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Telemedicine in Community Health Centers
By Libbey Chuy, MPH Telehealth and Practice Transformation Coordinator
Association for Utah Community Health
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Overview
What is a CHC and a PCA? Current landscape Challenges for implementing telemedicine Telemedicine at AUCH Q & A
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What is a Primary Care Association?
Authorized by Section 330(l) of the Public Health Service Act to provide necessary technical and non-financial assistance to potential and existing health centers.
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What is a Primary Care Association?
Responsibilities continued: • Expand services and support growth • Enhance operations and performance • Support strategies to recruit and retain staff
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Provide training and technical assistance
Monitor emerging primary care issues
Expand services and support growth
Enhance operations and performance
Support strategies to recruit and retain staff
Assist with emergency preparedness
Support development of new health centers
Conduct statewide program assistance activities
Functions of a PRIMARY
CARE ASSOCIATION
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What is a Community Health Center?
Health centers are non-profit private or public entities that serve designated medically underserved populations/areas or special medically underserved populations comprised of migrant and seasonal farm workers, the homeless, or residents of public housing.
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National Health Center Grantees and Sites
1,128 Grantees 9,014 Delivery Sites
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What is a Community Health Center?
Private, charitable, tax-exempt nonprofit organization OR public entity through a direct or co-applicant arrangement Must serve a medically underserved area (MUA) or medically underserved population (MUP) designated by DHHS Open to all, regardless of insurance status. Offers a sliding fee discount that adjusts according to family income and a patient’s ability to pay for families at or below 200% of Federal Poverty Level (FPL).
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What is a Community Health Center?
• Community-based and patient-driven health care homes that serve populations with limited access to health care.
• Provide high quality, affordable primary care and preventive health care services regardless of insurance status.
• Serve as a part of the health care safety net, with a mission to ensure access to quality care for the underserved (economically and geographically).
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What is a Community Health Center?
Held to strict accountability and performance measures for clinical, financial and administrative operations by HRSA Have a governing board, the majority − at least 51% − of whose members are patients of the health center Comprehensive healthcare and related services based on the needs of the community
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What is a Community Health Center? Required services:
Primary Health Care Dental Care Behavioral Health Pharmacy Basic Lab Emergency Care
Radiological Services Transportation Case Management After Hours Care Hospital/Specialty Care Translation Services
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Utah’s CHCs
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Health Centers in Utah, 2013
ENCOUNTERS NATION* STATE RURAL URBAN
MEDICAL 59,846,057 293,004 95,692 197,312
DENTAL 10,692,278 43,402 21,052 22,350
BEHAVIORAL HEALTH 6,285,014 16,709 6,264 10,445
VISION 503,800 594 0 594
OTHER PROFESSIONAL 1,280,525 5,684 5,493 191
ENABLING SERVICES 5,158,479 24,322 0 24,322
TOTAL 83,766,153 373,715 128,501 255,214
SITES NATION* UTAH UT-RURAL UT-URBAN
TOTAL GRANTEES 1,198 13 7 6
TOTAL SITES 9,329 39 21 18
PATIENTS NATION* UTAH UT-RURAL UT-URBAN
TOTAL PATIENTS 21,102,391 115,410 32,415 82,995
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Patients by Race, 2012
1%
1%
1%
4%
12%
82%
Hawaiian/Pacific
Asian
Black/African American
More than one race
American Indian/Alaska
White
CY 2012 Uniform Data System
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Non- Hispanic/Latino vs. Hispanic/Latino, 2012
46%
54%
Hispanic/Latino
Not Hispanic/Latino
CY 2012 Uniform Data System
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Patients by Poverty Level, 2012
74%
16%
6%
4%
100% and Below
101 - 150%
151 - 200%
Over 200%
CY 2012 Uniform Data System
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Patients by Insurance Status, 2012
2%
5%
18%
18%
57%
Other Public
Medicare
Medicaid
Private
Uninsured
CY 2012 Uniform Data System
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Current Landscape in Community Health Centers
Lots of movement in healthcare • Patient-Centered Medical Home Indicatives (PCMH) • Meaningful Use • Accountable Care Organizations (ACO) • Affordable Care Act – Outreach and Enrollment (O&E) activities
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Current Telemedicine Landscape in Community Health Centers
Resources • NACHC’s Telemedicine Page
• http://www.nachc.com/Telemedicine.cfm • FQHC Reimbursement for Telemedicine Services in Medicaid
• http://www.nachc.com/client//Telemedicine%20%20SPR482.pdf
Funding Opportunities • HRSA-14-110 “Mental Health Service Expansion – Behavioral Health
Integration Grant, Due mid-March
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Challenges
Reimbursement Balancing federal requirements Serving underserved populations with limited funds
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Telemedicine at AUCH
Dedicated staff position for 10+ years (unique) Innovative leadership Long-term relationship with the Utah Telehealth Network Expanding telemedicine services and programs
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Telemedicine at AUCH
Retinal Screening/Teleophthalmology (store-and-forward) Teledermatology – coming soon! (store-and-forward) Project ECHO (provider-to-provider eConsult) Telebehavioral/mental health (clinic level) Medical Spanish for Healthcare professionals Telepharmacy (clinic level)
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Telemedicine at AUCH
Teleradiology *Diabetes Education for Patients (English and Spanish) *Remote Monitoring *Text-messaging platforms * Currently not active programs, but will be started up again.
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Non-clinical telehealth services at AUCH
Trainings and Technical Assistance Peer learning groups (5-6) Basic Medical Spanish Course, for Healthcare Providers (8-week course)
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Technology used at AUCH
Connected to the Utah Telehealth Network (polycom) Adobe Connect (webinars and peer groups) AUCH Telemedicine Platform, released December 2013 www.auchtelemed.org
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AUCH’s Telemed Platform - Teleophthalmology
HIPAA compliant Security certified 7-year storage An organization can create multiple log-ins
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Built to support retinal and telederm programs.
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AUCH’s Teleophthalmology Program
11 retinal cameras 1 retinal provider (reader) 10 year anniversary (2014) Annual refresher courses for photographers
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Retinal Screening Program
207
531 452
676
809 894
1055
1275
*1339 Expected
0
200
400
600
800
1000
1200
1400
1600
2005 2006 2007 2008 2009 2010 2011 2012 2013
Tota
l # o
f pat
ient
s sc
reen
ed
Year
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Community Health Centers- Funding and Finances
• Self-Pay - Uninsured patients below 200% of the Federal Poverty Level (FPL) pay on a sliding fee scale based upon annual income and the ability to pay. Documentation of income is required.
• Medicaid/CHIP/Medicare – Prospective Payment System (PPS). A reimbursement mechanism roughly based upon the cost of a patient encounter. Rate is adjusted yearly by Medicare Economic Index (MEI).
• Private Insurance – Accepted just like private practices.
• Federal Grant – Provision of primary and preventive health care services for the uninsured.
• Community Support – Corporate, philanthropic and individual support.
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Contact Information
Libbey Chuy, MPH Association for Utah Community Health [email protected] 801-716-4603
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Questions