P acific I slands H ealth O rganization A ssociation Pacific Basin Primary Care Office Angela Techur-Pedro, MO/PhD PB-PCO Coordinator 1

Pacific Basin PCO Program Background HRSA funded, Bureau of Health Workforce (BHW) and Office of Shortage Designation (OSD) The PIHOA PBPCO is in its year 7 New grant: FY2 Supports PIHOA Secretariat Staff: 1 100% FTE; 1 20% FTE; 1 10% FTE and 10% Administrative cost and deliverable related expenses—Travel, equipments/supplies, communications, etc., 2

Pacific Basin PCO Program Goal of the PCO program Improve Access to Primary Care Access to primary care is “the timely use of personal health services to achieve the best health outcomes” (HP 2020) 3

Pacific Basin PCO Program To operationalize “Access to PC” based on the definition: Coverage Services Timeliness Workforce 4 Note: Limited resources restrict needs assessment specific for HPSA and MUA health indicators

Pacific Basin PCO Program Generally, the PCO program has 3 core deliverables: 1.Statewide Primary Care Needs Assessment (SPCNA) Services 2.NHSC site certification/recertification 3.NHSC provider recruitment, placement, and retention 5 To assess, describe, and meet the identified primary care needs

Pacific Basin PCO Program First core deliverable: 1.Statewide Primary Care Needs Assessment (SPCNA) Services (Pacific Basin Regional SPCNA Data Book) endorsed by 57 th PIHOA Executive Board during the last PIHOA meeting in Palau a.Coverage (insurance; accessible – within 30 minutes; affordable; acceptable;) b.Services (primary care, dental and mental health) c.Timeliness (appointments are <=2 weeks; clinic visits are within 2 hours after arrival d.Workforce—qualified provider (culturally sensitive) 6 To assess, describe, and meet the identified primary care needs

Pacific Basin PCO Program 2nd Core Deliverable: HPSA and MUAP Designations (New or Update) HPSA: Health Professional Shortage Areas (HPSAs) 1.3 Types: a.Primary care (Highest score=25) b.Dental Health (Highest score=26) c.Mental Health (Highest score=25) 2.May be geographic (county or service area), population (low income—at or below 100% Federal Poverty Level) or facilities (FQHCs, State or Federal facilities) 7

Pacific Basin PCO Program Data Sources: 1.Census for Population and SES indicators 2.MCH Annual Reports from MCHB and USAPIJ’s 3.CMS National Provider List based on National Provider Index (NPI) 4.Provider Survey (Physicians, Dentists, Psychiatrists and NHSC providers including PA, NP, Nurse Corp) 1.Primary Care Providers (PC Provider Survey)PC Provider Survey 2.Dental Health Providers (Dental Provider Survey)Dental Provider Survey 3.Mental Health (Mental Health Provider Survey)Mental Health Provider Survey 8 Note: Slight change to the Pacific Basin Regional SPCNA Data Book will be an expanded Health Workforce (Physicians, Dentists, and Psychiatrist) Inventory

Pacific Basin PCO Program Current Status: 9

Pacific Basin PCO Program MUAP Designations (New or Update) MUAP: Medically Underserved Area/Population 1.1 types: a.Primary care (Eligible score is <62 out of 100) 2.May be geographic (county or service area), population (low income—at or below 100% Federal Poverty Level) 3.Qualified Designation is based on an Index of Medical Underservice (IMU) score <62 10

Pacific Basin PCO Program MUAP Designations (New or Update) MUAP: Medically Underserved Area/Population 1.Qualifying for Designation is based on 4 indicator values  weighted values based on prescriptive criteria and added up to yield an IMU score a.Ratio of primary medical care physicians per 1,000 population, b.Infant mortality rate (IMR) c.Percentage of the population with incomes at or below 100%FPL d.Percentage of the population aged 65 or over 11

Pacific Basin PCO Program Example of MUAP Designation Application Qualifying CNMI as a MUA: Medically Underserved Area a.Ratio of primary medical care physicians per 1,000 population 12.5 provider FTE to 62,392 population  1/4991*1000=0.2, weight value~ 2.8 a.Infant mortality rate (IMR): <8.0 per 1000 LB ~ weighted value =26.0 b.Percentage of the population with incomes at or below 100%FPL: >50% ~weight value=0 c.Percentage of the population aged 65 or over: <7%, weighted value = 20.2 d.Together, these values total ~ 49 although OSD  IMU= Note: Access to the methodology “demystifies” the process and allows us an opportunity to try to create Service areas that gets the best scores!!

