carolina EHR Adoption UDS 2011 Data

Impact-BPHC Quality Strategy 1.Implementation of QI/QA Systems All Health Centers fully implement their QI/QA plans 2.Adoption and Meaningful Use of EHRs All Health Centers implement EHRs across all sites & providers 3.Patient-Centered Medical Home Recognition All Health Centers receive PCMH recognition 4.Improving Clinical Outcomes All Health Centers meet/exceed HP2020 goals on at least one UDS clinical measure 5.Workforce/Team-Based Care All Health Centers are employers/providers of choice and support team-based care Priorities & Goals ACCESS COMPREHENSIVE SERVICES INTEGRATED SERVICES INTEGRATED HEALTH SYSTEM Better Care ⃘ Healthy People & Communities ⃘ Affordable Care 1.Programs/Policies 2.Funding 3.Technical Assistance 4.Data/Information 5.Partnerships/Collaboration Strategy Implementation 19

Patient-Centered Medical Health Home Initiative Accreditation Initiative PCMH supplemental grant funds Partnership with the CMS Primary Care Demonstration 20 HRSA’s PCMH Investments

Demonstrates the quality of care provided in health centers and provides opportunity for continuous quality improvement. Positions health centers at an advantage for the changing health care landscape. Invests in the health center workforce resulting in reduced staff turnover and improved recruitment. Transforms patient care to help health centers achieve the three part aim of: Better care, Better health and communities, and Affordable care. Federal DHHS Priority o Goal: 13% of health centers PCMH recognized by 9/30/2012 o Goal: 25% of health centers PCMH recognized by 9/30/ Why PCMH?

Patient-Centered Medical/ Health Home Initiative (PCMHHI) Encourages and supports health centers to transform their practices and participate in the PCMHH recognition process to: –improve the quality of care and outcomes for health center populations; –increase access; and –provide care in a cost effective manner. HRSA/BPHC will cover recognition process fees and provide technical assistance resources for practice transformation. Participation is strongly encouraged and provides an opportunity for health centers to achieve PCMH recognition. For further information on the PCMHH Initiative: PCMHH Initiative PAL: BPHC Helpline: or BPHC PCMHH 22

23 Alignment of Health Center Program Requirements with PCMH Domains Section 330 Program RequirementNCQA PCMH Domain 1.Needs Assessment Identify and Manage Patient Populations 2.Required and Additional Services: Primary, preventive and enabling services Provide Self-Care Support and Community Resources 4.Accessible Hours of Operation/Locations 5.After Hours Coverage Enhance Access and Continuity 6.Hospital Admitting Privileges and Continuum of Care Plan and Manage Care 7.Quality Improvement/Assurance Plan Measure and Improve Performance 11.Collaborative Relationships 15.Program Data Reporting System Track & Coordinate Care Alignment of Health Center Requirements with PCMH Domains

FY 2011 PCMH Supplemental Funding Domains of Focus South Carolina Health Centers Enhance Access & Continuity Identify & Manage Patient Populations Plan and Manage Care Provide Self‐Care Support and Community Resources Track & Coordinate Care Measure and Improve Performance

2012 Health Center PCMH Recognition National and South Carolina Data as of September 1, 2012 PCMH Recognized Includes: NCQA, Joint Commission, and AAAHC 2012 Goal: 13% of Health Centers Recognized as PCMH

PCMH Resources PCMH Comparison Chart – cies/pcmhrecognition.pdfhttp://bphc.hrsa.gov/policiesregulations/poli cies/pcmhrecognition.pdf Fact Sheet: Quality Improvement Initiatives Available to HRSA Supported Health Centers – cies/qioverview.pdfhttp://bphc.hrsa.gov/policiesregulations/poli cies/qioverview.pdf 26

2011 National and South Carolina Health Center Performance and Healthy People 2020 Goals Goal: 10+% of Health Centers Meet or Exceed HP 2020 Goals Source: 2011 UDS and Healthy People 2020

28 HRSA, BPHC, Central Southeast Division (June 2012) South Carolina: Hypertensive Patients with Blood Pressure < 140/90 UDS 2011 Data for Federally-Support Health Centers

29 HRSA, BPHC, Central Southeast Division (June 2012) South Carolina: Diabetic Patients with HbA1c ≤ 9% UDS 2011 Data for Federally-Supported Health Centers

Policy Updates 30

Recently Released Final Policies Approved Uniform Data System Changes for 2012 CY 2013 Requirements for Federal Tort Claims Act (FTCA) Medical Malpractice Coverage for Health Centers Sites, Scope of Project, and Capital Projects Process for Becoming Eligible for Medicare Reimbursement under the FQHC Benefit Health Center Collaboration FTCA Health Center Policy Manual HRSA Patient-Centered Medical/Health Home Initiative HIV/AIDS Care and Treatment in Health Centers To Access these and other policies, visit: 31

