health center history & nachc...
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HealthCenterHistory&NACHCOverview
www.nachc.com|www.communityhealthventures.com
1965:Communityhealthcentersbeginasa“demonstra9onproject”(governmentspeakfor
“pilotphase”)inPresidentLyndonJohnson’sWaronPovertyeffort.Three“neighborhood”
healthcenters(astheywerecalledthen)arefundedinBoston,MA,MoundBayou,MSand
Denver,CO.
CHC History & Timeline
Tofirstunderstandwhocommunityhealthcentersareandwhatmakesthemunique,youmustfirstknowwheretheycamefrom:
www.nachc.com|www.communityhealthventures.com
CHC History & Timeline
1971:TheNa9onalAssocia9onofNeighborhoodHealthCentersisfoundedandlaterchanges
itsnametotheNa9onalAssocia9onofCommunityHealthCenter(NACHC).
1980-1987:Duringtheearlytomid-80’s,NACHC(pronounced“nak”)anditsmemberhealth
centersfoughtoffmul9pleeffortsbytheWhiteHousetoblockgrantthehealthcenter
program(effec9velydissolvingthefederal-localpartnershipmodelthatisatthecenterofthe
program).StateandRegionalPrimaryCareAssocia9ons(PCA)wereformedtomonitorstate
policydevelopments.
www.nachc.com|www.communityhealthventures.com
CHC History & Timeline
1989-1992:GeorgeH.W.Bushincreasesfederalfundingforhealthcenters
bymorethan$150million.TheWhiteHouseandCongresscreatespecial
designa9onforhealthcentersasFederallyQualifiedHealthCenters
(FQHC).ThisFQHCdesigna9on–amongotherthings–reimburseshealth
centersatcostforservicesprovidedtoMedicaidandMedicare
beneficiaries.Addi9onally,thePresidentandCongressexpandtheFederal
TortClaimsAct(FTCA)tohealthcenterswhichprovidesformalprac9ce
coverageforanyclinicianworkingatanFQHC.Lastly,Congresscreatesa
newpharmacydiscountprogramwhichrequirespharmaceu9cal
manufacturerstosellmedica9onstohealthcenters(andothersafetynet
providers)atdeepdiscounts.
www.nachc.com|www.communityhealthventures.com
CHC History & Timeline
2001-2002:GeorgeW.Bushcallsfor5yearini9a9vetoincreasehealth
centerfundingby$700million.
2002-2004:Federalfundingforhealthcentersreaches$1.6billion(60%
increasesince2000).
2009-present:AmericanRecoveryandReinvestmentActprovides
healthcenterswithover$13billioninexpansionandopera9onal
funding.
www.nachc.com|www.communityhealthventures.com
CommunityHealthCenterQualiDes
ConsumerDrivenBoard:Toensurethathealthcenters’services
reflecttheneedsofthepa9entsandcommunity,51%ofallhealth
centerboardmembersmustbeusersoftheclinic.
LocatedinHigh-NeedAreas:Healthcentersmustbelocatedinan
areaiden9fiedbyfederalagenciesinconjunc9onwithstatesas
havingelevatedpoverty,higherthanaverageinfantmortalityand
wherefewphysiciansprac9ce.
Sohowdohealthcentersdiffer“opera=onally”fromothergroupprac=cesorclinics?
www.nachc.com|www.communityhealthventures.com
CommunityHealthCenterQualiDes
OpenDoorPolicy:Healthcentersmustseeanyoneregardlessoftheir
insurancestatus.Healthcentersmustoffertheirservicestothe
uninsuredonaslidingfeescale.Thehighertheindividuals’incomethe
greaterthesharetheymustpayforthecostofprovidingapersons’health
care.Slidingfeescalesarebasedupontheannuallyupdatedpoverty
guidelinesgeneratedbytheDepartmentofHealthandHumanServices.
EnablingServices:Healthcentersarerequiredtoofferservicesthat
enableaccesstohealthcarefortheirpa9ents.Someoftheseenabling
servicesincludetransporta9on,interpreta9onservices,healtheduca9on,
casemanagement,etc.
www.nachc.com|www.communityhealthventures.com
CommunityHealthCenterQualiDes
Income
72%ofhealthcenterpa9entsare100%ofthefederalpovertylevel(FPL)
andbelow.Comparably,only21%ofpa9entsseekingcareatothernon-
FQHCprovidersare100%ofFPLorbelowna9onally.(NOTE:An
individualat100%ofFPLin2013isearning$11,490annually.Afamily
offourat100%ofFPLhasahouseholdincomeof$23,550).
