2013 NACHC WINTER STRATEGY MEETING

2. 2013 NACHC WINTER STRATEGY MEETING HEALTH CENTERS A SOLUTION OF CHOICE

3. 2013 NACHC WINTER STRATEGY MEETING CHARGE All components of the health center movement must continue to work together on policy issues while helping build the capacity to respond to a changing health care marketplace and ensure health center operations are efficient and effective. Develop a clear set of time specific actions that enable NACHC, PCAs, Networks & Health Centers to lead the way in achieving positive results related to access, quality, and cost.

4. HEALTH CENTER ASSETS AND VULNERABILITIES ASSET • Expertise in serving vulnerable populations -- services under one roof; staff with cultural/ linguistic competencies • Relationship with patients/communities we serve - we know them best & can communicate with them VULNERABILITY • Improve the patient experience or lose patient loyalty • Lack detailed outreach, enrollment, and navigation strategies

5. HEALTH CENTER ASSETS AND VULNERABILITIES ASSET • Existing programs, e.g., NHSC, help retain and recruit providers • Have the data to make the health center value proposition • Largest primary care network (patients, providers, etc.) – a “precious” commodity VULNERABILITY • Strong competition, including inability to match salaries offered • Not using the data we have to its full potential, e.g., comparative performance analysis • Don’t act like a “precious commodity”; improve alignment and use of assets

6. HEALTH CENTER ASSETS AND VULNERABILITIES ASSET • Knowledge of Medicaid; flexibility to experiment with APMs • PCMH, including experience with EHRs, chronic care management and service integration • Consumer-based boards • ETC.! VULNERABILITY • Limited Medicaid partner-ships; dependent on payment model that is bound to change • Care coordination and behavioral health capacity need to be increased • Consumer-based boards – without proper training, development, and communication, become a liability • ETC.!

7. 2013 NACHC WINTER STRATEGY MEETING CROSS-CUTTING CONCERNS • UNITY – “We are all stronger when we stand together and act together!” • DATA – We have data that we are not using to define performance measures and compare performance. • PATIENTS – “Our patients are potentially someone else’s enrollees!” • STAFF AND BOARDS – We must ensure that our staffs and board members are well informed.

8. 2013 NACHC WINTER STRATEGY MEETING CROSS-CUTTING CONCERNS 5. TRANSFORMATIONAL LEADERSHIP – “NACHC and the health center movement must embrace transformational leadership as a core value…” 6.SENSE OF URGENCY – We must create a sense of urgency that results in health centers being a major and trusted source of essential information for their patients, community, legislators, partners, etc.

9. 2013 NACHC WINTER STRATEGY MEETING RECOMMENDED ACTIONS FOR REACHING ALL HEALTH CENTERS • Message reinforcement via NACHC and PCA meetings and communications. • Sharing of patient stories, best practices and lessons learned. • NACHC and PCAs target and reach out to those health centers that are not active participants in either or both associations – including “a buddy system.”

10. 2013 NACHC WINTER STRATEGY MEETING RECOMMENDED ACTIONS FOR REACHING ALL HEALTH CENTERS 4. Regular updates presented to NACHC, PCA, and Network board members. • Communication strategy that uses more than usual venues – maximize social media. • Use other forums to reach staff other than health center CEOs (CFO trainings, clinician trainings, board member trainings, etc.).

11. 2013 NACHC WINTER STRATEGY MEETING HEALTH CENTER OPERATIONS For health centers to be both providers of choice and employers of choice, they must be able to operate efficiently and effectively and be able to document impact on quality and cost. What actions are required for health centers to operate successfully in the new health care environment?

12. 2013 NACHC WINTER STRATEGY MEETING GROUP A Outreach/Enrollment: current and prospective patients What should health centers be doing to keep existing patients and attract newly insured patients?

13. 2013 NACHC WINTER STRATEGY MEETING GROUP A RECOMMENDED ACTIONS • Tools, rooted in a client-driven belief system, that inform staff, patients and communities of ACA and reflect health centers as reliable sources of patient advice • State-focused resources that enable PCAs to work with state legislators/regulators to ensure health centers are viewed favorably • Client empowerment/navigation tools that can assist existing and potential health center patients identify that they are with a “community health center”

14. 2013 NACHC WINTER STRATEGY MEETING GROUP B PCMH Model Including clinical workforce How do we get to at least 40% of health centers recognized as PCMH by 2014 and what are the clinical workforce implications of doing that?

15. 2013 NACHC WINTER STRATEGY MEETING GROUP B RECOMMENDED ACTIONS • Segment and target at least 288 health centers to be PCMH recognized by 2014 • Target health centers already recognized/ accredited to sustain practice transformation and outcome documentation • Develop a framework to coordinate PCMH training and TA • Develop business case and practical models for sustainable PCMHs, and demonstrate clear and intuitive value for health centers, payers, and stakeholders

16. 2013 NACHC WINTER STRATEGY MEETING GROUP C Leadership: Management teams and boards How do we work to retain, recruit, and create strong leadership at health centers?

17. 2013 NACHC WINTER STRATEGY MEETING GROUP C RECOMMENDED ACTIONS • Acknowledge that leadership development is a strategic priority on par with advocacy efforts • Develop a “plan for enhanced leadership” that reflects innovation and transformational leadership • In concert with PCAs and Networks, execute the Plan across the country

18. 2013 NACHC WINTER STRATEGY MEETING GROUP D Efficient and Effective Operational Systems What business tools, e.g., financial benchmarks, patient flow analysis, practice improvements, etc., are needed to have business and clinical practices that produce sufficient resources to ensure stable operations?

