Advancing Quality in Health Centers: An overview of BPHC’s Quality Strategy

1. Advancing Quality in Health Centers:An overview of BPHC’s Quality Strategy MSCG Consultant Training Series May 1, 2012

2. Overview • Introduction • BPHC Quality Strategy • Alignment of Program Resources to Advance Quality • Quality Priorities & Goals • Quality Oversight & Accountability • Resources

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

4. BPHC Quality Strategy Better Care ⃘ Healthy People & Communities ⃘ Affordable Care Coordination & integration of patient information and services among HCs and other community-based providers of services INTEGRATED HEALTH SYSTEM INTEGRATED SERVICES Coordination and Integration services within a Health Home Provision of full scope of primary health services, including dental, behavioral health, and enabling services COMPREHENSIVE SERVICES Ability of patients to be seen in a timely, affordable and culturally competent manner ACCESS

5. BPHC Quality Strategy Better Care ⃘ Healthy People & Communities ⃘ Affordable Care INTEGRATED HEALTH SYSTEM Strategy Implementation Priorities & Goals • Implementation of QA/QI Systems • All Health Centers fully implement their QA/QI plans • Adoption and Meaningful Use of EHRs • All Health Centers implement EHRs across all sites & providers • Patient Centered Medical Home Recognition • All Health Centers receive PCMH recognition • Improving Clinical Outcomes • All Health Centers meet/exceed HP2020 goals on at least one UDS clinical measure • Workforce/Team-Based Care • All Health Centers are employers/providers of choice and support team-based care Programs/Policies Funding Technical Assistance Data/Information Partnerships/Collaboration INTEGRATED SERVICES COMPREHENSIVE SERVICES ACCESS

6. BPHC Quality Strategy Better Care ⃘ Healthy People & Communities ⃘ Affordable Care INTEGRATED HEALTH SYSTEM Strategy Implementation Programs/Policies Funding Technical Assistance Data/Information Partnerships/Collaboration INTEGRATED SERVICES COMPREHENSIVE SERVICES ACCESS

7. Quality Strategy Implementation: Programs/Policies Better Care ⃘ Healthy People & Communities ⃘ Affordable Care INTEGRATED HEALTH SYSTEM ACO Public Health Integration Beacon, HCCN INTEGRATED SERVICES Collaboration PIN PCMHHI, CMS Demo COMPREHENSIVE SERVICES Program Requirements Expanded Services ACCESS

8. Quality Strategy Implementation: Funding Better Care ⃘ Healthy People & Communities ⃘ Affordable Care INTEGRATED HEALTH SYSTEM • $150M for Health Center New Access Points (~220 to 230 awards) • $15M for Expanded Services, including Expanded HIV Services and Support for Health Center Recruitment and Retention Strategies, including the Health Center Veterans Hiring Challenge • $20M for Health Center Controlled Networks (~25 to 30 awards) • Capital Development: • $630M for Building Capacity • $100M for Immediate Facility Improvements • $75M for School-Based Health Center Capital program (~150 awards) INTEGRATED SERVICES COMPREHENSIVE SERVICES ACCESS

9. Quality Strategy Implementation: Technical Assistance Better Care ⃘ Healthy People & Communities ⃘ Affordable Care INTEGRATED HEALTH SYSTEM • National Cooperative Agreements • Homeless, Farmworkers, Public Housing, AAPI, LGBT • Primary Care Associations • Health Center Controlled Networks • HRSA Resources • Quality Improvement, HIT, Oral and Behavioral • Health • SAMHSA/HRSA Center for Integrated • Health Solutions (CIHS) INTEGRATED SERVICES COMPREHENSIVE SERVICES ACCESS

10. Quality Strategy Implementation: Partnerships/Collaboration Better Care ⃘ Healthy People & Communities ⃘ Affordable Care INTEGRATED HEALTH SYSTEM • National Partners • Federal: White House, HHS, Other Federal • agencies • Non-Governmental Partners • State Partners • Primary Care Associations • Primary Care Offices • Medicaid • Local Partners • HCCNs • Other Safety Net Providers • Hospitals • CBOs INTEGRATED SERVICES COMPREHENSIVE SERVICES ACCESS