Race
• 66%ofhealthcenterpa9entsarewhite.
• 24%areblack.
• 5%areAsianorPacificIslander.
Youknowthehistory.Youknowtheopera=onaldifferences.Howaboutthepa=ents?
www.nachc.com|www.communityhealthventures.com
CommunityHealthCenterQualiDes
InsuranceStatus
• 36%ofhealthcenterpa9entsareuninsured.Comparably,only4%ofpa9entsseekingcareata
privatephysicianprac9ceareuninsured.
• 40%arebeneficiariesofMedicaidorStateChildHealthInsurancePrograms(CHIP).Comparably,
only13%ofpa9entsseekingcareatprivatephysicianprac9ceareMedicaidbeneficiaries
na9onally.
• 14%areprivatelyinsured.
• 8%areMedicarebeneficiaries.
www.nachc.com|www.communityhealthventures.com
CommunityHealthCenterQualiDes
AnEmphasisonEducaDonandPersonalResponsibility
• Ifyou’reasmokerthere’sa74%greaterchancethatyou’llreceive
smokingcessa9oneduca9onatahealthcenterversusaprivate
provider.
• Ifyou’reanasthma9cthere’sa60%greaterchancethatyou’llreceive
educa9ononhowtopersonallycontrolyourasthmaatahealth
centerversusaprivateprovider.
Howarehealthcentersmakingadifference?
www.nachc.com|www.communityhealthventures.com
CommunityHealthCenterQualiDes
AnEmphasisonIncreasedAccesstoPrevenDveCareandReducedDispariDes
• 88%ofHispanicwomenreceiveamammogramathealthcenters;thena9onalaveragefor
Hispanicwomenis66%.
• 63%ofuninsuredwomenreceiveamammogramathealthcenters;thena9onalaveragefor
uninsuredwomenis45%.
• 62%ofAfricanAmericanmenreceivecolorectalcancerscreeningsathealthcenters;thena9onal
averageforAfricanAmericanmenis44%.
• 60%ofmenonMedicaidreceivecolorectalcancerscreeningsathealthcenters;thena9onal
averageformenonMedicaid35%.
Howarehealthcentersmakingadifference?
www.nachc.com|www.communityhealthventures.com
CommunityHealthCenterQualiDes
…savingtaxpayerdollars.
• $24billionannuallyinhealthcaresystemssavingsaccordingto
over20independentstudies.
• Nearly$7billioninMedicaidsavingsaccordingtomul9ple
independentstudies.
…sDmulaDngeconomicgrowthintheircommuniDes.
• In2009healthcentersgenerated$20billionineconomic
ac9vityintheirlocalcommuni9esandproducedmorethan
189,000jobs.
Anemphasisonpreven=vecareresultsinhealthcenters…
www.nachc.com|www.communityhealthventures.com
WhatDoesNACHCdoforHealthCenters?
NACHC Advocates for Health Center Interest:
NACHC has one of the most well respected and
successful legislative advocacy operations in
Washington, DC. Having built one of the strongest and
bi-partisan coalitions of legislators, NACHC enjoys
great support on Capitol Hill and in the White House
from both sides of the aisle. Following are some of
NACHC’s legislative achievements.
Andwhynotsupporttheorganiza3onthatsupportshealthcenters?
www.nachc.com|www.communityhealthventures.com
WhatDoesNACHCdoforHealthCenters?
NACHCachievements:
Opera=ngGrant:Everyyear,NACHCsecuresfundingforhealthcentersthatamounts(onaverage)
to20%ofahealthcenters’overallopera9ngbudget.Withouttheseopera9ngdollars,mosthealth
centerswouldfindthemselvesindirefinancialstraits.
ExpansionoftheHealthCenterProgram:DuringtheBushadministra9oninthe1990’s,thehealth
centermovementwentthroughanunprecedentedexpansion(including$150millioninnew
opera9nggrantdollars).DuringtheObamaadministra9on,healthcenterssawanother
unprecedentedexpansionwithaone9me$15billiondollarappropria9onforsiteexpansionand
capitalimprovements.
Andwhynotsupporttheorganiza3onthatsupportshealthcenters?
www.nachc.com|www.communityhealthventures.com
WhatDoesNACHCdoforHealthCenters?
