america’s health centers: yesterday, today and tomorrow
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America’s Health Centers: Yesterday, Today and Tomorrow. Presentation to 2006 Fall Conference Minnesota Association of CHCs Dan Hawkins National Association of Community Health Centers October 12, 2006. First, A Quick Check (-up). How many have 3+ years with CHCs? - PowerPoint PPT PresentationTRANSCRIPT
America’s Health Centers:Yesterday, Today and Tomorrow
Presentation to 2006 Fall ConferenceMinnesota Association of CHCs
Dan HawkinsNational Association of Community
Health Centers
October 12, 2006
National Association of Community Health Centers - 2006
First, A Quick Check (-up)How many have 3+ years with CHCs?How many – 3+ PCA Annual Conferences?
3+ NACHC Meetings (P&I, CHI, etc.)?How many are CHC Advocates at NACHC?A test:
What % of Minnesota CHC staff/Board members are CHC advocates today?
What % of those advocates typically respond to Action Alerts
National Association of Community Health Centers - 2006
Brief History of Health CentersCommon Roots: Turn-of-Century Dispensaries, Milk
Clinics, Public Health ReformsSpecial Heritage: Civil Rights, War on Poverty Efforts to
Address Needs of Poor & MinoritiesUnique Public-Private Partnership: Resources Directly to
Community-Owned OrganizationsHealth Centers: Two-Fold Purpose -
Be Agents of Care in Communities With Too Little of the Same Be Agents of Change, Giving Communities Control of their
Health Care System
National Association of Community Health Centers - 2006
Brief History of Health CentersHealth Centers: Five Basic Characteristics -
Location in high-need areas
Comprehensive health and related services (especially ‘enabling’ services)
Open to all residents, regardless of ability to pay, with charges prospectively set based on income
Governed by community boards, to assure responsiveness to local needs
Held to strict performance/accountability standards for administrative, clinical, and financial operations
National Association of Community Health Centers - 2006
Growth of Health Centers: 1970-2005
0
5
10
15
20
1970 1980 1990 2000 2005
Number of Persons Served by Coverage Source
Uninsured Medicaid Private Insurance Medicare
National Association of Community Health Centers - 2006
Accomplishments of Health Centers
Health Care Home for 16 Million Americans 1 of 7 Uninsured Persons (6.4 million) 1 of 9 Medicaid/CHIP Recipients (5.7 Million) 1 of 4 Low-Income Children (5.9 million) 1 of 5 Low-Income Births (400,000) 1 of 9 Rural Americans (7.9 Million) 10 Million People of Color, 750,000
Farmworkers, 700,000 Homeless Persons
National Association of Community Health Centers - 2006
Location of Community Health Centers
National Association of Community Health Centers - 2006
Accomplishments of Health Centers Excellent Quality of Care: More Effective Care, Better Control
of Chronic Conditions, Greater Use of Preventive Care, Fewer Infant Deaths
Major Impact on Minority Health: Significant Reductions in Disparities for Health Outcomes, Receipt of Preventive and Condition-Related Care
Higher Cost-Effectiveness: Lower Overall Costs, Lower Specialty Referrals and Hospital Admissions, Substantial Medicaid Savings
Significant Community Impact: Employment and Economic Effects, Contribution to Community Well-Being, Development of Community Leaders
National Association of Community Health Centers - 2006
Recent Recognition of Health Centersby Key Government Agencies
IOM recommended health centers as THE model for reforming the delivery of primary health care (Rapid Advances in Health Reform)
GAO credited CHCs for Collaboratives success and recommended expanding them further
OMB ranked CHC program 1st among all HHS programs and one of the top 10 federal government programs for effectiveness
National Association of Community Health Centers - 2006
Health Centers Provide One-Fourth of All Ambulatory Care for Uninsured…
Proportion of Visits by Uninsured, 2004 (N = 70 Million)
Hospital OPDs (11%)
Private Physicians
(36%)
Health Centers (26%)
Hospital ER Units (27%)
National Association of Community Health Centers - 2006
…But Millions of Americans Have No Regular Source of Care
35 Million People Have No Regular Source of Care (not even a Health Center)• Half are Uninsured• 40 percent are Members of Minority Groups• In 13 states, they number More Than 1 Million