11. BPHC Quality Strategy Better Care ⃘ Healthy People & Communities ⃘ Affordable Care INTEGRATED HEALTH SYSTEM Priorities & Goals • Implementation of QA/QI Systems • All Health Centers fully implement their QA/QI plans • Adoption and Meaningful Use of EHRs • All Health Centers implement EHRs across all sites & providers • Patient Centered Medical Home Recognition • All Health Centers receive PCMH recognition • Improving Clinical Outcomes • All Health Centers meet/exceed HP2020 goals on at least one UDS clinical measure • Workforce/Team-Based Care • All Health Centers are employers/providers of • choice and support team-based care INTEGRATED SERVICES COMPREHENSIVE SERVICES ACCESS

12. BPHC Quality Strategy Better Care ⃘ Healthy People & Communities ⃘ Affordable Care INTEGRATED HEALTH SYSTEM Priorities & Goals • Implementation of QA/QI Systems • All Health Centers fully implement their QA/QI plans • Adoption and Meaningful Use of EHRs • All Health Centers implement EHRs across all sites & providers • Patient Centered Medical Home Recognition • All Health Centers receive PCMH recognition • Improving Clinical Outcomes • All Health Centers meet/exceed HP2020 goals on at least one UDS clinical measure • Workforce/Team-Based Care • All Health Centers are employers/providers of choice • and support team-based care INTEGRATED SERVICES COMPREHENSIVE SERVICES ACCESS

13. Quality Priority:Implementation of QA/QI Systems • OIG study of quality assurance and care provided at health centers recommendations: • Provide additional guidance on: • Elements of QA/QI program • Information required in patient records • Required primary health services • Establish procedures to independently assess patients’ receipt of services and patient records • Draft QI PIN • Site Visits

14. FTCA Program Updates • FTCA Deeming Application enhancements • Focus is on implementation of risk management and quality improvement systems • FTCA site visits • Training and Technical Assistance Available - https://www.ecri.org/clinical_rm_program • FTCA Claims Management

15. BPHC Quality Strategy Better Care ⃘ Healthy People & Communities ⃘ Affordable Care INTEGRATED HEALTH SYSTEM Priorities & Goals • Implementation of QA/QI Systems • All Health Centers fully implement their QA/QI plans • Adoption and Meaningful Use of EHRs • All Health Centers implement EHRs across all sites & providers • Patient Centered Medical Home Recognition • All Health Centers receive PCMH recognition • Improving Clinical Outcomes • All Health Centers meet/exceed HP2020 goals on at least one UDS clinical measure • Workforce/Team-Based Care • All Health Centers are employers/providers of • choice and support team-based care INTEGRATED SERVICES COMPREHENSIVE SERVICES ACCESS

16. Quality Priority: Adoption and Meaningful Use of EHRs Source: Uniform Data System, 2010 data as of 5/10/11.

17. Adoption and Meaningful Use of EHRs • 2012 UDS includes additional EHR adoption questions • Participation in CMS Meaningful Use Incentive Payment Program • Beacon Supplemental • FY12 HCCN Funding Opportunity • HRSA’s Network Guide - The guide, currently including information on 46 networks, is available at http://www.hrsa.gov/healthit/networkguide/index.html

18. BPHC Quality Strategy Better Care ⃘ Healthy People & Communities ⃘ Affordable Care INTEGRATED HEALTH SYSTEM Priorities & Goals • Implementation of QA/QI Systems • All Health Centers fully implement their QA/QI plans • Adoption and Meaningful Use of EHRs • All Health Centers implement EHRs across all sites & providers • Patient Centered Medical Home Recognition • All Health Centers receive PCMH recognition • Improving Clinical Outcomes • All Health Centers meet/exceed HP2020 goals on at least one UDS clinical measure • Workforce/Team-Based Care • All Health Centers are employers/providers of choice • and support team-based care INTEGRATED SERVICES COMPREHENSIVE SERVICES ACCESS

