Bureau of Primary Health Care Updatefor the

South Carolina Primary Health Care Association

John CafazzaDivision DirectorCentral Southeast DivisionU.S. Department of Health and Human ServicesHealth Resources and Services AdministrationBureau 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 2011

80 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

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Under 511%

5 to 1213%

13 to 178%

18 to 2410%

25 to 6451%

65 and up7%

Health Center Serve All Ages

Medicaid38%

Medicare6%

Other Public Insurance2%Other 3rd Party

7%

Self-Pay6%

State/Local/Other

17%

BPHC Grants17%

ARRA Grants5%

Other Federal Grants2%

Health Center Revenue Sources

Health Center Program National Presence – May

2012

4

Health Center Program Overview

National Impact

Source: Health Center Data: Uniform Data System, 2011. National Data: U.S. Census Bureau, 2010 Current Population Reports and Current Population Survey.

5

Health Center Program Growth:

National Impact 2008 - 2011

2008 2009 2010 2011 17,000,000

17,500,000

18,000,000

18,500,000

19,000,000

19,500,000

20,000,000

20,500,000

21,000,000

Patients

2008 2009 2010 2011 7,000

7,200

7,400

7,600

7,800

8,000

8,200

8,400

8,600

8,800

Sites

2008 2009 2010 2011 100,000

105,000

110,000

115,000

120,000

125,000

130,000

135,000

140,000

145,000

150,000

Jobs

 2008 2009 2010 2011

Growth from 2008-2011 (% Increase)

Patients 17,122,535 18,753,858 19,469,467 20,224,757 3,102,222 (18.1%)

Sites 7,518 7,892 8,156 8,501 983 (13.1%)

Jobs 113,059 123,012 131,660 138,403 25,344 (22.4%)

Source: Uniform Data System, 2008-2011 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 2nd 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: http://www.bphc.hrsa.gov/policiesregulations/performancemeasures/index.html Source: Uniform Data System, 2011. National Birthweight Data: 2010. Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2010. National vital statistics reports web release; vol 60 no 2. Hyattsville, MD: National Center for Health Statistics. 2011.

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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 Performance2009 Health Center Patient

Survey

8

South Carolina Health CentersCalendar 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 65+ • 6.9% nationally

• Served by (FTEs): – 170.31 Physicians

– 108.99 Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives

9Source: Uniform Data System, 2011

South Carolina Health CentersCalendar Year 2011 - Fiscal Year 2012

PERFORMANCE

Among South Carolina Health Center Patients:• 59.0% entered prenatal care in

the 1st 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 ≤ 9

• 62.5% of hypertensive patients with blood pressure ≤ 140/90

• $570 total cost per patient• $159 cost per visit

FUNDING

10Source: 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 CareOur 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

- Governance11

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?

2011 2010

60%

52%

50%

39%

39%

39%

35%

35%

34%

34%

31%

28%

28%

24%

22%

19%

18%

13%

2%

3%

53%

52%

50%

46%

33%

41%

38%

44%

N/A

38%

37%

32%

34%

27%

27%

30%

18%

15%

4%

4%

Patient-Centered Medical Home

Quality Improvement

Risk Management

Behavioral Health Service Integration with Primary Care

FTCA

Governing Board Training

Billing

HIT

Capital/Growth Planning

Needs Assessments

Strategic Planning

Fiscal

Staff Retention and Recruitment

School-Based Health Centers

EHR

Teaching Health Centers

Outreach to Special Populations

Patient Safety

Other TA resource or tool

None

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%

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Source: Uniform Data System, 2011

Percentage of EHR Adoption by State UDS 2011

16

Health Center EHR Adoption National and South Carolina, UDS

2011

National South Carolina0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

65%

47%

14%

16%

EHR at Some Sites

EHR at All Sites

2015 Goal: 100% of Health Centers use EHR at All Sites

Source: Uniform Data System, 2011

2012 Goal: 50% of Health Centers use EHR at All Sites

All Sites/Providers Some Sites/Providers No EHR

South Carolina Health Centers have not met the 2012 HRSA EHR goal based on UDS 2011 data.

