Bureau of Primary Health Care Update New Mexico Primary Care Association 2011 Annual Meeting and Conference Bureau of Primary Health Care Update June 16, 2011 Vanessa Shaw, MPH, MA Chief, Central Valley Branch, Southwest Division U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care

Today’s Presentation National Overview New Mexico Health Center Program Performance Primary Health Care Focus New Mexico Impact Funding Primary Health Care Updates Organizational Structure Policy Quality and Data Additional HHS and HRSA Resources HRSA Priorities

Primary Health Care Mission Improve the health of the Nation’s underserved communities and vulnerable populations by assuring access to comprehensive, culturally competent, quality primary health care services 3 3

Health Center Program Overview Calendar Year 2009 18.8 Million Patients 92% At or Below 200% Poverty 38% Uninsured 63% Racial/Ethnic Minorities Over 1 Million Homeless Individuals 865,000  Migrant/Seasonal Farmworkers 165,000  Residents of Public Housing 73.8 Million Patient Visits 1,131 Grantees – half rural 7,900+ Service Sites Over 123,000 Staff 9,100+ Physicians 5,700+ NPs, PA, & CNMs 4 Source: Uniform Data System, 2009, Service Sites: HRSA Electronic Handbooks Scope Repository 12/31/2009 4 4

Health Center Program National Presence 5

Health Center Program Overview National Impact Source: Health Center Data: Uniform Data System, 2009. National Data: U.S. Census Bureau, 2009 Current Population Reports and Current Population Survey. 6 6 6

Health Center Performance Calendar Year 2009 Among Health Center Patients: 67.3% entered prenatal care in the first trimester Rate of low birth weight babies (7.3%) continues to be lower than national estimates (8.2%) 68.8% of children received all recommended immunizations by 2nd birthday 63.1% Hypertensive Patients with Blood Pressure<= 140/90 70.7% Diabetic Patients with HbA1c <= 9 $600 Total Cost per Patient $131 per Medical Visit For more information: http://www.bphc.hrsa.gov/policiesregulations/performancemeasures/index.html 7 Source: Uniform Data System, 2009 7 7

Health Center Performance 2009 Health Center Patient Survey Over 80% reported the overall quality of services received at the health center were “excellent” or “very good.” Over 80% reported that they were “very likely” to refer friends and relatives to the health center. Over 75% reported the main reason for “going to the health center for healthcare instead of someplace else” was because it was convenient (28%), affordable (25%), and provided quality healthcare (22%).

Primary Health Care Measures of Success 9

Primary Health Care Drivers of Success Technical Assistance and Support Grantee - Project Officer Relationship Application Guidance and Electronic Support Management and Administrative Support Decision Support and Work Environment 10

New Mexico State Health Centers Calendar Year 2009 New Mexico State Health Center Grantees In 2009, 15 Health Centers Served 274,397 patients: 37.45% were uninsured 89.03% were at or below 200% of poverty 57.06% Female 58.90% nationally 27.51% Children < age 18 32.78% nationally 10.92% Seniors age 65+ 6.89% nationally Served by (FTEs): 122.96 Physicians 95.27 Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives Map and Data to be inserted Source: Uniform Data System, 2009

New Mexico State Health Centers Calendar Year 2009 PERFORMANCE FUNDING $37.99 M base operational grants (FY ‘09) $19 M in ARRA grants $4.96 M – Increased Demand for Services $12.82 M – Capital Improvement Projects $1.22 M - Facilities Investment Program 45,533 additional patients served via ARRA 29,319 additional uninsured patients served via ARRA Among New Mexico State Health Center Patients: 65.08% entered prenatal care in the 1st trimester Rate of low birth rate: 5.79% 70.24% of children have received all recommended immunizations by second birthday 77.54% Diabetic Patients with HbA1c <= 9 68.75% Hypertensive Patients with Blood Pressure <= 140/90 $621.73 Cost per Patient; $153.43 per Visit Source: Uniform Data System, 2009 and HRSA Health Center Quarterly Report, March 31, 2011.

