Health Care Reform Our State: Problems and Perceptions State Medicaid: Issues and Direction A Case for Federal Reform Community Health Centers

WOOD-WOOD- FORD WEBSTER ADAIR ALLEN BALLARD BARREN BATH BELL BOONE BOURBON BOYLE BRACKEN BREATHITT BULLITT BUTLER CALLOWAY CAMPBELL CARLISLE CARROL CARTER CASEY CHRISTIAN CLARK CLAY CLINTON CRITTENDEN DAVIESS ELLIOT ESTILL FAYETTE FLEMING FLOYD FULTON GALLATIN GRANT GRAVES GRAYSON GREEN GREENUP HANCOCK HARDIN HARLAN HARRISON HART HENDERSON HENRY HICKMAN HOPKINS JACKSON JEFFERSON JOHNSON KENTON KNOTT KNOX LARUE LAUREL LAWRENCE LEE Leslie LETCHER LEWIS LINCOLN LIVINGSTON LOGAN LYON MCCREARY MCLEAN MADISON MARION MARSHALL MARTIN MASON MEADE MENIFEE MERCER MONROE MORGAN NELSON OHIO OLDHAM OWEN OWSLEY PERRY PIKE POWELL PULASKI ROWAN RUSSELL SCOTT SHELBY SIMPSON SPENCER TAYLOR TODD TRIGG TRIMBLE UNION WARREN WAYNE WHITLEY WOLFE CRACKEN MC- CUMBER- LAND 1 NICHOLAS CUMBER- LAND MUA/P and HPSA Designations Boyd LYON Designations as of March 2009 CALDWELL BRECKINRIDGE EDMONSON METCALFE WASHINGTON ANDERSON FRANKLIN GARRARD JESSAMINE MONTGOMER PENDLETON MAGOFFIN ROCKCASTLE MUHLENBERG Shortage Designation Legend Medically Underserved Area or Population (MUA/P) Health Professional Shortage Area (HPSA) Both MUA/P and HPSA FORD R OBERTSON

Cunningham, Peter J., and Laurie E. Felland, Falling Behind: Americans’ Access to Medical Care Deteriorates, , Tracking Report No. 19, Center for Studying Health System Change, Washington, D.C. (June 2008).

STATE OF THE STATE Medicaid growth and cost is unsustainable. New leadership gets it! They understand the Big Picture and see how the parts fit together. Trying to move Medicaid from an entitlement program to a program that will improve the health of a population. Using Stimulus, HITECH and MTG funding to move changes in Medicaid and the health of the State Focus on Medical Home and outcomes

THE CASE FOR REFORM AT THE FEDERAL LEVEL ACCESSMILLIONS OF AMERICANS LACK COVERAGE COST GROWTH IN HEALTH CARE SPENDING IS UNSUSTAINABLE FOR FAMILIES, BUSINESSES, AND THE FEDERAL GOVERNMENT QUALITY POOR RETURN ON OUR HUGE INVESTMENT

PROBLEMS There is no health care system. It is a business enterprise. We have a series of silos. Accountability is limited. It has about the same controls as Wall Street.

SOCIETIAL DECISION As a society we have decided that education is a right. We have not made a decision whether health care is a right or a privilege. LESSONS LEARNED AND UNLEARNED What we are learning as a society is that education is a key to our economic success. What we have not learned is that a well educated and healthy workforce is the true key to our future.

Innovative Approaches in Healthcare Technology National Quality Initiative

WOOD-WOOD- FORD WEBSTER ADAIR ALLEN BALLARD BARREN BATH BELL BOONE BOURBON BOYLE BRACKEN BREATHITT BULLITT BUTLER CALLOWAY CAMPBELL CARLISLE CARROL CARTER CASEY CHRISTIAN CLARK CLAY CLINTON CRITTENDEN DAVIESS ELLIOT ESTILL FAYETTE FLEMING FLOYD FULTON GALLATIN GRANT GRAVES GRAYSON GREEN GREENUP HANCOCK HARDIN HARLAN HARRISON HART HENDERSON HENRY HICKMAN HOPKINS JACKSON JEFFERSON JOHNSON KENTON KNOTT KNOX LARUE LAUREL LAWRENCE LEE Leslie LETCHER LEWIS LINCOLN LIVINGSTON LOGAN LYON MCCREARY MCLEAN MADISON MARION MARSHALL MARTIN MASON MEADE MENIFEE MERCER MONROE MORGAN NELSON OHIO OLDHAM OWEN OWSLEY PERRY PIKE POWELL PULASKI ROWAN RUSSELL SCOTT SHELBY SIMPSON SPENCER TAYLOR TODD TRIGG TRIMBLE UNION WARREN WAYNE WHITLEY WOLFE CRACKEN MC- CUMBER- LAND 1 NICHOLAS CUMBER- LAND Section 330 Health Center Sites by County with MUA/P and HPSA Designations Boyd LYON Health Center Legend New Section 330 Health Center sites funded by the ARRA Stimulus Package Section 330 Health Center Sites by County (Number of sites in the County is indicated in circle) Shortage Designation Legend Medically Underserved Area or Population (MUA/P) Health Professional Shortage Area (HPSA) Both MUA/P and HPSA : 19 grantees with 76 sites in 30 counties As of March 2009: 20 grantees with 83 sites in 37 counties (The additional sites will be open by July 2009) CAL DW ELL BRECKINRIDGE EDMONSON METCALFE WASHINGTON ANDERSON FRANKLIN GARRARD JESSAMINE MONTGOMER PENDLETON MAGOFFIN ROCKCASTLE MUHLENBERG

What is a Health Center? For more than 40 years, HRSA-supported Health Centers have provided comprehensive, culturally competent, quality primary health care services to medically underserved communities and vulnerable populations. Health centers are community-based and patient-driven organizations that serve populations with limited access to health care. These include low income populations, the uninsured, those with limited English proficiency, migrant and seasonal farm workers, individuals and families experiencing homelessness, and those living in public housing.

Health Center Program Fundamentals Located in or serve a high need community (designated Medically Underserved Area or Population). Governed by a community board composed of a majority (51% or more) of health center patients who represent the population served. Provide comprehensive primary health care services as well as supportive services (education, translation and transportation, etc.) that promote access to health care. Provide services available to all with fees adjusted based on ability to pay. Meet other performance and accountability requirements regarding administrative, clinical, and financial operations.

Internet T-1 Teleradiology Hospital Portals PrimaryPlus Vanceburg T-1 Video Only PrimaryPlus Robertson County University of Louisville PrimaryPlus Flemingsburg PrimaryPlus Tollesboro PrimaryPlus Maysville PrimaryPlus Bracken University of Kentucky Insurance Other Data Sources Other Comprehend Family Med., Women’s Health, Dental, PT and Fitness Center and Pharmacy T-1 Voice Data TeleHealth Family Med., Pharmacy Family Medicine OB/GYN, Family Medicine, Pharmacy Family Medicine

Community Programs

National Quality Initiative

HOW IS DATA BEING USED TO IMPR0VE CARE IN CHCs

An example is provided by the analysis we performed in linking data on diabetics from Big Sandy’s information system with Medicaid claims data. We accomplished this with the assistance of Artemetrx. We had observed, as stated earlier, that Big Sandy clinicians prescribe 80% of their diabetic patients renal-protective agents. In looking at the Medicaid claims data, however, we find that a full 29% of those patients prescribed such medications never get them filled at a pharmacy. Further analysis of claims data reveals that only 39% of patients prescribed these medications are compliant with the medication at least 75% of the time. With access to this type of information, Big Sandy would be in a position to greatly enhance its already leading edge care management programs.