Safety Net Providers and Health Care Transportation Presented by Oklahoma Primary Care Association HRSA/BPHC State Liaison

Human Nature & Health Care Health care is put on ‘back burner’ until needed Health care is put on ‘back burner’ until needed Can’t schedule earaches, sore throats, etc. Can’t schedule earaches, sore throats, etc. Risky behavior (e.g., smoking, overeating) is hard to reverse Risky behavior (e.g., smoking, overeating) is hard to reverse Health care provision is one of first items to get cut from personal budgets Health care provision is one of first items to get cut from personal budgets Oklahoma Primary Care Association

America’s Health Structure 2008 Tertiary Care Secondary Care Primary Care

Oklahoma Primary Care Association Where We Want to Be Tertiary Care Secondary Care Primary Care = PREVENTIVE HEALTH!

Oklahoma Primary Care Association Who is OPCA? Funded by Health Resources and Services Administration (HRSA)/Bureau of Primary Health Care (BPHC) to assist community health centers (CHCs) and create a regional and state presence Funded by Health Resources and Services Administration (HRSA)/Bureau of Primary Health Care (BPHC) to assist community health centers (CHCs) and create a regional and state presence OPCA has hybrid membership – community health centers (CHCs), other safety net providers and health advocates OPCA has hybrid membership – community health centers (CHCs), other safety net providers and health advocates Mission: Strengthening access for community-based health care through advocacy, education, and technical assistance Mission: Strengthening access for community-based health care through advocacy, education, and technical assistance

Oklahoma Primary Care Association What are CHCs/FQHCs? 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, receiving grant funds under Section 330 of the Public Health Service Act are federally mandated to provide access based on affordable sliding fees for anyone seeking primary health care. Note: FQHC – a deemed reimbursement status for 330-funded CHCs due to greater amount of mandatory uninsured services

Oklahoma Primary Care Association Oklahoma CHC Presence Prior to 2001 Six CHC Sites Six CHC Sites - 4 CHC grantees - 2 Homeless Sites CHC Grantee Homeless Center

2008 Oklahoma CHC Presence 2008 Oklahoma CHC Presence Over $9.5 million in CHC funds to OK since the inception of President Bush’s Initiative! CHC Grantee Homeless Center Expansion/Satellite Oklahoma Primary Care Association

Core Elements of CHCs Overcoming Health Care Access Barriers Federal Resources be targeted to communities with highest need – must serve an MUA Federal Resources be targeted to communities with highest need – must serve an MUA Health services are available to all people regardless of ability to pay (sliding fee scale) Health services are available to all people regardless of ability to pay (sliding fee scale) Provide comprehensive primary care enabling services (transportation, translation) and health education Provide comprehensive primary care enabling services (transportation, translation) and health education Health centers must be directed by a governing board of which 51% are patients of the health center Health centers must be directed by a governing board of which 51% are patients of the health center Must meet performance & accountability requirements Must meet performance & accountability requirements

Oklahoma Primary Care Association Who Do Oklahoma CHCs Serve? By Income Level, % FPL and Below 75.6% % 16.4% % 4.0% Over 200% 4.0% Source: BPHC, HRSA, DHHS, 2006 Uniform Data System Of Health Center Patients in America… Half reside in rural areas One in five low income children are served Over 70% have family incomes at or below poverty ($17,600 annual income for family of three – 2008 FPL)

Oklahoma Primary Care Association Who Do Oklahoma CHCs Serve? By Insurance Status, 2006 Uninsured 50.7% Medicaid/SCHIP 26.3% Medicare 11.8% Private 11.2% Source: BPHC, HRSA, DHHS, 2006 Uniform Data System

2006 Oklahoma Health Center Population by Age Oklahoma Primary Care Association

Examples of Health Center Services Primary Care – All Ages Primary Care – All Ages Well Child Well Child Well Baby Well Baby Lab, X-Ray Lab, X-Ray Oral Health Oral Health Mental Health/ Mental Health/ Substance Abuse Pre- and Postnatal Care Pre- and Postnatal Care Family Planning Family Planning Pharmacy Pharmacy Immunizations Immunizations Translation Translation Prevention Prevention Outreach Outreach Home Health Home Health Child Care Child Care Social Services Social Services Referral Referral Patient Education Patient Education School-Based Services School-Based Services Homeless Health Care Homeless Health Care Transportation Transportation