Primary Health Care Updates Organizational Structure Policy Recent Program Policies Anticipated Program Policies Funding American Recovery and Reinvestment Act Affordable Care Act Fiscal Year 2011 Funding and FY 2012 President’s Budget Quality and Data Medical/Health Home Initiative FTCA and Patient Safety/Risk Management UDS Additional HHS and HRSA Resources HRSA and BPHC Priorities

Organizational Structure Updates

Bureau of Primary Health Care New Structure Purpose and Goals Build on current structure but prepare for program growth Promote integration of BPHC’s service delivery programs Improve coordination of internal and external technical assistance and training activities Provide increased administrative service and support for grantees and staff 15

Bureau of Primary Health Care New Organizational Structure OFFICE OF THE ASSOCIATE ADMINISTRATOR Office of Administrative Management Office of Policy and Program Development Office of Quality and Data Office of Special Population Health Office of Training &Technical Assistance Coordination Northeast Division Central Southeast Division North Central Division Southwest Division Division of National Hansen’s Disease Program 16 16

New Organizational Structure: Primary Health Care Divisions Transition from Three to Four Divisions Project Officers for: Health Centers State/Regional Primary Care Associations FQHC Look-Alikes Technical Assistance and Support 17

New Organizational Structure: Primary Health Care Divisions 18 18

Southwest Division Regions: 6 and 9 Division Director: Angela Powell Operations Director: Cynthia Phillips Five Branches: Central Southwest Branch: Texas Central Valley Branch: Arizona, Central California and New Mexico East Southwest Branch: Arkansas, Louisiana and Oklahoma North Pacific Branch: Nevada and Northern California South Pacific Branch: Southern California, Hawaii and the Pacific Islands 19

Policy Updates

Recently Released Policies Process for Becoming Eligible for Medicare Reimbursement under the FQHC Benefit Health Center Collaboration FINAL Federal Tort Claims Act (FTCA) Health Center Policy Manual HRSA Patient-Centered Medical/Health Home Initiative HIV Testing in Health-Care Settings Free Clinics Federal Tort Claims Act (FTCA) Program Policy Guide To Access these and other policies, visit: http://www.bphc.hrsa.gov/policiesregulations/policies/index.html

2011 Anticipated Policy Topics FINAL Requirements for Medical Malpractice Coverage for Free Clinics (Spring 2011) FINAL Governance (Spring 2011) DRAFT Change in Scope for Non-Traditional Facilities (Spring 2011) DRAFT Sliding Fee Discount Program (Summer 2011) DRAFT Sub-Recipients/Sub-Contracts (Fall 2011) DRAFT Quality Improvement/Assurance (Fall 2011) Final and draft policies open for comments will be posted at: http://www.bphc.hrsa.gov/policiesregulations/policies/index.html

Funding Updates

American Recovery and Reinvestment Act Health Center Awards to Date Awarded $156 million to support 127 New Access Point (NAP) grants. Awarded $342 million to support almost 1,130 grants for Increased Demand for Services (IDS). Awarded $853 million to support over 1,120 grants for Capital Improvement Program (CIP). Awarded $520 million to support 86 grants under the Facility Investment Program (FIP). Awarded $121 million for 99 grants to expand Health Information Technology (HIT).  

