Missouris Community Health Centers Strategic Considerations Missouri Primary

Missouri’s Community Health Centers: Strategic Considerations Missouri Primary Care Association March 2011 Missouri Primary Care Association 1

Federal Budget Senate and House approved Continuing Resolution through April 8. $6. 1 billion in cuts ◦ $3. 5 billion in program reductions ◦ $2. 6 billion in earmark cuts No funding cuts to CHCs in Continuing Resolution Uncertainty regarding final budget and cuts – negotiations behind the scenes Missouri Primary Care Association 2

Affordable Care Act Dedicated Funding for CHCs Total $9. 5 billion for operations and expanded capacity (New Access Points, Expanded Medical Capacity, and Service Expansion) $1. 5 billion for capital improvement projects (new facilities, new equipment, renovation) Primary Care Provider Capacity $1. 5 billion for National Health Service Corps to train, recruit and retain primary care providers to serve the underserved Missouri Primary Care Association 3

Policy Changes Medicaid Expansion for all individuals under 65 at or below 133% of FPL in 2014; many current sliding fee patients will be able to access Medicaid coverage Private insurance plans in Health Insurance Exchanges will be required to contract with FQHCs and pay cost-based PPS rates. Premium and cost sharing assistance available to individuals between 133%-400% FPL Missouri Primary Care Association 4

Policy Changes Preventive services added to FQHC Medicare services and removal of cap on payment for Medicare visits Funding for teaching FQHCs and FQHC-based residency programs Missouri Primary Care Association 5

Policy Changes Medical Home Demonstration: FQHCs become recognized as Patient-Centered Medical Homes. (BPHC Priority) Accountable Care Organizations: Provider led organization whose members engage in joint decision making, that manages full continuum of care and is held accountable for overall costs and quality of care FQHC providers receive Medicaid incentives for Meaningful Use of Health Information Technology Missouri Primary Care Association 6

What Does All of This Mean for Missouri FQHCs Community Health Center model prominent – we must deliver Focus on Becoming Providers of Choice Anticipate increased demand for services Patient Satisfaction with Care Experience is Critical as is Patient Retention and Outreach Provider Recruitment and Retention is Critical Missouri Primary Care Association 7

MPCA and BPHC Recommend CHCs should Pursue Patient Centered Medical Home (PCMH) Recognition Focus on Operational Excellence, Effective and Efficient Operations Fully Implement Electronic Medical Records (EMRs) and Participate in Health Information Exchanges (HIEs) Improve Quality and Be Transparent Enhance External Communications and Advocacy Missouri Primary Care Association 8

Missouri Quality Improvement Network (MOQu. IN) Bring Clinical, Quality, and HIT together ◦ Finish Data Warehouse to enable accurate, reliable, timely quality measures reporting ◦ Statewide Quality Improvement Effort ◦ Meaningful Use Incentives Arcadia Solutions is consultant Actively working with 16 of 23 FQHCs 17 measures reported for 7 FQHCs Missouri Primary Care Association 9

Missouri Quality Improvement Network (MOQu. IN) Operating Board Appointed by MPCA Board of Directors ◦ Clinical Provider Staff ◦ Quality Improvement Staff ◦ HIT Staff Staffed by MPCA Center for Quality Meets Quarterly Determines Priorities for MOQu. IN Missouri Primary Care Association 10

MPCA Strategic Vision Own your data…Own your future. ACO/PCMH Quality Improvement Quality of data equals quality of care Adoption Stage 2 Stage 3 Meaningful Use may not achieve all of your organizational goals. Stage 1 Missouri Primary Care Association 11 Arcadia Solutions Proprietary & Client Confidential

MO Chronic Disease Collaborative 16 FQHCs participate at present 10 measures for diabetes and cardiovascular disease Combination of reporting from patient registries, EMRs, and manual chart audits Transitioning to use of MOQu. IN data warehouse and reporting to satisfy state contract requirements Missouri Primary Care Association 12

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Funding ARRA HITECH HIT Innovation and Implementation Special Congressional Initiative Missouri HIT Assistance Center Missouri Primary Care Association 14

MO HIT Assistance Center MPCA is partner and contractor Funding supports MPCA providing technical assistance to Health Centers to achieve Meaningful Use of HIT and receive incentive payments No cost to Health Centers Work is coordinated with Arcadia Solutions in tandem with MOQu. IN Missouri Primary Care Association 15

