NACHC UPDATE

National Association of Community Health Centers

Health Choice Network20th Annual Education Session and Health Care Quality

InstituteSaturday June 28, 2014

2011 Biggest Internal Challenges ???

To integrate with other providers

(including other CHCs)

To coordinate patient care to assure sharing of clinical data/information.

To coordinate service delivery and match capacity while linking patients with enabling services.

Re-engineering our health center operations (data and insurance focused)

Workforce (all levels)

2011: Biggest External Challenges ???

Competition from managed care organizations.

Forming partnerships without losing mission focus & autonomy (CAHs)

External ChallengesGreatest Challenges: Appropriations and Medicaid

TODAY’S AGENDA

• THE ENVIRONMENT FOR HEALTH CENTERS

• FEDERAL POLICY UPDATE:

• MEDICARE PPS

• HEALTH CENTER TRANSFORMATION

• QUESTIONS?

THE ENVIRONMENT

The Environment in Washington – the BAD

• Political Polarization

• ACA is as divisive as ever

• “Must-pass” bills pass, but not much else

• Heightened scrutiny of federal programs• Budget caps and future funding uncertainty

THE ENVIRONMENT

The Environment in Washington – the GOOD• Bipartisan support for Health Centers’

Program, Model and Mission

• Both sides looking for solutionsin the health care arena

• Health Centers are at the center of the conversation

HEALTH CENTERS IN A POST-ACA WORLD

• Access to primary care is vital for cost savings and improved outcomes

(Transformation)

• Increased demand, among newly insured and uninsured (MA experience)

• Federal support, through 330 grant and Medicaid payment, crucial to model of care

• We will have to advocate louder than ever

• New funding essential for base grant adjustments, expanded capacity, service

expansion, new access points

• Since ACA, funding comes two ways:

HEALTH CENTER FUNDING STREAMS – SINCE ACA ENACTED

DISCRETIONARY• Annual, up to Congress to

determine amount• Prior to ACA, the only funding

for CHC program• Cut in 2011, backfilled with

mandatory funds• Currently $1.5 billion

(FY14)

MANDATORY• Required spending, unless

Congress changes the law• Special Fund created in ACA to

boost Health Center Capacity• Currently 2.2 billion (FY14)• Expires in FY2016 (more on

that in a moment)

HEALTH CENTERS FUNDING CLIFF• Mandatory funding

expires at the end of FY15

• Without action by Congress, up to 70% cut to Health Center grants

• NHSC, THCs in same position (though ALL mandatory)

FIXING THE CLIFF – OUR PLAN• Extends, grows

mandatory funding

• $20b over 5 years

• Grow from current 22m patients to 35m

• Continue funding for NHSC, Teaching Health Centers

• Message: Act Now!

THE CLIFF – KEY POINTS

1. This is real. Health Centers have had success in gaining new funding, but even our biggest champions can’t predict the outcome here.

2. Estimate the impact. What would a 70% cut to your grant mean in your community, to your patients?

3. Raise the drumbeat for a fix. We have a long fight ahead, but our best hope is the understanding that this is a “must-do”.

HEALTH CENTERS SUCCESS - OUR COLLECTIVE FUTURE - DEPEND ON THE

STRENGH OF OUR ADVOCACY.

• Local connections are the key to policy change – build relationships and demonstrate impact over time

• Advocacy requires ACTION - the key is to develop a sustained culture of advocacy in your center

• The challenges and opportunities ahead are huge. Let’s take them on TOGETHER.

• Campaign Website: www.saveourchcs.org

ADVOCACY: THE BOTTOM LINE

REGULATORY UPDATE

Medicare PPS – GAME CHANGER!• Greatest opportunity to mover into Medicare

ever!• The PPS base rate for October 1, 2014, through

December 31, 2015, is $158.85 (roughly a 35% increase)

• Transition to new FQHC PPS begins on the 1st day of cost reporting period on or after 10/1/14 (updated annually)• Increased rates for new patients: can bill for

subsequent illness/injury visits and mental health visits on same day

• FQHCs must now use “G” Codes and must create appropriate charges for the new codes

• Do your charges reflect your real costs?

Medicare PPS cont….• When was the last time your FQHC reviewed your charges?

• Cost of care isn’t decreasing• Do nothing? - THIS RULE HURTS! – Medicare rate may go

down• Rule will have HUGE impact on sliding fee scale policies if it

isn’t reviewed and adjusted on a regular basis

• Huge potential for Medicare Advantage Plans!

• NACHC will be rolling out national trainings shortly• First trainings to focus on Sept, Oct, Nov due dates - 150

CHCS, Jan - >300 CHCs

Transformation – VC2

VC2 – A vision started by NACHC Chair Dr. Gary Wiltz

• Strategy to enhance CHC capacity in transformation and a means to cope with the enormous shifts we are now facing.• EHRs: Identify needed performance improvements, implement

solutions, and measure the effects of those solutions. • clinical quality, cost control, operational effectiveness, financial

performance, and patient experience.• Develop systems integrated with other providers in the

community.• Provide organization-wide focus and team training• A continual performance strategy, “This is how we do business.”• Create system to share proven ways to improve quality and lower

cost.• Disseminate methods to all health centers

Transformation • It is all up to the Health Centers, HCCNs and PCAs

• NACHC can’t lead this – its all local/regional• Convener, collect and spread

• HCCN’s are the key to success! • Health Choice Network is a best practice model!

• OCHIN and Clinical Informatics tools • Medicare ACOs• Managed care products

• ACA changed everything for health care delivery (more business less politics)• Local, regional and state work will dominate for business

success• PCAs and HCCNs must work together

The Future• Health Centers are one of the critical pieces of

health care delivery moving forward• ACA provided unparalleled growth and

opportunities• Capital• Growth• Medicaid Expansion and Marketplace Exchanges• Medicare PPS

• Health Centers must start taking risk – more business thinking less grant dependence• NACHC tools (ACO/IPA toolkits)

Today

• NACHC must work closer with HCCNs and PCAs recognizing the new roles we are now have• Ohio

• We must continue to advocate for our cause • The Primary Care Cliff is real!• Never forget FY’11 - $600M decrease

Invite Your Members of Congress to Visit During NHCW – August 10th-16th

NATIONAL HEALTH CENTER WEEK

More info updated regularly at www.healthcenterweek.org

QUESTIONS?

Shawn K. FrickAssociate Vice President, PCA & Network Relations

National Association of Community Health CentersDirect:301-347-0447

E-Mail: sfrick@nachc.com

QUESTIONS and CONTACT INFO