American Recovery and Reinvestment Act Health Center Program Outcomes What have we accomplished so far? 4.3 million patients served More than 2.4 million uninsured patients served What’s next? 1,600+ New or Improved Health Center Sites 650+ Health Centers with new equipment or health information technology systems 380+ Health Centers with new/enhanced certified EHRs Source: HRSA Health Center Quarterly Report March 31, 2011

Affordable Care Act: Support for Health Centers The Affordable Care Act provides $11 billion in funding over the next 5 years for the operation, expansion, and construction of health centers throughout the Nation. $9.5 billion is targeted to: Support ongoing health center operations. Create new health center sites in medically underserved areas. Expand preventive and primary health care services, including oral health, behavioral health, pharmacy, and/or enabling services, at existing health center sites. $1.5 billion will support major construction and renovation projects at community health centers nationwide. 26 26

Affordable Care Act: Other Key Health Center Provisions National Health Service Corps and Workforce Programs Teaching Health Centers School-Based Health Centers Negotiated Rulemaking for Shortage Designation Community-Based Collaborative Care Networks

Fiscal Year 2011 Funding The appropriation for the Health Center Program in Fiscal Year (FY) 2011 is $1.585 billion which is a $600 million reduction from FY 2010. When combined with the Affordable Care Act funding, the overall amount available for health centers in FY 2011 is approximately $400 million above the 2010 fiscal year funding level. Includes continued support for the 127 health center sites and more than 1,100 Increased Demand for Services grants initially established through the Recovery Act. The U.S. Department of Health and Human Services (HHS) reviewed its operating plan and has made adjustments.

Fiscal Year 2012 President’s Budget $3.3 billion for Health Centers, including $96 million for FTCA coverage $50 million for School-Based Health Center Capital grants 29 29

Quality and Data Updates

Patient Centered Medical/ Health Home (PCMHH) Initiative Encourages and supports health centers to transform their practices and participate in the PCMHH recognition process to: improve the quality of care and outcomes for health center populations; increase access; and provide care in a cost effective manner. HRSA/BPHC will cover recognition process fees and provide technical assistance resources for practice transformation. Participation is strongly encouraged and provides an opportunity for health centers to achieve PCMH recognition. For further information on the PCMHH Initiative: PCMHH Initiative PAL: http://www.bphc.hrsa.gov/policiesregulations/policies/pal201101.html BPHC Helpline: bphchelpline@hrsa.gov or 1-877-974-BPHC (2742) PCMHH email: PCMHHinitiative@hrsa.gov 31 31

FTCA Consolidated Policy Manual FTCA Program Updates FTCA Consolidated Policy Manual Primary source for information on FTCA grantees and related stakeholders Consolidates, clarifies and synthesizes existing FTCA policy documents and statutory language Available at: http://bphc.hrsa.gov/policiesregulations/policies/pin201101.html Application Review/Deeming in EHB 2011 Requirements for FTCA Deeming available in PAL 2010-06: http://www.bphc.hrsa.gov/policiesregulations/policies/pal201006.html For TA on submitting FTCA Applications in EHB contact: Email: BPHCHelpline@hrsa.gov Phone: 1-877-974-2742

Patient Safety Web Resources Risk Management and Patient Safety Web Resources ECRI risk management and patient safety resources are available to Health Center Program grantees and Free Clinics at no cost.  Resources include: Risk management courses Continuing medical education (CME) credits at no cost to health care providers Links to archived audio-conferences/webinars to supplement evidence-based risk management training Guidance articles, self-assessment tools, ready-made training materials on patient safety, quality and risk management for the health center and free clinic setting Risk & Safety E-news Visit: www.ecri.org/clinical_RM_program. 

Review PAL 2010-12 for additional details: 2011 UDS Reporting New/revised 2011 clinical measures approved January 3, 2011. New Measures:  Weight Assessment and Counseling for Children and Adolescents Adult Weight Screening and Follow-up Tobacco Use Assessment and Cessation Counseling Asthma – Pharmacological therapy Revised Measures: Diabetes HbA1c Control Childhood Immunizations 2 years Review PAL 2010-12 for additional details: http://www.bphc.hrsa.gov/policiesregulations/policies/pdfs/pal201012.pdf