HRSA, BPHC, Central Southeast Division (June 2012)

South Carolina EHR AdoptionUDS 2011 Data

Impact-BPHC Quality Strategy

1. Implementation of QI/QA SystemsAll 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 OutcomesAll Health Centers meet/exceed HP2020 goals on at least one UDS clinical measure

5. Workforce/Team-Based CareAll 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

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• Patient-Centered Medical Health Home Initiative

• Accreditation Initiative

• PCMH supplemental grant funds

• Partnership with the CMS Primary Care Demonstration

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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 9/30/2013

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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:

http://www.bphc.hrsa.gov/policiesregulations/policies/pal201101.html

• BPHC Helpline: bphchelpline@hrsa.gov or 1-877-974-BPHC (2742)

• PCMHH email: PCMHHinitiative@hrsa.gov

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Alignment of Health Center Program Requirements with PCMH Domains

Section 330 Program Requirement NCQA 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 Relationships15.Program Data Reporting

System

• Track & Coordinate Care

Alignment of Health Center Requirements with PCMH Domains

FY 2011 PCMH Supplemental FundingDomains of Focus

South Carolina Health Centers

0%

10%

20%

30%

40%

50%

60%

70%

80%73.3%

26.7%33.3%

26.7%33.3%

13.3%

Chart Title

Enha

nce

Acces

s

& C

ontin

uity

Iden

tify

&

Man

age

Patie

nt

Popu

lation

s

Plan

and

Man

age

Care

Prov

ide

Self‐

Care

Supp

ort an

d

Com

mun

ity

Resou

rces

Trac

k &

Coor

dina

te C

are

Mea

sure

and

Impr

ove

Perfor

man

ce

2012 Health Center PCMH Recognition

National and South Carolina

National South Carolina0%

10%

20%

30%

40%

50%

60%

70%

28%

47%

11%

0%

PCMHHI Partic-ipants

PCMH Rec-ognized

2013 Goal: 25% of

Health Cen-ters Recog-

nized as PCMH

Data as of September 1, 2012PCMH Recognized Includes: NCQA, Joint Commission, and AAAHC

2012 Goal: 13% of Health Centers

Recognized as PCMH

PCMH Resources

• PCMH Comparison Chart

– http://bphc.hrsa.gov/policiesregulations/policies/pcmhrecognition.pdf

• Fact Sheet: Quality Improvement Initiatives Available to HRSA Supported Health Centers

– http://bphc.hrsa.gov/policiesregulations/policies/qioverview.pdf 26

2011 National and South Carolina Health Center Performance and Healthy People

2020 Goals

27

National South Carolina0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

57%50%

10%

0%

36%

8%

61%

42%

Hypertension Control

Diabetes Control

Early Entry to Prenatal Care

Low Birthweight

Percentage of Health Centers Meeting or Ex-ceeding Healthy People 2020 Goals

2012 Goal: 10+% of Health Centers Meet or Exceed HP 2020 Goals

Source: 2011 UDS and Healthy People 2020

28HRSA, BPHC, Central Southeast Division (June 2012)

Stat

eGra

ntee

1Gra

ntee

2Gra

ntee

3Gra

ntee

4Gra

ntee

5Gra

ntee

6Gra

ntee

7Gra

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8Gra

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9Gra

nte.

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0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

67.1%

78.1%80.0%

55.7%

64.0%

60.5%

62.9%

57.5%

74.3%77.1%

60.0% 54.6%

61.4%

68.6%

38.6%

65.7%

51.8%51.1%

54.3%

44.2%

Healthy People 2020 Goal = 61.2%

South Carolina: Hypertensive Patients with Blood Pressure

< 140/90UDS 2011 Data for Federally-Support Health Centers

29HRSA, BPHC, Central Southeast Division (June 2012)

State

Gra

ntee

1G

rant

ee 2

Gra

ntee

3G

rant

ee 4

Gra

ntee

5G

rant

ee 6

Gra

ntee

7G

rant

ee 8

Gra

ntee

9G

rant

ee 1

0G

rant

ee 1

1G

rant

ee 1

2G

rant

ee 1

3G

rant

ee 1

4G

rant

ee 1

5G

rant

ee 1

6G

rant

ee 1

7G

rant

ee 1

8G

rant

ee 1

9

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

65.7%

72.9%

80.0%

72.9%

85.4%

53.8%52.9%

66.5% 67.1%

78.6%74.3%

72.7%74.3%

78.6%75.7%

64.3%68.5%

73.0%

61.4%56.1%

Healthy People 2020 Goal = 85.4%

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:http://www.bphc.hrsa.gov/policiesregulations/policies/index.html

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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 2011-04http://www.bphc.hrsa.gov/policiesregulations/policies/pal201104.html

.

