2. NACHC UPDATE National Association of Community Health Centers Health Choice Network 20th Annual Education Session and Health Care Quality Institute Saturday June 28, 2014

3. 2011 Biggest Internal Challenges ???  To integrate with other providers (including other CHCs)  To coordinate patient care to assure sharing of clinical data/information.  To coordinate service delivery and match capacity while linking patients with enabling services.  Re-engineering our health center operations (data and insurance focused)  Workforce (all levels)

4. 2011: Biggest External Challenges ??? Competition from managed care organizations. Forming partnerships without losing mission focus & autonomy (CAHs) External Challenges Greatest Challenges: Appropriations and Medicaid

5. TODAY’S AGENDA THE ENVIRONMENT FOR HEALTH CENTERS FEDERAL POLICY UPDATE: MEDICARE PPS HEALTH CENTER TRANSFORMATION QUESTIONS?

6. THE ENVIRONMENT The Environment in Washington – the BAD Political Polarization ACA is as divisive as ever “Must-pass” bills pass, but not much else Heightened scrutiny of federal programs Budget caps and future funding uncertainty

7. THE ENVIRONMENT The Environment in Washington – the GOOD Bipartisan support for Health Centers’ Program, Model and Mission Both sides looking for solutions in the health care arena Health Centers are at the center of the conversation

8. HEALTH CENTERS IN A POST-ACA WORLD Access to primary care is vital for cost savings and improved outcomes (Transformation) I ncreased demand, among newly insured and uninsured (MA experience) Federal support, through 330 grant and Medicaid payment, crucial to model of care We will have to advocate louder than ever New funding essential for base grant adjustments, expanded capacity, service expansion, new access points Since ACA, funding comes two ways:

9. HEALTH CENTER FUNDING STREAMS – SINCE ACA ENACTED DISCRETIONARY Annual, up to Congress to determine amount Prior to ACA, the only funding for CHC program Cut in 2011, backfilled with mandatory funds Currently $1.5 billion (FY14) DISCRETIONARY Annual, up to Congress to determine amount Prior to ACA, the only funding for CHC program Cut in 2011, backfilled with mandatory funds Currently $1.5 billion (FY14) MANDATORY Required spending, unless Congress changes the law Special Fund created in ACA to boost Health Center Capacity Currently 2.2 billion (FY14) Expires in FY2016 (more on that in a moment) MANDATORY Required spending, unless Congress changes the law Special Fund created in ACA to boost Health Center Capacity Currently 2.2 billion (FY14) Expires in FY2016 (more on that in a moment)

10. HEALTH CENTERS FUNDING CLIFF Mandatory funding expires at the end of FY15 Without action by Congress, up to 70% cut to Health Center grants NHSC, THCs in same position (though ALL mandatory)

11. FIXING THE CLIFF – OUR PLAN Extends, grows mandatory funding $20b over 5 years Grow from current 22m patients to 35m Continue funding for NHSC, Teaching Health Centers Message: Act Now!

12. THE CLIFF – KEY POINTS 1. This is real. Health Centers have had success in gaining new funding, but even our biggest champions can’t predict the outcome here. 2. Estimate the impact. What would a 70% cut to your grant mean in your community, to your patients? 3. Raise the drumbeat for a fix. We have a long fight ahead, but our best hope is the understanding that this is a “must-do”.

13. HEALTH CENTERS SUCCESS - OUR COLLECTIVE FUTURE - DEPEND ON THE STRENGH OF OUR ADVOCACY. Local connections are the key to policy change – build relationships and demonstrate impact over time Advocacy requires ACTION - the key is to develop a sustained culture of advocacy in your center The challenges and opportunities ahead are huge. Let’s take them on TOGETHER. Campaign Website: www.saveourchcs.orgwww.saveourchcs.org ADVOCACY: THE BOTTOM LINE

14. REGULATORY UPDATE

15. Medicare PPS – GAME CHANGER! Greatest opportunity to mover into Medicare ever! The PPS base rate for October 1, 2014, through December 31, 2015, is $158.85 (roughly a 35% increase) Transition to new FQHC PPS begins on the 1 st day of cost reporting period on or after 10/1/14 (updated annually) Increased rates for new patients: can bill for subsequent illness/injury visits and mental health visits on same day FQHCs must now use “G” Codes and must create appropriate charges for the new codes Do your charges reflect your real costs?

16. Medicare PPS cont…. When was the last time your FQHC reviewed your charges? Cost of care isn’t decreasing Do nothing? - THIS RULE HURTS! – Medicare rate may go down Rule will have HUGE impact on sliding fee scale policies if it isn’t reviewed and adjusted on a regular basis Huge potential for Medicare Advantage Plans! NACHC will be rolling out national trainings shortly First trainings to focus on Sept, Oct, Nov due dates - 150 CHCS, Jan - >300 CHCs

17. Transformation – VC 2 VC 2 – A vision started by NACHC Chair Dr. Gary Wiltz Strategy to enhance CHC capacity in transformation and a means to cope with the enormous shifts we are now facing. EHRs: Identify needed performance improvements, implement solutions, and measure the effects of those solutions. clinical quality, cost control, operational effectiveness, financial performance, and patient experience. Develop systems integrated with other providers in the community. Provide organization-wide focus and team training A continual performance strategy, “This is how we do business.” Create system to share proven ways to improve quality and lower cost. Disseminate methods to all health centers

18. Transformation It is all up to the Health Centers, HCCNs and PCAs NACHC can’t lead this – its all local/regional Convener, collect and spread HCCN’s are the key to success! Health Choice Network is a best practice model! OCHIN and Clinical Informatics tools Medicare ACOs Managed care products ACA changed everything for health care delivery ( more business less politic s) Local, regional and state work will dominate for business success PCAs and HCCNs must work together

19. The Future Health Centers are one of the critical pieces of health care delivery moving forward ACA provided unparalleled growth and opportunities Capital Growth Medicaid Expansion and Marketplace Exchanges Medicare PPS Health Centers must start taking risk – more business thinking less grant dependence NACHC tools (ACO/IPA toolkits)

20. Today NACHC must work closer with HCCNs and PCAs recognizing the new roles we are now have Ohio We must continue to advocate for our cause The Primary Care Cliff is real! Never forget FY’11 - $600M decrease

21. Invite Your Members of Congress to Visit During NHCW – August 10 th -16 th NATIONAL HEALTH CENTER WEEK More info updated regularly at www.healthcenterweek.orgwww.healthcenterweek.org

22. QUESTIONS? Shawn K. Frick Associate Vice President, PCA & Network Relations National Association of Community Health Centers Direct:301-347-0447 E-Mail: sfrick@nachc.comsfrick@nachc.com QUESTIONS and CONTACT INFO