America’s Voice for Community Health Care The NACHC Mission To promote the provision of high quality, comprehensive and affordable health care that is coordinated, culturally and linguistically competent, and community directed for all medically underserved people. 2

Community Treatment Provider Caucus of NIDA’s National Drug Abuse Treatment Clinical Trials Network Federally Qualified Health Centers March 15, 2011 Michael R. Lardiere, LCSW Director HIT; Sr. Advisor Behavioral Health National Association of Community Health Centers 3

“My presentation today does not include any discussion about a particular commercial product/service and I do not have any significant financial interest/relationship with any organizations that make/provide this product/service” 4

5 “Neighborhood Health Centers” funded in  Congressional authorization of Community Health Centers and Migrant Health Centers: sections 329 and 330 of the Public Health Service Act.  Authorization of Health Care for the Homeless Program and Public Housing Primary Care Programs in 1987 and 1990  Health Centers Consolidation Act of 1996 brought all four programs under section 330 of the PHS Act  Allowed for combined applications for funding Federally Qualified Health Centers

6  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.

Health Center Program Overview: In 2009, the health center program made the following impact: Served 18.8 million patients 92% below 200% poverty 71% below 100% poverty 38% uninsured 1,018,000 homeless individuals 865,000 migrant/seasonal farmworkers 165,000 residents of public housing Provided 74 million patient visits 1,131 grantees - half of which are located in rural areas 7,900+ service sites Employed more than 123,000 staff 9,100 physicians 5,800 nurse practitioners, physicians assistants, and certified nurse midwives Source: HRSA Uniform Data System (UDS) 2009Source: HRSA Uniform Data System (UDS) 2009

09/19/08 - Bureau of Primary Health Care Health Center Program: Who Is Served Nationally, Health Centers serve: 1 in 20 individuals; 1 in 12 African- Americans; 1 in 9 Hispanic/Latinos; 1 in 8 uninsured; 1 in 7 individuals living below 200 percent of the Federal poverty level; and 1 in 4 homeless individuals and migrant/seasonal farmworkers.

09/19/08 - Bureau of Primary Health Care Health Center Program: Who We Serve Source: Uniform Data System, 2006 and U.S. Census Bureau, Current Population Reports. Income, Poverty, and Health Insurance Coverage in the United States: 2005 (revised estimate), March 2007.

 7 million are uninsured (38.9%)  6.4 million have Medicaid (35.4%)  1.4 million have Medicare (7.6%)  2.8 million have private insurance (15.5%)  468,000 have other public insurance coverage (including non- Medicaid  expanded SCHIP) (2.6%)  12.7 million are below poverty (70.4%)  16.5 million are low income (below 200% of poverty) (91.4%)  7.9 million are rural (44%) Federally Qualified Health Centers

Primary Diagnosis 1. Hypertension 2. Diabetes 3. Depression and other mood disorders 4. Other mental disorders, excluding drug or alcohol dependence (includes mental retardation) 5. Anxiety disorders including PTSD 6. Heart disease (selected) 7. Other substance abuse related disorders (excluding tobacco use disorders) 8. Attention deficit and disruptive behavior disorders

© Copyright 2010 National Association of Community Health Centers. All rights reserved.  70% of Health Centers Currently Provide Behavioral Health Services  All Health Centers are required to have a behavioral health intervention identified in their annual plan Federally Qualified Health Centers

EHR Uptake

Federally Qualified Health Centers

 90% of Health Centers Screen for Depression  61% Screen for Substance Abuse

Federally Qualified Health Centers  16% provide Buprenorphine Treatment  84% are interested in at least one provider being trained to provide Buprenorphine Treatment

Federally Qualified Health Centers NACHC 2010 Assessment of Behavioral Health Services in FQHCs NACHC is a Partner in the SAMHSA/HRSA funded Center for Integrated Health Solutions

Federally Qualified Health Centers EHR Uptake  Approximately 40% of all Health Centers have EHRs  NACHC 2008 HIT survey  Recent Commonwealth Fund Survey on Medical Home

Federally Qualified Health Centers EHR Uptake How Did They Get There?

What is a Health Center Controlled Network(HCCN)? Collaborative Partnerships 3 or more Federally Qualified Health Centers Must be 51% controlled by FQHCs Perform Core Functions to Promote –Integration & Coordination of Primary Care Business & Clinical Functions –Not duplicated across HCCN partner FQHCs 21

Advancing HIT through Health Center Controlled Networks (HCCN) Why Networks? –Collaboration of health centers and other safety net providers. –Economies of scale/cost efficiencies/volume. –Enhanced efficiencies in business and clinical core areas. –Higher performance and value. –Sharing of expertise and staff among collaborators. 22

EHR Implementation Grants (2007- Present) Funds used for: EHR system, training, hardware, software, conversion process, network infrastructure (hardware and people) Overview 23

EHR Investment (as of 10/09) 137 health centers participants 108 health centers live with EHR (79%) 2007 (Project Period ends 2010) 53 health center participants 31 health centers live with EHR (61%) 2008 (Project Period ends 2011) 62 health center participants 2 health centers live with EHR (2%) 2009 (Project Period ends 2011) 252 health center participants 141 health centers live with EHR (56%) TOTAL 24

Characteristics of HCCN’s EHRs Meaningful Use of EHR 99% CCHIT Certified 97% have PMS 67% have Registry 52% have CPOE 55% have Electronic Prescribing 74% have Eligibility Screening 81% have CDS 25

Strengthening the Patient Centered Medical Home New Hampshire –Lamphrey Health Center, CHAN's largest member, received a Level 3 Patient-Centered Medical Home by NCQA. CHAN used existing HIT data warehouse and EHR plus new reporting capabilities to assist LHC in receiving the designation. New York –EHR-based reports were used to assist the Institute's in becoming a Level 3 Patient-Centered Medical Home by the National Committee for Quality Assurance (NCQA). 26

Linking Primary Care and Specialty Care In Massachusetts, grantee implemented an eReferral system as part of their HIE project to improve care coordination Lag days between a CHC referral request and when the appointment is scheduled BEFORE: 56 Days AFTER: 2.7 Days Lag days between when the patient was seen by specialist and when the specialist report is available to CHCs BEFORE: 32.9 Days AFTER: 9.4 Days 27

Telehealth and Migrant Populations: Solution Finger Lakes Community & Migrant Health uses telehealth for: –Specialty care (oral, ENT, dermatology, etc) – Distance learning and training for providers –Enabling Services (i.e., interpreters, outreach, etc) 28

29 Evolving HCCN Landscape Vendors HCCNs as Regional Organizers and Niche Service Providers Hospitals / Plans HCCNs as Key Participants in Rapidly Changing Market RECs States & Designated Entities New Customers? Consortia as Regional Organizers ARRA/HITECH has introduced new opportunities, as well as new threats, for HCCNs to consider in addition to their already evolving roles as partners with CHCs and other HCCNs.

30 Where are we going? The ultimate requirement to realize the potential EHR benefits is the organizational vision and infrastructure to utilize the data to introduce improvements in the clinical process. Readiness Adoption Meaningful Use How do we get there? Better Quality of Care

Where are HCCN’s Located?

32 How To Find a HCCN? NACHC Web Site: HRSA Web site:

33 Contact Info: Michael R. Lardiere, LCSW Director HIT Sr. Advisor Behavioral Health National Association of community Health Centers