UDS Web Tools UDS Website: Data analysis tools http://www.hrsa.gov/data-statistics/health-center-data/index.html. Data analysis tools Data download functionality UDS Grantee/State/National Summaries Health Center Trend Reports State and National Roll-up Reports Reporting and Training Resources UDS Mapper: www.udsmapper.org HRSA has developed a mapping and support tool driven primarily from data within the Uniform Data System (UDS) Webinar trainings on using Mapper functionality available: http://www.udsmapper.org/webinars.cfm

Additional HHS and HRSA Resources

Partnership for Patients: Better Care, Lower Costs New HHS-supported public-private partnership that will help improve the quality, safety and affordability of health care for all Americans.  Goals: Keep patients from getting injured or sicker. Help patients heal without complication. Partners include: Hospitals and national organizations representing physicians and nurses; Patient and consumer organizations; and Employers, unions, health plans and States. For more information visit: www.HealthCare.gov/center/programs/partnership

Technical Assistance (TA) Resources National and state-based support for training and technical assistance: Primary Care Associations Primary Care Offices National Cooperative Agreements Federal TA Support: Project Officer TA Calls/Trainings Onsite Consultant Support BPHC TA Website For more information visit the NEW BPHC TA Website: http://www.bphc.hrsa.gov/technicalassistance/index.html

Competing and Non-Competing Continuation Technical Assistance Budget Period Progress Report (BPR) Technical Assistance: http://www.bphc.hrsa.gov/policiesregulations/continuation/index.html Service Area Competition (SAC) Technical Assistance: http://www.hrsa.gov/grants/apply/assistance/sac/  

Bureau of Primary Health Care Help Line Single point of contact to assist grantees and stakeholders with information in the following areas: BHCMIS – System in EHB (Electronic Handbook) Health Center Quarterly Reporting (HCQR)/ARRA 1512 Reporting Uniform Data System (UDS) Federal Torts Claims Act (FTCA) for Health Centers and Free Clinics Phone: 1-877-974-BPHC (2742) Email: bphchelpline@hrsa.gov. Available Monday to Friday (excluding Federal holidays), from 8:30 AM – 5:30 PM (ET), with extra hours available during high volume periods.

HRSA’s Electronic Handbooks (EHBs) Grantees must electronically submit requests to change grant-related information (Prior Approval requests) and post award submissions (Conditions and Reporting Requirements) to HRSA through the EHBs HRSA will review and approve/disapprove requests through EHBs Automated notifications will facilitate review and approval processes All members of the grantee organization who are responsible for submitting prior approval requests or other post award submissions must register in the HRSA EHBs Go to https://grants.hrsa.gov/webexternal/login.asp If you have registered before, you do not have to register again. Contact the HRSA Call Center if you do not remember your username or password Phone: 877-Go4-HRSA/877-464-4772; 301-998-7373 (9:00 AM to 5:30 PM ET M-F) HRSA Electronic Handbooks URL: https://grants.hrsa.gov/webexternal/home.asp Email: callcenter@hrsa.gov

HRSA Priorities

FY 2011 HRSA Strategic Priorities Improve Access to Quality Health Care and Services Community/new site development Expansion planning Patient-centered medical/health home development Strengthen the Health Workforce Workforce recruitment and retention Meaningful use adoption Build Healthy Communities and Improve Health Equity

Health Center Program Overview Calendar Year 2016 Million Patients % At or Below 200% Poverty % Uninsured % Racial/Ethnic Minorities Homeless Individuals  Migrant/Seasonal Farmworkers  Residents of Public Housing Million Patient Visits Grantees – rural Service Sites Over Staff Physicians NPs, PA, & CNMs 44 Source: Uniform Data System, 2016 44 44

Thank You! Questions? 45

Chief, Central Valley Branch, Southwest Division Vanessa Shaw, MPH, MA Chief, Central Valley Branch, Southwest Division U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care 5600 Fishers Lane Rm. 16C-26 Rockville, MD 20857 Telephone: 301.594.4282 Email: vshaw@hrsa.gov 46