NACHCachievements(con3nued):
FQHCDesigna=on:InsecuringtheFQHCdesigna9on,healthcentersareeligibleforenhanced
MedicaidandMedicarepaymentsinrecogni9onofthepersistentandchallengingchronichealth
condi9onsthatexistinthecommuni9estheyserveandtheenablingservicestheyprovideto
adequatelycareforthesedifficulttocareforpopula9ons.
340BDiscountPrescrip=onDrugProgram:Thisdiscountpharmacyprogramwasextendedto
includehealthcentersintheearly90s.Discountstohealthcentersare–onaverage–55%offof
wholesaleprice.
Andwhynotsupporttheorganiza3onthatsupportshealthcenters?
www.nachc.com|www.communityhealthventures.com
WhatDoesNACHCdoforHealthCenters?
NACHCachievements(con3nued):
FederalTortClaimsAct(FTCA):ByhavingFTCAmalprac9cecoverageextendedtohealthcenters,
NACHCwasabletoeliminateamajorcostcentertohealthcenteropera9ons.
Na=onalHealthServiceCorp:Thelargestna9onalloanrepaymentprograminopera9ontoday
rewardsnewlygraduatedmedicalstudentswithfullorpar9alloanforgivenessinexchangeforthat
student’scommitmenttoworkatacommunityhealthcenter.NACHCadvocatesforrenewedand
expandedfundingforthisprogrameveryyear.
.
Andwhynotsupporttheorganiza3onthatsupportshealthcenters?
www.nachc.com|www.communityhealthventures.com
WhatDoesNACHCdoforHealthCenters?
OtherNACHCbenefits:
ProvidesTrainingandTechnicalAssistance:
NACHCprovideshealthcentersongoing
educa9ononanyruleorregulatorychangesthat
effecttheiropera9on.Whetherthroughclass
roomtraining,conferences,webinarsorissue/
opera9onalbriefs,NACHCdeliverseduca9onina
varietyofways..
www.nachc.com|www.communityhealthventures.com
KeyWords/Phrases
The“movement”:Howmanyhealthcenterleadersdescribethehealthcenterindustry.Health
centerswereborneoutofsocialmovementthatwasPresidentLyndonJohnson’sGreatSociety.The
WaronPovertysocialmovementwasoneaspectofhisvisionofaGreatSociety.
FQHC(FederallyQualifiedHealthCenter):Itisthespecialdesigna9onawardedclinicswhosepurpose
itistoserveAmerica’sunderserved.FQHCsreceivegrantfundingandenhancedMedicaidand
Medicarepaymentsasaresultofthisdesigna9on.
Tobesuccessful,youhavetotalktheCHCTalk…
www.nachc.com|www.communityhealthventures.com
KeyWords/Phrases
PCA(PrimaryCareAssociaDon):Astateorregionalassocia9onrepresen9nghealthcenterinterestsat
thestateorregionlevel.Thereare52state/regionalprimarycareassocia9onsinopera9ontoday(i.e.,
CaliforniaPrimaryCareAssocia9on,NorthwestRegionalPrimaryCareAssocia9on,Washington
Associa9onofCommunityandMigrantHealthCenters,etc.).
BPHC(BureauofPrimaryHealthCare):Theagencyresponsibleforawardinghealthcentergrants,
providinghealthcenterleaderswithdirec9onrelatedtogovernmentregula9onandgenerally
responsibleforallthingsFQHCrelated.“TheBureau”(asit’salsoknowninthehealthcenterworld),is
adivisionoftheHealthResourcesandServicesAdministra9on(HRSA)andHealthandHumanServices
(HHS).
www.nachc.com|www.communityhealthventures.com
KeyWords/Phrases
WiththesavingsahealthcentercanachievethroughtheValueinPurchasing(ViP)program,health
centerscanenhancethelevelofserviceprovidedintheircommunity.Withthemoneysavedthrough
ViPhealthcenterscandeveloppharmacyassistanceprogramsforimpoverishedclients,hireaddi9onal
outreachand/oradministra9vestafforhireclinicalstafftoseemorepa9ents.
Forexample:
$144,789saved=1FamilyPrac9cePhysicianFTE=3,781newvisitsperyear*
$141,015saved=1PediatricPhysicianFTE=3,781newvisitsperyear*
$81,788saved=1PhysicianAssistant/NursePrac99onerFTE=2,870newvisitsperyear*
$40,000saved=1RegisteredNurseFTE=383newvisitsperyear*
*Source:NACHCHealthCenterSalary&BenefitsReport2010-2011,Na9onalDataAmerica’sHealthCentersFactSheet,2009
Savingstranslatesintoimprovedpa=entcare
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