19. 2013 NACHC WINTER STRATEGY MEETING GROUP D RECOMMENDED ACTIONS • Develop a methodology and training to assist health centers track/monitor/explain total costs • Develop tools related to practice redesign – principles, techniques, best practices, etc. • Convene Networks and PCAs to develop strategy on how to engage health centers not yet involved in networks or data warehouses • Develop and implement strategy for consistency or integration across organizations hosting data warehouses

20. 2013 NACHC WINTER STRATEGY MEETING MARKETPLACE Ultimately, success in this area will require that health centers are appropriately recognized in new payment arrangements, i.e., both Medicaid Expansions and State Insurance Exchange offerings, and have entered into strategic partnerships with other groups in the health care industry. What actions are required to assist health centers to be successful in what will continue to be a changing and challenging health care marketplace?

21. 2013 NACHC WINTER STRATEGY MEETING GROUP E Partnerships and Linkages What actions can be taken to assure that health centers are forming appropriate partnerships/linkages and executing contracts that allow for success?

22. 2013 NACHC WINTER STRATEGY MEETING GROUP E RECOMMENDED ACTIONS • Develop training, tools, and best practices to assist with negotiations • Promote a national payment model that allows payers to risk adjust for social determinants of health • Identify and remove HRSA roadblocks regarding mergers, change of scope, and other innovative approaches to care that require HRSA approval

23. 2013 NACHC WINTER STRATEGY MEETING GROUP F Insurance Exchange Implementation What are the practical health center operational strategies that will enable them to maximize opportunities of participating in the new State Insurance Exchanges?

24. 2013 NACHC WINTER STRATEGY MEETING GROUP F RECOMMENDED ACTIONS • Define timelines and decision trees for State Exchanges that clearly articulate the process moving forward (including key dates) and how health centers and patients will be impacted • Develop a curriculum for training health center staff on State Exchanges to be carried down to patients via health center staff • Advocate at federal/state levels for additional health center funding for Outreach, Enrollment, and Navigator purposes • Promote and disseminate information on IPA and ACO state and/or local best practice models

25. 2013 NACHC WINTER STRATEGY MEETING GROUP G Strategic Understanding and Positioning What can be done to assure that all health centers recognize, understand, and are positioned to take advantage of the ACA opportunities?

26. 2013 NACHC WINTER STRATEGY MEETING GROUP G RECOMMENDED ACTIONS • Develop internal and external analytical tools to inform strategic decision-making • Strengthen health center brand identity, i.e., F – fees based on ability to pay Q – quality health care to all people regardless of insurance status H – highly competitive health care professional teams C – community controlled by patient majority boards

27. 2013 NACHC WINTER STRATEGY MEETING POLICY Our responsibility is to inform all members of the health center movement, including patients, of what is at stake and provide them with a direction of how to proceed. What actions are needed to inform and mobilize all parts of the health center movement to deliver the value proposition of health centers to elected officials and policy makers?

28. 2013 NACHC WINTER STRATEGY MEETING POLICY: Taking It To The Street We must have a UNIFIED message for all levels of officials • This includes federal, state, and local officials • For advocate champions and new advocates alike • Legislative, regulatory, and all policy-related actions

29. 2013 NACHC WINTER STRATEGY MEETING GROUP J Negotiating State Medicaid Payments What will it take to effectively work with State officials to ensure that the Medicaid Expansions have appropriate reimbursement?

30. 2013 NACHC WINTER STRATEGY MEETING GROUP J RECOMMENDED ACTIONS • Create a method for sharing state negotiations regarding Medicaid payments in real-time • Collect data to develop risk adjustment models recognizing the social determinants of health • Expand training on new and existing payment models

31. 2013 NACHC WINTER STRATEGY MEETING GROUP I State/Federal Regulatory Policies How do we prioritize and respond to critical state and federal regulatory policies that will define the actual details of how Medicaid Expansions and State Insurance Exchanges will operate?

32. 2013 NACHC WINTER STRATEGY MEETING GROUP I RECOMMENDED ACTIONS • Continue to support appropriate payment methodologies within CMS • Medicaid • Exchanges • CMS demonstration projects • Ensure HRSA & CMMS regulatory policies are timely • “The bureaucracy should respond at the speed of the marketplace” • Align consistent messages with our policy agenda

33. 2013 NACHC WINTER STRATEGY MEETING GROUP H Elected Officials: Value proposition of health centers What actions are needed to educate elected officials, including those at the state and local levels, on the role health centers can play as we move forward, including what the health return on investment is?

34. 2013 NACHC WINTER STRATEGY MEETING GROUP H RECOMMENDED ACTIONS • Build “Key Contact” infrastructure and program • Arrange in-house visits at CHCs for every federal, state, and local elected official, every year • Raise visibility of advocacy at all meetings

35. 2013 NACHC WINTER STRATEGY MEETING Thank you, Group Leaders! Mark Bryant Mary Bufwack Lindsay Farrell Kathy Grant-Davis Bruce Gray Ricardo Guzman Stephanie Harrison Paloma Hernandez Sherry Hirota Craig Hostetler Kevin Kearns Walter Keeley Annette Kowal Lolita Lopez Toni McGuire Ben Money Louise Reese Cheri Rinehart Bobbi Ryder Susan Wilson