19. PCMH Recognition by Region 2013 Goal: 25% Health Centers Recognized as PCMH 2012 Goal: 13% Health Centers Recognized as PCMH PCMH Recognized Includes: NCQA, Joint Commission, and AAAHC

20. BPHC Quality Strategy Better Care ⃘ Healthy People & Communities ⃘ Affordable Care INTEGRATED HEALTH SYSTEM Priorities & Goals • Implementation of QA/QI Systems • All Health Centers fully implement their QA/QI plans • Adoption and Meaningful Use of EHRs • All Health Centers implement EHRs across all sites & providers • Patient Centered Medical Home Recognition • All Health Centers receive PCMH recognition • Improving Clinical Outcomes • All Health Centers meet/exceed HP2020 goals on at least one UDS clinical measure • Workforce/Team-Based Care • All Health Centers are employers/providers of choice and support team-based care INTEGRATED SERVICES COMPREHENSIVE SERVICES ACCESS

21. 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%).

22. Health Center PerformanceHealth Disparities • Access to Primary Health Care • No racial/ethnic differences in the proportion of HC patients who are satisfied with the overall care received (98% overall). • Preventive Services Counseling • No racial/ethnic differences in the proportion of HC patients who receive weight management counseling. • Diabetes • Patients were more likely to be current with their A1c testing and see or talked with an eye doctor  if they received diabetes management support from HC staff. • Hypertension • Patients reporting unmet healthcare needs in past year were more than twice as likely to have a hypertension-related ED visit or hospitalization. • Cancer Screening • African American and Hispanic/Latino colorectal cancer screening rates are higher than national average.

23. Quality Priority:Improving Clinical Outcomes 2012 Goal: 10% of Health Centers Meet or Exceed HP 2020 Goals Source: 2010 UDS and Healthy People 2020

24. 2012 UDS Reporting Changes to CY 2012 UDS: • New staff tenure table; • Three new clinical measures; • Coronary Artery Disease (CAD): Lipid Therapy • Ischemic Vascular Disease (IVD): Aspirin Therapy • Colorectal Cancer Screening • Reporting on all (versus primary) diagnoses for selected conditions; and • Questions about electronic health record capabilities and national quality recognition Refer to the UDS website for more information: http://bphc.hrsa.gov/healthcenterdatastatistics/index.html

25. BPHC Quality Strategy Better Care ⃘ Healthy People & Communities ⃘ Affordable Care INTEGRATED HEALTH SYSTEM Priorities & Goals • Implementation of QA/QI Systems • All Health Centers fully implement their QA/QI plans • Adoption and Meaningful Use of EHRs • All Health Centers implement EHRs across all sites & providers • Patient Centered Medical Home Recognition • All Health Centers receive PCMH recognition • Improving Clinical Outcomes • All Health Centers meet/exceed HP2020 goals on at least one UDS clinical measure • Workforce/Team-Based Care • All Health Centers are employers/providers of choice and support team-based care INTEGRATED SERVICES COMPREHENSIVE SERVICES ACCESS

26. Quality Priority: Workforce/Team-Based Care • Student/Resident Education &Training (Bureau of Health • Professions) • Teaching Health Centers • Recruitment and Retention (Bureau of Clinician Recruitment and • Services) • NHSC • Loan Repayment • Training and Development • Guidelines & Best Practices • Inter-Professional Team-Based Care • Integrated within Medical/Health Home • Enabling Services Providers

27. Shared Accountability for Quality in Health Centers Health Centers NCAs PCAs HCCNs • Project Officers • Site Visits – integration and support of Quality Priorities (with Consultants) • UDS Data and Performance Reports • Annual Progress Reviews • Discuss Quality Priorities and progress during quarterly calls

28. Quality Improvement Resources • National Quality Recognition • Accreditation: http://bphc.hrsa.gov/policiesregulations/accreditation.html • AAAHC, TJC • NCQA recognition: http://bphc.hrsa.gov/policiesregulations/policies/pal201101.html • Comparison chart: http://bphc.hrsa.gov/policiesregulations/policies/qualrecogn.pdf • ECRI Institute Resources • Available to all Health Centers and FQHC LALs https://www.ecri.org/clinical_rm_program/Pages/default.aspx

