Diversifying Revenue Streams in Federally Qualified Health Centers Presented by Zara Marselian, MA, FACHE Founder, President and Chief Executive Officer

About La Maestra Our Mission: “To provide quality healthcare and education, improve the overall well-being of the family, bringing the underserved, ethnically diverse communities into the mainstream of our society, through a caring, effective, culturally and linguistically competent manner, respecting the dignity of all patients.” History: Clinic formed in 1990 under La Maestra Amnesty Center. The need for culturally competent healthcare was identified by Student Council representing over 12,000 students who participated in legal residency and citizenship programs, ESL, VESL, job training at LMAC. First Clinic, opened 1990LEED Certified Gold Health Center, opened 2010

Locations 5 medical and 9 dental sites; 4 school-based clinics; Hope Clinic (Access Point for Homeless) in San Diego communities: City Heights El Cajon National City Lemon Grove Mental health services onsite & via telehealth Digital imaging – mammo, X-ray, ultrasound, dexa and CT scan Mobile clinic – medical, dental, optometry, telehealth NEW - mobile mammo coach - first in San Diego

Annual Number of Patients & Visits 65% of Patients indicated best served in a language other than English in 2014 Total Unduplicated Patients Total Visits 4

Serving the Culturally Diverse Community o One of the most culturally diverse health centers in California – sites are in refugee resettlement areas and along US-Mexican border. o 65% of patients prefer communication in language other than English o Staff come from the cultures served, ensuring cultural and linguistic competency. o More than 30 languages and dialects spoken by 400+ employees o Medically Trained Cultural Liaisons provide valuable, ongoing support, education to local residents and identify new needs – two-way communication

Innovative Models at La Maestra o La Maestra’s Circle of Care™ - All services and programs have elements focusing on education, case management, social services − Integrated approach o Medically Trained Cultural Liaison (MTCL) model o School-Based, Mobile Clinics; Hope Clinic for homeless; Telehealth: Alternative Access Points and Bringing Services to where residents live, work, learn, play and worship o Electronic and Cloud-based Program/Case Management o Specialty Care in the Medical Home via Telehealth and Partnerships o Digital Imaging o Contemporary Management Team Model

La Maestra’s Circle of Care ™

Diversifying Revenue Streams in FQHCs – Challenges and Solutions

Challenges Facing FQHCs Financial Implications with Affordable Care Act: o Exchange Program and Unintended Consequences o Changes in Reimbursement o ICD 10 Codes o Managed Care / IPAs o Volume to Value Potential Impact on FQHCs  Revenue Loss

Exchange o Exchange Implementation – Challenges o Residual Uninsured o Self-pay patients at FQHCs with insurance coverage elsewhere o Unintended Consequences

Reimbursement o Shift from Prospective Payment System (PPS) to Alternative Payment Models (APM) o Goal: Eliminate fragmented care and tie performance outcomes to reimbursement o Pilots in California o ICD 10 Codes

Managed Care / IPAs o Managed Care & IPA – revenue streams o Incentives o State Reconciliations o Contracts

Volume to Value o Statewide PCA Webinars, NACHC o Focus on HEDIS measures o PCMH model o Meaningful Use  EHR o Dashboard Reports o Data Analytics – Must Extract and Analyze Data o Invest in software (i2i Tracks, PopIQ) through collaboratives o Managed Care Negotiations with Incentives / Bonuses (Not revenue or part of capitation)

What FQHCs Need to Prepare for Changes o Establish or strengthen: o Population Health Management o Data Management o Financial Management o Revenue Cycle Management

What FQHCs Need to Prepare for Changes o Coders - specialized staff o Ensure billing correctly for all applicable codes per visit o Dashboard Reports o Data Analytics – Must Extract and Analyze Data o Invest in software (i2i Tracks, PopIQ) through collaboratives o Managed Care Negotiations with Incentives / Bonuses (Not revenue or part of capitation)

Diversifying Funding o Possible additional revenue streams o Capitation incentives o Additional contracts o Hospitals outsourcing to FQHCs o Pharmacy

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