1. Federally Qualified Health Centers (FQHCs) & Medicaid: Increasing Access, Reducing Cost, Sustaining Quality and Improving Health Outcomes Regan Crump, MSN, DrPH U.S. Department of Health and Human Services Health Resources and Services Administration Office of Planning and Evaluation Health Systems and Financing Group Fall 2004 Annual Meeting National Association of State Medicaid Directors November 18, 2004

2. 2 The FQHC & Medicaid Partnership Working together to provide health care for vulnerable populations! A partnership that generates an outstanding return for State Medicaid Agencies (SMAs)!

3. 3 The FQHC & Medicaid Shared Mission Improve access to cost effective services for vulnerable populations. Improve quality of care and health outcomes for Medicaid beneficiaries, including the elimination of health disparities.

4. 4 Eight Facts Supporting the Outstanding Return from FQHCs Health Centers * … 1. Are a major source of care for Medicaid beneficiaries; 2. Are cost efficient; *All Section 330-funded health centers are FQHCs.

5. 5 Health Centers * … 3. Tailor services to the needs of the populations and communities you serve; 4. Coordinate care with other providers in the community; Eight Facts Supporting the Outstanding Return from FQHCs

6. 6 Health Centers… 5. Reduce risk and improve health outcomes for vulnerable populations; 6. Provide high quality care for patients with multiple chronic conditions; Eight Facts Supporting the Outstanding Return from FQHCs

7. 7 Health Centers * … 7. Are strengthened by technical assistance from linkages at the National, State and local levels; 8. Stand ready to serve Medicaid beneficiaries as your provider of choice. *All Section 330-funded health centers are FQHCs. Eight Facts Supporting the Outstanding Return from FQHCs

8. Health Centers Fact #1 Health centers are a major source of care for Medicaid beneficiaries, serving 4.4 million beneficiaries.

9. 9  12.4 Million served  50.0 Million patient encounters  3,600 service delivery sites  89.7% below 200% poverty  39.3% uninsured  63.8% racial/ethnic minority  Serve all ages – 12.5 % 4 and under – 14.25-12 years – 20.013-24 years – 46.425-64 – 7.165 and over Health Center Program – CY03 Source: BPHC UDS, 2003

10. 10 Health Centers serve: 1 out of 10 Medicaid beneficiaries 1 out of 20 SCHIP beneficiaries 1 out of 7 migrant farmworkers 1 out of 5 homeless persons Source: BPHC UDS, 2003

11. 11 Medicaid Beneficiaries in Health Centers Medicaid beneficiaries seen in health centers tripled between 1980 and 2001. 1 4.4 million Medicaid beneficiaries were seen in health centers in 2003. 2 The number of Medicaid beneficiaries seen in health centers continues to grow. Sources: 1 Kaiser Family Foundation 2 BPHC UDS Data, 2003

12. Health Centers Fact #2 Health centers are cost-efficient providers of care.

13. 13 Health Center Services Comprehensive primary care Preventive services & screenings Chronic disease management Enabling services (e.g., translation) Quality Assurance/Improvement Prenatal and post partum care Dental and mental health

14. 14 Health Centers Provide High Quality Cost-Efficient Care Cost of treating Health Center Medicaid patients is 30-34% less than cost for those receiving care elsewhere; 26-40% lower for prescription costs; 35% lower for diabetics; 20% lower for asthmatics. Center for Health Policy Studies. Final Report; November 1994. Health Center Medicaid patients are 22% less likely to be hospitalized for potentially avoidable conditions than those obtaining care elsewhere. Health Center Medicaid patients are less likely to use the ER and less likely to be hospitalized for potentially avoidable conditions than those with a usual source of care who obtained care elsewhere. Falik et al. Medical Care Vol. 39, No 6; 2001.

15. 15 Health Center Medicaid Savings, 2002 $2.4 B $1.8 B $600 M Source: Center for Health Policy Studies, 1994

16. 16 Medicaid Savings through Health Centers Lower prescription drug costs (340B Drug Pricing Program) Lower medical costs due to effective chronic disease management Avoidable hospitalizations prevented

17. Health Centers Fact #3 Health centers tailor services to the needs of the populations and communities you serve.

18. 18 Tailoring Services to the Community 51% user-majority governing board directs the center. Services are based on community needs assessment, including prevalent diseases. Respects the local language, values and culture. Services designed for homeless and migrant users as appropriate. Conveniently located in underserved areas.

19. 19 Sources:BPHC UDS, 2003 U.S. Census, 2000

20. Health Centers Fact #4 Health centers coordinate with other providers in the community.

21. 21 Health Centers are in Networks Integrated Service Delivery Initiative (ISDI) Shared, Integrated Management Information System (SIMIS) Information and Communication Technology (ICT) Programs Electronic Health Record (EHR) Networks

22. 22 Healthy Communities Access Program (HCAP) networks include Health Centers Coordinates horizontal and vertical integration Improves chronic care coordination Builds information technology systems Strengthen local safety net infrastructure Strengthen local emphasis on health care for underserved

23. 23 Source: BPHC, KDay June, 2003

24. Health Centers Fact #5 Health centers reduce risk and improve health outcomes for vulnerable populations.

25. 25 Source: 1999 Health Plan Employer Data and Information Set (HEDIS), Partridge, et. al. Based on Performance of Nine Health Center-Based Plans

26. 26 Low Birth Weight: Health Centers Better Sources:Uniform Data System, 1999 – 2003 National Center for Health Statistics (NCHS) - Health U.S. 2002 * 2003 NCHS data available Dec 2004