Initiating and Maintaining Medicare FQHC Reimbursement CMS requires ALL permanent and seasonal sites within a health center’s approved scope of project to be enrolled INDIVIDUALLY in Medicare. Each site must also indicate its unique Medicare Billing Number (also known as a PTAN or CCN) on claims for all services rendered at that site. Please ensure that your health center has all of its correct Medicare Billings Numbers listed in EHB as soon as possible, for each of their permanent and seasonal sites. For more information about the requirements and process for enrolling sites in Medicare, review PAL

Anticipated Policy Topics DRAFT Sliding Fee Discount Program Policy –Released July 10, 2012 for Public Comment –Comments due to HRSA by September 28, 2012 DRAFT Sub-Recipients/Sub-Contracts DRAFT Quality Improvement/Assurance Draft policies open for comments are posted at:

Funding Updates 34

Fiscal Year 2013 Spending Plan o $19 Million for Health Center New Access Points (25 awards) o $20 million for Health Center Controlled Networks (~25 to 30 Awards) o $75 Million for School-Based Health Center Capital program (~150 awards) 35

Fiscal Year 2013 Continuation Funding Opportunities Health Centers: –FY 2013 Budget Period Progress Report (BPR) Technical Assistance: –FY 2013 Service Area Competition (SAC) Technical Assistance: Cooperative Agreements: –National –State/Regional Primary Care Associations 36

Fiscal Year 2012 Primary Care Association Requirements Statewide/Regional Health Center T/TA Activities A. Program Requirements Goal: % of Health Centers with No Program Conditions T/TA Focus Areas: Need Services – QI/QA Systems Management and Finance – Fiscal Operations/Systems Management and Finance – Workforce Recruitment and Retention Governance B. Performance Improvement Goals: % of Health Centers that Meet/Exceed Healthy People 2020 Goals on One or More Clinical Performance Measures % of Health Centers with PCMH Recognition % of Health Centers with Cost Increase Less than National Average % of Health Centers Financially Strong (No Going Concern Issues) T/TA Focus Areas: Clinical Performance Measures Financial Performance Measures 37

Fiscal Year 2012 Primary Care Association Requirements Statewide/Regional Program Assistance Workplan o Information on Available Resources o Annual T/TA Needs Assessment o Special Populations o Collaboration o Emergency Preparedness o Regional/Statewide Surveillance Analysis o Newly Funded Health Centers 38

Quality and Data Updates 39

FTCA Program FTCA Health Center Policy Manual o Primary source for information on FTCA grantees and related stakeholders o Consolidates, clarifies and synthesizes existing FTCA policy documents and statutory language Available at: Application Review/Deeming in EHB o 2013 Requirements for FTCA Deeming available in PAL : o For Programmatic of Technical TA on FTCA contact: Phone: 40

Technical Assistance Resources 41

Technical Assistance (TA) Resources National and state-based support for training and technical assistance: o National Cooperative Agreements o State/Regional Primary Care Associations o State Primary Care Offices Federal TA Support: o Project Officer o TA Calls/Trainings o Onsite Consultant Support o BPHC TA Website-New Search Engine Feature Added For more information visit the BPHC TA Website:

Bureau of Primary Health Care Help Line Single point of contact to assist grantees and stakeholders with information in the following areas: BHCMIS – System in EHB (Electronic Handbook) Health Center Quarterly Reporting (HCQR)/ARRA 1512 Reporting Uniform Data System (UDS) Federal Torts Claims Act (FTCA) for Health Centers and Free Clinics Phone: BPHC (2742) Available Monday to Friday (excluding Federal holidays), from 8:30 AM – 5:30 PM (ET), with extra hours available during high volume periods. 43

UDS Website: o Data analysis tools o Data download functionality UDS Grantee/State/National Summaries Health Center Trend Reports State and National Roll-up Reports Reporting and Training Resources UDS Mapper: HRSA has developed a mapping and support tool driven primarily from data within the UDS Webinar trainings on using Mapper functionality available: UDS Web Tools 44

ECRI risk management and patient safety resources are available to Health Center Program grantees and Free Clinics. Resources include: –Risk management courses –Continuing medical education (CME) credits at no cost to health care providers –Links to archived audio-conferences/webinars to supplement evidence-based risk management training –Guidance articles, self-assessment tools, ready-made training materials on patient safety, quality and risk management for the health center and free clinic setting –Risk & Safety E-news Visit: Risk Management and Patient Safety Web Resources 45

All Health Centers and Primary Care Associations are encouraged to explore and participate in the following key HHS public health initiatives: National Quality Strategy HHS Action Plan to Reduce Racial and Ethnic Health Disparities National Prevention Strategy National HIV/AIDS Strategy Primary Health Care and Public Health Leadership 46

National Oral Health Initiatives Behavioral Health Initiatives Healthy Weight Collaborative Million Hearts Campaign Text4baby Viral Hepatitis Initiative Primary Health Care and Public Health Leadership 47

John Cafazza Director, Central Southeast Division U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care 5600 Fishers Lane Rm. PKLN/17-61 Rockville, MD Telephone:

Thank You! Questions? 49