47 Million People are Uninsured• Three-fifths are in Low-Income Families• One in 3 Latinos is Uninsured
National Association of Community Health Centers - 2006
Major Challenges AffectingHealth Centers
Growth in Uninsured: Continue to be Largest and Fastest-Growing Group of Health Center Patients
Decline in Charity Care: Cutbacks by Private Providers Squeezed by Managed Care
Loss of Medicaid and Other Public Funding: Severe “Deficit Reduction” Cuts by States & now Congress
Changing Nature of Insurance Coverage: Growing Shift to Catastrophic/High-Deductible Plans that Cover Little or no Preventive/Primary Care
National Association of Community Health Centers - 2006
Growth in Uninsured PopulationServed by Health Centers, 1990-2005
0%
25%
50%
75%
100%
125%
1990 1995 2000
All Uninsured
(47 million; 34% increaseSince 1990)
Uninsured Servedby Health Centers
(6.4 million; 128% increase since 1990)
Percent Increase
SOURCE: Data from 1996-2005 UDS; National estimates from Bureau of the Census.
2005
National Association of Community Health Centers - 2006
NACHC’s Legislative Priorities for 20061. Reauthorize Health Center ‘330’ law without change2. Appropriate at least the President’s request for a
$181 million increase in FY2006, plus increases for other key programs (eg, NHSC)
3. Medicaid reforms must not hurt people or safety net providers
4. State Flexibility must not violate Congressional intent to protect FQHCs and preserve PPSAlso, revise Medicare FQHC payment cap, make FTCA available for volunteers & emergencies, and allow CHC staff to have FEHBP coverage
National Association of Community Health Centers - 2006
ReauthorizationWhat is it and why is it needed?
Core features: location in area of need, open to all, comprehensive services, community-owned and operated
Support for continuation & growthWho wants to change it?
Non-community owned providers (faith-based, others) who want access to funding, FQHC, FTCA, 340B, VFC, etc.
What is the current status? House passed straight reauthorization (HR 5573) 424-
3; Senate action pending on similar bill (S 3771)
National Association of Community Health Centers - 2006
Appropriations:Measuring Funding Results
Fiscal Year
Admin. Request
NACHC Target
Final Approp.
Final vs. Target
2007 $+181 $+181 $+206/+145 ????
2006 $+304 $+304 $+48
2005 $+219 $+250 $+117
2004 $+122 $+225 $+113
2003 $+114 $+200 $+161
2002 $+124 $+175 $+175
National Association of Community Health Centers - 2006
Medicaid: What Did Congress Do? The Deficit Reduction Act (DRA) gives states broad new
flexibility to re-shape Medicaid: Benefit Flexibility: States can enroll most beneficiaries in private
insurance programs, with fewer benefits [NOTE: The Deal amendment assures continued access to FQHCs and payment at PPS rates]
Cost-sharing: States can increase cost-sharing for all above-poverty beneficiaries, and can charge premiums & deductibles for the first time
New Waivers: States can set up “Health Opportunity Accounts” (HOAs), giving beneficiaries a fixed cash account for preventive/primary care, with back-up coverage only for catastrophic specialty or hospital care
It also requires states to verify the citizenship or legal status of all Medicaid applicants beginning July 1, 2006
National Association of Community Health Centers - 2006
State Flexibility: What Does it Mean? States can now change their Medicaid programs without a
waiver, and in most cases without legislative action In most states, the Governor can change Medicaid without asking the
legislature for approval
CMS is actively encouraging states to implement Medicaid reform, promising a quick review of State Plan Amendments
This means that there may be NO public notice or opportunity to review or comment on proposed changes before they’re approved
CMS is also encouraging states to apply for HOA and other waivers, promising quick review & approval also
Here, too, there may be little or no opportunity to review & comment on proposed waivers before they’re approved
National Association of Community Health Centers - 2006
What is NACHC Doing About This? NACHC has organized a special program of legal, technical, and
advocacy assistance to PCAs, especially in ‘high-risk’ states Developed & distributed special model state legislation to make sure that any state
Medicaid changes are publicly disclosed and reviewed in state legislatures Identified which of the 50 states currently have no legislative oversight of their
