Achieving Affordable Community-Based Health Care for Oklahomans Presented by Oklahoma Primary Care Association HRSA/BPHC State Liaison Strengthening access to affordable community-based health care through advocacy, education, and technical assistance

Oklahoma Primary Care Association America’s Health Structure 2010 Tertiary Care Secondary Care Primary Care

Oklahoma Primary Care Association An Ounce of Prevention… Cost Effective and Better Patient Outcomes Tertiary Care Secondary Care Affordable Primary Care

Oklahoma Primary Care Association Oklahoma Ranks 50 th in /DataByState/State.aspx?state=OK

Oklahoma Primary Care Association What are CHCs/FQHCs? 330 Community Health Centers (CHCs), initially referred to as “Neighborhood Health Centers,” are an outgrowth of President Lyndon B. Johnson’s Great Society Program, in CHCs, as public/private partnerships, receive Section 330 grant funds to provide affordable health care to individuals at or below 200% FPL. Note: FQHC is a status given to 330-funded CHCs

Presidential Initiatives to Improve America’s Health : President Bush Double the number of patients served in Community Health Centers (CHCs) within 5 years Double the number of patients served in Community Health Centers (CHCs) within 5 years * CHC patients have increased from 10 million to more than 18 million; dental services have doubled and behavioral health increased 170% Increase current total of 3,200 CHCs by 1,200 to reach goal of 4,400 CHCs at the end of 5 years Increase current total of 3,200 CHCs by 1,200 to reach goal of 4,400 CHCs at the end of 5 years * Goal of 1,200 was reached – at 1278 end of present: President Obama Funded 126 new sites; $250M for 350 sites in FFY2011 Funded 126 new sites; $250M for 350 sites in FFY2011 Oklahoma Primary Care Association

2010 Oklahoma CHC Presence Over $18.6 million in additional CHC grant dollars to OK since 2001! CHC Grantee Homeless Center Expansion/Satellite Oklahoma Primary Care Association 4300 N. Lincoln Blvd., Ste. 203 Oklahoma City, OK  Fax Copyright OKPCA. This publication was made possible by Grant Number U58CS06840 from Health Resources & Services Administration (HRSA)/Bureau of Primary Health Care (BPHC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the HRSA/BPHC.

Section 330 CHC Core Tenets Serve areas of highest need Serve areas of highest need Provide comprehensive primary care to people of all life cycles; including provision of oral and behavioral health services Provide comprehensive primary care to people of all life cycles; including provision of oral and behavioral health services Must serve all people regardless of ability to pay Must serve all people regardless of ability to pay Patient-majority governing board that oversees public/private partnership Patient-majority governing board that oversees public/private partnership Must meet performance & accountability requirements Must meet performance & accountability requirements Must adhere to BPHC PIN – Program Expectations 8Oklahoma Primary Care Association

Required Financial Performance Measures Total Cost Per Patient (UDS) Total Cost Per Patient (UDS) Medical Cost Per Medical Encounter (UDS) Medical Cost Per Medical Encounter (UDS) Change in Net Assets to Expense Ratio (Audit) Change in Net Assets to Expense Ratio (Audit) Working Capital to Monthly Expense Ratio (Audit) Working Capital to Monthly Expense Ratio (Audit) Long Term Debt to Equity Ratio (Audit) Long Term Debt to Equity Ratio (Audit) Oklahoma Primary Care Association

Required Clinical Performance Measures Quality/Risk Management 1. % of first trimester prenatal care 2. Immunization rates for two-year olds 3. % of women receiving Pap tests Health Outcomes/Disparities 4. % of diabetic patients with HBA1c levels < or = 9% 5. % of hypertensive patients with BP less than 140/90 6. % of births < or = to 2,500 grams (approx. 5 lbs,8 oz) Plus… 7. One self-identified Oral Health Measure 8. One self-identified Behavioral Health Measure

Oklahoma Primary Care Association In 2009, Oklahoma CHCs … Source: BPHC, HRSA, DHHS, 2009 Uniform Data System, 17 Grantees Served 118,810 patients Served 118,810 patients Generated 396,672 total patient visits Generated 396,672 total patient visits 46% of patients were uninsured 46% of patients were uninsured 46,994 patients were at or below Federal Poverty Level (FPL) 46,994 patients were at or below Federal Poverty Level (FPL) Over 68% were at or below 200% FPL (known status) Over 68% were at or below 200% FPL (known status)

OK CHC Revenue by Source Federal Grant % Federal Grant % Self-Pay – 25.13% Self-Pay – 25.13% Medicaid – 25.16% Medicaid – 25.16% Medicare – 9.74% Medicare – 9.74% Other 3 rd Party -.09% Other 3 rd Party -.09% Oklahoma Primary Care Association Source: BPHC, HRSA, DHHS, 2009 Uniform Data System, 17 Grantees

Oklahoma Primary Care Association OK CHC Patients by Age Aggregate Totals for OK CHC Grantees – Varies by CHC Source: BPHC, HRSA, DHHS, 2009 Uniform Data System % of Oklahoma OK CHC Population AgePopulationIn Age Group ‘ ,40810% ,45911% ,1417% ,46237% ,22126% 65+10,1199% 118, %

Full-Time Equivalent Employees: Federal Grant Dollars Returning to Oklahoma: $25.29 Million Health Center Total Costs Excluding Donations: $66.65 Million Direct Impact in Oklahoma (2009 – 17 Grantees) Oklahoma Primary Care Association

Collaboration to Protect the Investment & Improve Health Coordination between HRSA grantees (including CAHs & RHCs) to avoid duplication Coordination between HRSA grantees (including CAHs & RHCs) to avoid duplication Work with other neighborhood groups to deliver services Work with other neighborhood groups to deliver services Support letters to demonstrate working relationships with other health care providers Support letters to demonstrate working relationships with other health care providers Leveraging resources and use of technology to strengthen local health care systems & improve patient outcomes Leveraging resources and use of technology to strengthen local health care systems & improve patient outcomes Oklahoma Primary Care Association

Commonwealth Fund 2009 State Scorecard: Cross-Cutting Highlights & Themes Oklahoma Primary Care Association Symptoms of poor care coordination and inefficient or suboptimal use of resources point to opportunities to improve both quality and cost. The State Scorecard points to evidence of gaps in care and fragmented care that reflects health system dysfunction: the failure to provide timely and effective preventive and chronic care; high and, in many states, increasing hospital readmission rates; and rising hospitalization rates for nursing home residents and home health care patients across most states. Despite improvement, rates of potentially preventable hospitalizations remain relatively high in many states. And the gaps in receipt of recommended preventive care such as cancer screenings and immunizations across states underscore the need for a stronger primary care infrastructure in the United States.

Oklahoma Primary Care Association Oklahoma’s Medically Underserved Areas by County With Safety-Net Resources (Community Health Centers, Rural Health Clinics and Critical Access Hospitals) Sources: HRSA, OKPCA & ESRI

Oklahoma Primary Care Association Resources For further information, contact Judy Grant Director of Community Development Oklahoma Primary Care Association 4300 N. Lincoln Blvd., Ste. 203 Oklahoma City, OK (405) , Ext. 104