Transportation Barriers for Low-Income & Elderly Patients Inability to afford personal transportation - initial cost of car - fuel costs and maintenance Inability to afford personal transportation - initial cost of car - fuel costs and maintenance Unable to drive due to… - vision impairment and other health conditions - medications that prohibit driving Unable to drive due to… - vision impairment and other health conditions - medications that prohibit driving Absence of an ‘on call’ driver Absence of an ‘on call’ driver Oklahoma Primary Care Association

Transportation Barriers Cause… Delay in care - more serious illness - reduced quality of life - increased cost of care Delay in care - more serious illness - reduced quality of life - increased cost of care Inability to secure medication, social services, etc. Inability to secure medication, social services, etc. Use of ER for non-emergent problems Use of ER for non-emergent problems Increased medical costs for everyone Increased medical costs for everyone Oklahoma Primary Care Association

The Driving Forces Behind Health Care Policy 1. Cost, Cost, Cost 2. Wide Variation in Health Care Delivery 3. Public Outcry

Oklahoma Primary Care Association 1. America’s Health Care Costs Health care costs in America exceed $2 trillion now expected to double within next decade Health care costs in America exceed $2 trillion now expected to double within next decade The U.S. is the worldwide leader in costs The U.S. is the worldwide leader in costs In FY2006, Medicaid and Medicare expenditures totaled $600 billion In FY2006, Medicaid and Medicare expenditures totaled $600 billion By 2030, 50% of all federal dollars are projected to be spent on Medicaid and Medicare – given the current trend By 2030, 50% of all federal dollars are projected to be spent on Medicaid and Medicare – given the current trend Spending is unevenly distributed with a reimbursement system that encourages ‘churning’ – 43% of ‘top 5% population in expenditures’ is 65 years or older Spending is unevenly distributed with a reimbursement system that encourages ‘churning’ – 43% of ‘top 5% population in expenditures’ is 65 years or older

Oklahoma Primary Care Association Health Care Costs & The Aging of America Medicare population 1960 – 16.6 million 2050 – 78.9 million (projected) Medicare population 1960 – 16.6 million 2050 – 78.9 million (projected) While Medicare costs escalate, Social Security funding mechanisms are beginning to flat line While Medicare costs escalate, Social Security funding mechanisms are beginning to flat line The intersection where Medicare costs exceed the Social Security funding mechanism is expected just before the year 2025 The intersection where Medicare costs exceed the Social Security funding mechanism is expected just before the year 2025 In SFY2006, 19.17% of Oklahoma Medicaid Enrollees were Aged, Blind & Disabled (ABD); 59.30% of Total Expenditures were for ABD In SFY2006, 19.17% of Oklahoma Medicaid Enrollees were Aged, Blind & Disabled (ABD); 59.30% of Total Expenditures were for ABD

Transportation Issues Facing Safety Net Providers Schedule difficulties result in ‘no shows’ Schedule difficulties result in ‘no shows’ Lack of culturally-sensitive services Lack of culturally-sensitive services Insurance rarely pays for transportation Insurance rarely pays for transportation Rural areas have no or limited public transportation options with many patients residing more than 30 miles away from health center Rural areas have no or limited public transportation options with many patients residing more than 30 miles away from health center Logistically difficult to schedule a ‘van load’ of patients Logistically difficult to schedule a ‘van load’ of patients Oklahoma Primary Care Association

What Safety Net Providers Do to Enable Transportation Offer transportation service – limited by budget constraints, manpower, etc. Offer transportation service – limited by budget constraints, manpower, etc. Use SoonerRide when possible (3-day process) Use SoonerRide when possible (3-day process) Connect with local community action agencies for transportation solutions Connect with local community action agencies for transportation solutions Offer vouchers and bus tokens to patients Offer vouchers and bus tokens to patients Develop health center sites near public transportation lines Develop health center sites near public transportation lines Oklahoma Primary Care Association

What Safety Net Providers Would Like to See Statewide transit plan for OK Statewide transit plan for OK Dedicated funding for non-urgent health care transportation Dedicated funding for non-urgent health care transportation Culturally sensitive services for all people Culturally sensitive services for all people Increased dependability of SoonerRide Increased dependability of SoonerRide Oklahoma Primary Care Association

Questions? For further information, contact Judy Grant, Director of Community Development Oklahoma Primary Care Association 4300 N. Lincoln Blvd., Ste. 203 Oklahoma City, OK (405)  Fax (405)