Medicaid programs, and is providing legal & technical assistance to PCAs in these ‘high-risk’ states
Offering strategic advocacy assistance to all PCAs that request it NACHC’s special Partnership for Medicaid will continue to fight
for Medicaid’s future The Partnership includes public & children’s hospitals, primary care and minority
physician groups, nursing homes, the cities and counties, and other safety net providers It has produced a series of proposals for making Medicaid more efficient & effective,
without cutting current eligibility, benefits, or provider payment rates Working closely with the HHS Medicaid Commission to influence its report to
Congress, due at the end of 2006
National Association of Community Health Centers - 2006
Other Major Policy Issues
Increase the Medicare Payment Cap 75% of all FQHCs affected, $51M+ in lost revenues Can be fixed administratively, without legislation
Extend FTCA Coverage Allow coverage across state lines in emergencies, and
coverage for providers who volunteer to see patientsAllow CHCs to enroll employees in FEHBP
Multiple plans, excellent benefits, lower costs, but CHCs must pay employer share (75%)
National Association of Community Health Centers - 2006
The Future – Our Vision
Grow health centers to become the health care home for all 51 million Americans who need a health care home (51/15/15)
Reform health professions programs to promote Primary Care careers, workforce diversity, and service to underserved via health centers
Preserve the Medicaid guarantee of coverage for low-income, elderly & disabled Americans
National Association of Community Health Centers - 2006
The Future – Our Vision (cont’d)
Wire every health center for complete health information technology (HIT)
Lead the way to a high-performing health system, grounded in primary care
Play a central role in emergency preparedness, at the local & national levels
National Association of Community Health Centers - 2006
How Health Centers Re-pay the Public Investment
They reduce hospital and ER use (5.8 fewer admits per 1,000; 13 - 38% fewer ER visits) for their patients
Their Medicaid patients cost 30 percent less than those served by other providers, saving Billions of $$$
Their disparities collaboratives are found to reduce health disparities significantly for minority patients
They stand ready to serve more uninsured people with limited support (about $500 annually/person)
National Association of Community Health Centers - 2006
Success (and Our Future) WillDepend on Strength of Advocacy
Advocacy is not just a clinical or social work act for individual patients, but a responsibility of leaders for their communities
Advocacy involves full participation in groups that support your cause (PCAs and NACHC)
This means organizational membership (dues support) Also means active individual participation (grassroots
advocacy with state/federal policymakers)
National Association of Community Health Centers - 2006
Why Care About Advocacy? Health centers: a remarkable record of achievement –
open access, superior care, cost-effectiveness – we are part of the SOLUTION
= BUT = Not enough people know about us & our record
The challenges we face are daunting –= AND =
The only way we can win is to grow our Grassroots, (100,000 staff/Board members, 16 million patients), speak with one voice, make it count!
National Association of Community Health Centers - 2006
What Can You Do to Help?Sign up as a Health Center Advocacy Coordinator or as an
Advocate (go to www.nachc.com for details) By signing up, you will receive regular updates from
NACHC and will be notified when action is needed Get 5 colleagues/friends to do the same Invite your Member of Congress and State legislators to visit
your health center (especially during recesses, and National Health Center Week, August 5 – 11, 2007 – begin preparing NOW!
Send the message that health centers are part of the solution, and ask them to support our efforts to do even more!
Join the National Association of Community Health Centers and Your State & Regional PCAs
National Association of Community Health Centers - 2006
NACHC Resources
Visit our improved, expanded web site… for more information on all issues,
for the latest on federal & state policy developments,
to sign up as an advocate and send a message to your Members of Congress on key Health Center issues
Address is: www.nachc.com