27. 27 Mammography: Health Centers Better Mammography Screenings Among Health Center Females Remain Higher Than Females Below 200% FPL in the Nation HP2010 Goal: 70% For age 40 and over Sources:2002 User Visit Survey 2000 National Health Interview Survey

28. 28 Pap Smears: Health Centers Better Pap Tests Among Health Center Females Remain Higher Than Females Below 200% FLP in the Nation HP2010 Goal: 90% For age 18 and over Sources:2002 User Visit Survey 2000 National Health Interview Survey

29. Health Centers Fact #6 Health centers provide high quality care for patients with multiple chronic conditions.

30. 30 Treating Chronic Illnesses Source: 15 Illnesses Drive Up Costs. Connolly C. The Washington Post. Wednesday, August 25, 2004

31. 31 Health Centers Provide Leadership in Evidence-based Disease Management More than half of health centers have participated in at least one Chronic Disease Management Collaborative: Cancer Diabetes Depression Asthma Prevention Perinatal

32. 32 Health Center Chronic Disease Management African Americans & Hispanics with Hypertension at Health Centers are 3 Times as Likely to Report Blood Pressure Under Control as NHIS Comparable Group Source: National Health Interview Survey - Measure is 140/90 and hypertension control is self-reported.

33. 33 Collaboratives: A Success in Health Centers “With federally funded health centers having fully embraced the (Disease Management Collaborative) model…this has become arguably the largest, most important health care quality improvement initiative in the country. It’s exactly what the health care system needs right now – a demonstration that it is possible both to improve care dramatically and even reduce health care costs.” Tracy Orleans, Ph.D., senior scientist at the Robert Wood Johnson Foundation Advances Online, Robert Wood Johnson Foundation Newsletter, October 2002

34. 34 Registry Growth – Diabetes Collaboratives Feb 1999-October 2003 Source: HRSA/BPHC/IHI Contact: Jerry Langley Email: jlangley@apiweb.org 1,685 Patients March 1999 139,295 Patients October 2003

35. 35 Source: HRSA/BPHC/IHI Contact: Jerry Langley Email: jlangley@apiweb.org Summary Measures: Diabetes Collaboratives Feb 2000-Oct 2003 DM1 teams did not submit until Jun 2000 92,472 Patients October 2003 21,561 Patients 4,343 Patients

36. 36 Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Accreditation 30% of health centers are accredited by the JCAHO. * HRSA is providing support to help health centers achieve accreditation. Goal is for 90% of health centers to be accredited. *Based on data as of 9/1/2004

37. 37 Federal Tort Claims Act (FTCA) Covers Most Health Centers 69% of health centers are “deemed” (covered) under the Federal Torts Claim Act. * Deeming indicates they have met patient safety and quality criteria: e.g., peer review & quality assurance program e.g., primary source credentialing of providers Health centers save the cost of malpractice insurance when covered by FTCA. *Based on data as of 10/25/2004

38. Health Centers Fact #7 Health center operations are strengthened by technical assistance from linkages at National, State and local levels.

39. 39 National Linkages for FQHCs HRSA Bureau of Primary Health Care (BPHC) National Association of Community Health Centers (NACHC) National Health Care for the Homeless Council (NHCHC) National Center for Farmworker Health (NCFH) National Rural Health Association (NRHA) White House – President’s Health Center Growth Initiative

40. 40 State-Level Linkages for FQHCs Primary Care Associations (PCAs) Workforce Recruitment Statewide Strategic Planning Emergency Preparedness Primary Care Offices (PCOs) * Shortage Area Designations *Located in State Health Departments

41. 41 Local Linkages for FQHCs Local health departments Local hospitals Other primary care providers Managed Care Organizations Specialists Pharmacies Collaborating with local providers :

42. 42 Local Linkages for FQHCs Schools & universities Community-based programs Medical society Business groups Employers Faith-based institutions

43. Health Centers Fact #8 HRSA-funded health centers stand ready to serve Medicaid beneficiaries as your provider of choice.

44. 44 As Medicaid Providers of Choice, Health Centers… help SMAs assure access and quality in local provider networks. accept new Medicaid patients when other providers do not. are opening new access points in areas of greatest need.

45. 45 Why should SMAs partner with health centers? They already serve a large number of Medicaid beneficiaries. They have demonstrated cost- efficiency with drug purchasing, preventing avoidable hospitalizations, and managing chronic disease.

46. 46 They tailor services to the beneficiaries you serve. They coordinate with other providers in the community. The quality of care they provide for Medicaid beneficiaries is very high. Why should SMAs partner with health centers?

47. 47 They improve the health of high risk and high cost populations using state of the art chronic disease management techniques. The system of support for the health center system is strong – funded by HRSA and others at the national, state and local levels. Why should SMAs partner with health centers?

48. 48 They share and spread their quality improvement, disease management and cost saving strategies. They can help you get the kind of return that your State needs. Why should SMAs partner with health centers?

49. 49 Next Steps to Improve the Value of Partnership with FQHCs SMAs, health centers and PCAs address issues jointly. SMAs partner with PCAs in developing Medicaid waiver applications.

50. 50 HRSA, CMS and SMAs exchange pertinent data and information. Share “best practices” in Medicaid- FQHC partnerships; in writing and in meetings. Next Steps to Improve the Value of Partnership with FQHCs

51. 51 Increasing Access, Reducing Cost, Sustaining Quality and Improving Health Outcomes

52. 52 Contact Information Regan Crump, MSN, DrPH U.S. Department of Health and Human Services Health Resources and Services Administration Office of Planning and Evaluation Director, Health Systems and Financing Group 5600 Fishers Lane Parklawn Building, Room 10-29 Rockville, Maryland 20857 Telephone:301.443.1550 Fax:301.480.0773 Email:rcrump@hrsa.gov