Pacific Basin PCO Program 2 Core Benefits of HPSA and MUAP Designation 1.Qualifies USAPIJ to apply for $ Funding for Community Health Centers (MUAP) among other funding opportunities 2.Qualifies USAPIJ sites for provider placements and other funding opportunities (CAH), Rural Health Clinics 13

Pacific Basin PCO Program Application Process 1.HRSA BHW online application software system –SDMS (Shortage Designation Management System) 2.SDMS rolled out in December 15, Many technical and non-technical issues 4.Pacific Basin sites 1.Only Guam has an account 2.BHW has not completely developed the application for the USAPI 3.Proposed solution: Paper application yet to be approved 14

Pacific Basin PCO Program 3nd core deliverable: 1.NHSC site certification and recertification a. Certification (4/1-6/2); Recertification (Aug 1-9/30) b. Bureau of Health Workforce (BHW) Program Portal ( Each USAPIJ can create accounts for advertisements, recruitments, and profile sharing of sites information 15 Note: CAH

Pacific Basin PCO Program 3rd core deliverable (cont): 2. NHSC provider recruitment, placement, and retention a.Rationale: short-term gap solution for HPS in the region 1)Feasible for AS, CNMI, Guam 2)Currently not as feasible in the FAS b.PCO Annual Meeting: 6/22-6/25/2015 in Rockville, MD 1)ASTHO sponsored PCO Director Peer Mentoring Program (Danielle Garrett (ASTHO) and Lynnette Araki (HRSA) 2)2-days Meetings with NHSC, ASTHO, BPHC, HIV, STI, MCH, COINN etc., 3)Potential Solution – SLRP 4)Requires non-federal matching dollars 5)New Application cycle opens in 9/

Pacific Basin PCO Program Updates: 1.PCO Annual Meeting: 6/22-6/25/2015 in Rockville, MD 1.Address many of the SDMS technical issues face to face/one-on-one so that the system’s technical team can see on the computer screen what I encounter with the SDMS system for the USAPIs 2.ASTHO sponsored PCO Director Peer Mentoring Program (Danielle Garrett (ASTHO) and Lynnette Araki (HRSA) 1)2-days Meetings with NHSC, ASTHO, BPHC, HIV, STI, MCH, COINN etc., 2)Potential Solution – SLRP 3)Requires non-federal matching dollars 4)New Application cycle opens in 9/ Upcoming Site visits: 9/6-10/5 a.PBMA in Palau (Face-to-face provider interview) b.Site visits across—Guam, CNMI, Chuuk, Pohnpei, Kosrae, Ebeye, Majuro 17

Pacific Basin PCO Program 18 Comments? Questions? Recommendations?

Acknowledgements Executive Board Members Palau Board Members & Partners Guam Board Members & Partners CNMI Board Members & Partners FSM Board Members & Partners RMI Board Members & Partners American Samoa Board Members and Partners Associate and Affiliate Members Pacific Basin Dental Association Board Pacific Basin Medical Association Pacific Basin Mental Health Association Pacific Islands Primary Care Association 19

Contact & Helpful US HRSA Health Professional Shortage Designation HPSA or MUA/P Designation Scores Primary Health designated Areas or Facilities in the Pacific Basin _BCD_HPSA_H1_FederalRegister.pdf (pg. 224 – 234) _BCD_HPSA_H1_FederalRegister.pdf Dental Health designated Areas or Facilities in the Pacific Basin _BCD_HPSA_H6_FederalRegister.pdf (pg ) _BCD_HPSA_H6_FederalRegister.pdf Mental Health designated Areas or Facilities in the Pacific Basin _BCD_HPSA_H7_FederalRegister.pdf (pg ) _BCD_HPSA_H7_FederalRegister.pdf (PIHOA & PB-PCO) Web: Web: Angela Techur-Pedro (HPSA/MUAP/SPCNA) Dr. Greg Dever (HRH & TA for Workforce Dev.) Emi Chutaro (PIHOA Ex. Director) Regie Tolentino (Honolulu Office Manager) PIHOA/PB-PCO Office in Honolulu, HI Pacific Guardian Center Suite #2075, Mauka Tower 737 Bishop Street Honolulu, Hawaii Office: (808) I Fax: (808) (808) (808)