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2012-2013 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:http://www.bphc.hrsa.gov/policiesregulations/policies/draftsforcomment.html

.

33

Funding Updates

34

Fiscal Year 2013Spending 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:http://www.bphc.hrsa.gov/policiesregulations/continuation/index.html

– FY 2013 Service Area Competition (SAC) Technical Assistance:

http://www.hrsa.gov/grants/apply/assistance/sac/

 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 Resourceso Annual T/TA Needs Assessmento Special Populationso Collaborationo Emergency Preparednesso Regional/Statewide Surveillance Analysis o Newly Funded Health Centers

38

Quality and Data Updates

39

FTCA Program

• FTCA Health Center Policy Manualo Primary source for information on FTCA

grantees and related stakeholderso Consolidates, clarifies and synthesizes existing

FTCA policy documents and statutory languageAvailable at: http://bphc.hrsa.gov/policiesregulations/policies/pin201101.html

• Application Review/Deeming in EHBo 2013 Requirements for FTCA Deeming available in

PAL 2012-02:

http://www.bphc.hrsa.gov/policiesregulations/policies/pal201202.html

o For Programmatic of Technical TA on FTCA contact:

Email: BPHCHelpline@hrsa.gov Phone: 1-877-974-2742

40

Technical Assistance Resources

41

Technical Assistance (TA) Resources

• National and state-based support for training and technical assistance:

oNational Cooperative AgreementsoState/Regional Primary Care AssociationsoState Primary Care Offices

• Federal TA Support:oProject OfficeroTA Calls/TrainingsoOnsite Consultant SupportoBPHC TA Website-New Search Engine

Feature Added

For more information visit the BPHC TA Website:

http://www.bphc.hrsa.gov/technicalassistance/index.html

42

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: 1-877-974-BPHC (2742) Email: bphchelpline@hrsa.gov.

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: http://www.hrsa.gov/data-statistics/health-center-data/index.html.

o Data analysis toolso Data download functionality

• UDS Grantee/State/National Summaries• Health Center Trend Reports• State and National Roll-up Reports• Reporting and Training Resources

UDS Mapper: www.udsmapper.org• HRSA has developed a mapping and support tool driven

primarily from data within the UDS• Webinar trainings on using Mapper functionality available:

http://www.udsmapper.org/webinars.cfm

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: www.ecri.org/clinical_RM_program. 

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

http://www.ahrq.gov/workingforquality/nqs/

• HHS Action Plan to Reduce Racial and Ethnic Health Disparities

http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf

• National Prevention Strategy

http://www.healthcare.gov/prevention/nphpphc/strategy/index.html

• National HIV/AIDS Strategy

http://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf

Primary Health Care and Public Health Leadership

46

• National Oral Health Initiatives

http://www.hrsa.gov/publichealth/clinical/oralhealth/

• Behavioral Health Initiatives

http://bphc.hrsa.gov/technicalassistance/tatopics/clinicalcareservices/index.html#Behavioral

• Healthy Weight Collaborative

http://www.collaborateforhealthyweight.org/

• Million Hearts Campaign

http://millionhearts.hhs.gov/

• Text4babyhttp://www.cdc.gov/women/text4baby/index.htm

• Viral Hepatitis Initiative

http://www.hhs.gov/ash/initiatives/hepatitis/index.html

Primary Health Care and Public Health Leadership

47

John CafazzaDirector, Central Southeast Division

U.S. Department of Health and Human ServicesHealth Resources and Services Administration

Bureau of Primary Health Care 5600 Fishers Lane Rm. PKLN/17-61

Rockville, MD 20857Telephone: 301.594.4420Email: jcafazza@hrsa.gov

48

Thank You!

Questions?

49