1. Painting a portrait of utilization: Medicare and nurse managed health centers American Public Health Association 140 th Annual Meeting San Francisco, CA 30 October 2012 Jennifer Bellot, PhD, RN, MHSA, CNE Jennifer.bellot@jefferson.edu Presented by Sarah J. Powell, MA

2. Presenter Disclosures The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Jennifer Bellot No relationships to disclose

3. Background Access to primary care for older adults Safety net Patient centered medical home Medicare utilization

4. Nurse managed health centers “Nurse-managed health centers, often referred to as nurse-managed health clinics or NMHCs, are (outpatient centers) run by nurses. Many have advanced practice degrees and are nurse practitioners, clinical nurse specialists, nurse midwives, and public health nurses. (NMHCs)… have the expertise to diagnose illness and prescribe medication, to make referrals to specialists, to provide pre-and post-natal care, and to offer a wide variety of other primary health care services. (NMHCs) are focused on the needs of communities.” -Definition taken from the National Nursing Centers Consortium www.nncc.us

5. Sample 15 total NMHCs, 10 met criteria for participation – 5 others were wellness clinics (did not bill for services) or pediatric NMHCs (did not have Medicare beneficiaries) 9 in urban areas, 1 suburban-rural Total of 1,077 discrete Medicare beneficiaries seen across SEPA NHMCs in 2011, ranging from 31 to 332 at each site.

6. Findings: Demographics Mean age 53.6 years (Range 0-96 years)

7. Findings: Dual eligibility Source: Kaiser Family Foundation www.kff.org

8. Findings: Dual eligibility Almost 80% under age 65 Concentrated under age 42 Indicates young disability, rather than poor elderly

9. Implications and Limitations Medicare older adults in NMHCs Need to expand sample to determine if this is a geographic phenomenon Further exploration of ICD-9, CPT codes and RVUs Does not address wellness care, free care or undocumented care

10. Future directions Expansion of sample to regional, possibly wider Urban, suburban, rural comparisons Service level intensity Focus groups of older adults Comparisons with standard FQHCs

11. Acknowledgements This project is funded by the Robert Wood Johnson Foundation Nurse Faculty Scholars Program, a national program of the Robert Wood Johnson Foundation administered by the Johns Hopkins University School of Nursing. Thanks to Marie Dennis, PhD, for her assistance with data organization and analysis. October 12, 2009