1. 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

2. 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

3. 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

4. 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

5. Health Center Program National Presence5

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

7. 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: 7
Source: Uniform Data System, 2009 7 7

8. 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%).

9. Primary Health Care Measures of Success9

10. 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

11. 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):
Physicians
95.27 Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives
Map and Data to be inserted
Source: Uniform Data System, 2009

12. 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
$ Cost per Patient; $ per Visit
Source: Uniform Data System, 2009 and HRSA Health Center Quarterly Report, March 31, 2011.

13. 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

14. Organizational Structure Updates

15. 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

16. 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

17. 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

18. New Organizational Structure: Primary Health Care Divisions18 18

19. 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

20. Policy Updates

21. 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:

22. 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:

23. Funding Updates

24. 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).

25. 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

26. 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

27. 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

28. 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.

29. 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

30. Quality and Data Updates

31. 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:
BPHC Helpline: or BPHC (2742)
PCMHH 31 31

32. 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:
Application Review/Deeming in EHB
2011 Requirements for FTCA Deeming available in PAL :
For TA on submitting FTCA Applications in EHB contact:
Phone:

33. 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:

34. 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 for additional details:

35. UDS Web Tools UDS Website: Data analysis tools
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:
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:

36. Additional HHS and HRSA Resources

37. 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:

38. 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:

39. Competing and Non-Competing Continuation Technical Assistance
Budget Period Progress Report (BPR) Technical Assistance:
Service Area Competition (SAC) Technical Assistance:

40. 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: BPHC (2742)
Available Monday to Friday (excluding Federal holidays), from 8:30 AM – 5:30 PM (ET), with extra hours available during high volume periods.

41. 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
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/ ; (9:00 AM to 5:30 PM ET M-F)
HRSA Electronic Handbooks URL:

42. HRSA Priorities

43. 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

44. 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

45. Thank You! Questions? 45

46. 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: 46