Meaningful Use Incentives Eligible professionals can receive up to $63, 750 over six years. First Calendar Year in which the EP Receives and Incentive Payment Calendar Year CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016 2011 $21, 250 2012 $8, 500 $21, 250 2013 $8, 500 $21, 250 2014 $8, 500 $21, 250 2015 $8, 500 $21, 250 2016* $8, 500 $8, 500 $21, 250 2017 $8, 500 $8, 500 2018 $8, 500 2019 $8, 500 2020 $8, 500 2021 $8, 500 TOTAL $63, 750 $63, 750 Missouri Primary Care Association 16 Arcadia Solutions Proprietary & Client Confidential

Missouri Legislative Priorities Health Home Initiative PRIMO Revamped Health Insurance Exchange Legislation and Implementation Missouri Primary Care Association 17

Why Advocacy Is More Important than Ever 1. 2. 3. 4. 5. Ignorance is not Bliss: too many people don’t know who we are Nearly 100 New Members of Congress and 80 members of the Missouri Legislature know little or nothing about Health Centers State and Federal Deficit Reduction Efforts: we are now big enough to matter The Appearance of Power is Power Elected officials fear the voters more than ever (See #2) Missouri Primary Care Association 18

Effective Advocacy = POWER ◦ Grassroots advocacy is about one thing – building power. ◦ Power is not measured by the number of advocates we have on a list. ◦ Power is not measured by the number of small (or even large) victories we win every now and then. ◦ Power must be measured by our ability to successfully advance our own agenda and to make it unthinkable that any other political or special interest would ever want to take us on. Missouri Primary Care Association 19

Patient Centered Medical Home Alignment with FQHC Requirements Health Center Expectations (PIN 98 -23) FTCA (PIN 11 -01) Corporate Compliance (HIPAA) Meaningful Use Missouri Primary Care Association 20

Joint Principles of PCMH Originate from Two Conceptual Frameworks Community-Oriented Primary Care Foundation for CHC movement accessible first contact care, or serving as the entry point a continuous relationship with patients over time; comprehensive care coordination of care Care Model focuses on “system changes intended to guide quality improvement and disease management activities” for chronic illness. Missouri Primary Care Association 21

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Joint Principles of the Patient-Centered Medical Home Developed and Adopted March 2007 Personal Physician Directed Medical Practice Whole Person Orientation Care is Coordinated and/or Integrated Quality and Safety Enhanced Access Payment Reform Missouri Primary Care Association 23

Who is Driving Patient- Centered Medical Home Efforts? Centers for Medicare and Medicaid Health Resources and Services Administration: Bureau of Primary Health Care (HRSA-BPHC) All CHCs recognized by 2014 Awarded contract to National Committee for Quality Assurance (NCQA) to cover application costs Insurers-Private and Public Medical Societies Foundations Missouri Primary Care Association 24

Benefits of PCMH Process Provides an excellent review of the organization’s : ◦ Quality Improvement Programs ◦ Care Coordination- Both internal and external ◦ Community Linkages and access to specialty care ◦ Policies and procedures ◦ Corporate compliance ◦ Data extraction/reporting ◦ Meaningful Use of EMR Missouri Primary Care Association 25

National Committee for Quality Assurance (NCQA) and the PCMH NCQA developed a set of standards and a 3 tiered recognition process program) to assess the extent to which health care organizations are functioning as medical home Recognition requires completing an application and providing adequate documentation to show evidence that specific processes and policies are in place Recognition is offered at three levels: Level 1 – basic Level 2 – intermediate Level 3 – advanced Missouri Primary Care Association 26

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PCMH Tools and Resources National Committee for Quality Assurance: www. ncqa. org/tabid/631/Default. aspx The Joint Commission: www. jointcommission. org/accreditation/pchi. aspx Primary Care Development Corporation of New York: www. pcdc. org/resources/patient-centered-medical-home Patient-Centered Primary Care Collaborative: www. pcpcc. net/content/patient-centered-medical-home Commonwealth Initiative: Fund: Safety Net Medical Home www. qhmedicalhome. org/safety-net/change-concepts. cfm Improving Chronic Illness Care: www. improvingchroniccare. org/index. php? p=Patient-Centered_Medical_Home&s=224 American College of Physicians: www. acponline. org/running_practice/pcmh/ Missouri Primary Care Association 29

Contact Information Susan Wilson- swilson@mo-pca. org Angela Herman- aherman@mo-pca. org Danny O’Neill- doneill@mo-pca. org Missouri Primary Care Association 3325 Emerald Lane Jefferson City, MO 65109 -6879 (573) 636 -4222 www. mo-pca. org Missouri Primary Care Association 30