29. Quality Improvement Resources • HRSA • FTCA Resources http://bphc.hrsa.gov/ftca/index.html • BPHC QI Plan Learning Series and Modules http://bphc.hrsa.gov/policiesregulations/quality/index.html • BPHC Training and Technical Assistance http://bphc.hrsa.gov/technicalassistance/tatopics/qualitymanagementimprovement/index.html • HRSA Office of HIT and Quality http://www.hrsa.gov/quality/toolsresources.html • HIV/AIDS Bureau Quality Resources http://nationalqualitycenter.org/ • Safety Net Medical Home Initiative http://www.qhmedicalhome.org/safety-net/qistrategy.cfm

30. HIT Resources • HRSA’s HIT Web Page (http://www.hrsa.gov/healthit/) • HIT Health IT Adoption Tool Boxes: http://www.hrsa.gov/healthit/toolbox/ • HIT Health IT and Quality Webinars: http://www.hrsa.gov/healthit/toolbox/webinars/index.html • HRSA Network Guide, currently including information on 46 networks: http://www.hrsa.gov/healthit/networkguide/index.html • The Office of the National Coordinator for Health Information Technology: http://healthit.hhs.gov • HIT Regional Extension Center program: http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__rec_program/1495 • 2010 report on HIT in Underserved Communities:http://www.healthit.gov/sites/default/files/pdf/hit-underserved-communities-health-disparities.pdf • The AHRQ National Resource Center for HIT: http://healthit.ahrq.gov

31. Data Resources HRSA Data Warehouse:http://datawarehouse.hrsa.gov/ Public site for UDS Data: http://bphc.hrsa.gov/healthcenterdatastatistics/index.html UDS Performance Reports: Health Center Trend Report (National/State/Grantee) Health Center Summary Report (National/State/Grantee) Performance Profile (National/State) – Performance on Key Indicators UDS Mapper: http://www.udsmapper.org/

32. PCMH Resources • PCMH Readiness Assessment Tools • Primary Care Development Corporation (PCDC): http://www.pcdc.org/resources/patient-centered-medical-home/pcdc-pcmh/ncqa-2011-medical-home.html • PCMH Assessment (PCMH-A) from the Safety Net Medical Home Initiative: http://www.safetynetmedicalhome.org/practice-transformation/assessment • Medical Home Implementation Quotient Assessment (MHIQ) from TransforMED: http://www.transformed.com/userLogin.cfm • PCMH Change Concepts: http://www.safetynetmedicalhome.org/change-concepts • Patient-Centered Primary Care Collaborative (PCPCC): http://www.pcpcc.net/content/pcmh-outcome-evidence-quality

33. PCMH Resources • Agency for Healthcare Research and Quality (AHRQ) PCMH Resource Center: http://www.pcmh.ahrq.gov/portal/server.pt/community/pcmh__home/1483 • Clinical Practice Guidelines:http://www.ahrq.gov/clinic/cpgsix.htm • US Preventive Services Task Force: http://www.uspreventiveservicestaskforce.org/tools.htm • Consumer Assessment of Healthcare Providers and Systems (CAHPS patient experience survey): https://www.cahps.ahrq.gov/default.asp • Innovations Exchange: http://www.innovations.ahrq.gov/ • Patient Health Literacy Toolkit: http://www.ahrq.gov/qual/literacy/

34. Behavioral Health Resources • HRSA BH website: www.hrsa.gov/publichealth/clinical/BehavioralHealth/index.html • Center for Integrated Health Solutions: • Motivational Interviewing for Better Outcomes • Peer Support Wellness Respite Centers • Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Clinical Settings  • Person-Centered Health Homes • Introduction to Effective Behavioral Health in Primary Care http://www.thenationalcouncil.org/cs/center_for_integrated_health_solutions • SAMHSA SBIRT page http://www.samhsa.gov/prevention/SBIRT/index.aspx

35. Contact Information MSCG Point of Contact for additional information or questions: Sheri Hughes shughes@mscginc.com 301-577-3100

36. Evaluation Here is the link to the online evaluation survey for the session below: http://www.surveymonkey.com/s/B3DHFMF