Quality Improvement Efforts in Community Health Centers

1. Quality Improvement Efforts in Community Health Centers

2. Health Centers – Key Characteristics Federally Qualified Health Centers (FQHCs), free clinics, nurse-run clinics, public hospitals, and others all make up the safety net in terms of health care for the un- and underinsured. Today’s discussion will refer to FQHCs when talking about “community health centers” or “health centers”. • Location in high-need areas • Comprehensive health and related services (especially ‘enabling’ services) • Open to all residents, regardless of ability to pay, with charges prospectively set based on income • Governed by community boards, to assure responsiveness to local needs • Held to strict performance/accountability standards for administrative, clinical, and financial operations Find a community health center at: http://ask.hrsa.gov/pc/

3. Characteristics of Health Center Patients Health Care Home for 16 Million Americans • 1 of 5 Low-income Uninsured Persons (6.4 million) • 1 of 9 Medicaid/CHIP Recipients (5.7 Million) • 1 of 4 Low-Income Children (5.9 million) • 1 of 5 Low-Income Births (400,000) • 1 of 10 Rural Americans (7.9 Million) • 1 of 7 People of Color (10.2 Million) • 800,000 Farm workers, 800,000 Homeless Persons State-by-State Data can be found at http://www.nachc.com/research/ssbysdat.asp

4. The Effectiveness and Cost Effectiveness of Health Centers • Average total yearly cost per health center patient is $475, compared to the mean per person expenditure for office-based medical provider service = $737 • Health centers reduce unnecessary hospital admissions and specialty care referrals • Save Medicaid at least 30% = $3 billion saved in state/federal spending ($1.2 billon for states) • Increased health center usage reduces non-urgent ER usage and could save up to $6 billion • Health centers’ $7 billion budgets produce nearly $20 billion in overall economic output for communities • America’s Health Centers: Making Every Dollar Count (http://www.nachc.com/research/Files/Cost%20Effectiveness%20Fact%20Sheet.pdf ) • Access to Community Health and Wasted Expenditures on Avoidable Emergency Room Visits: Summary of Findings, 2006http://www.nachc.com/research/files/2006Datasummary.pdf

5. Federal and State Policy Support for Community Health Centers • Appropriations (http://www.nachc.com/advocacy/2007_approps.asp) • Medicaid and Medicare (http://www.nachc.com/advocacy/cmsreghome.asp#recent) • FTCA Coverage (http://www.nachc.com/hco/ftcamrm.asp) • State Support for Health Centers (http://www.nachc.com/advocacy/Files/state-policy/State%20Policy%20Report%2013.pdf) • Health Information Technology (http://www.nachc.com/research/files/CHC%20HIT%20survey%20fact%20sheet.pdf)

6. Major Challenges Affecting Health Centersin How Health Care is Covered • Growth in Uninsured: continue to be the largest and fastest-growing group of health center patients • Decline in Charity Care: reductions by private providers by managed care • Reduction in primary care providers: there is a continuing growing trend of less providers moving into the primary care sector, coupled with the growing need for more nurses • Loss of Medicaid and Other Public Funding: severe “Deficit Reduction” cuts by states and now Congress • Changing Nature of Insurance Coverage:Since the release of Crossing theQuality Chasm: The IOM Health Care Quality Initiative from the Institute of Medicine (IOM), the health care system has shifted the focus of delivery systems, accrediting bodies, and payors to evaluate and align cost with quality of care (e.g., pay for performance)

7. Clinical Quality: Where We Are Today National Health Disparities Collaboratives - National initiative aimed at improving health outcomes for chronic conditions among the medically vulnerable, particularly minorities. Results: • Low birth weight rates for health center women are comparable to the Nation's, yet health center women are more likely to be at greater risk, and the national disparity in rates between African American & others is reduced by 50% for African American women served by health centers. • Health center Medicaid beneficiaries are 22% less likely to be hospitalized for potentially avoidable conditions than beneficiaries who obtain care elsewhere. • The cost of treating health center Medicaid recipients is 30-34% less than the cost for beneficiaries receiving care elsewhere; 26-40% lower for prescription drugs; 35% lower for diabetics, and 20% lower for asthmatics.

8. Health Centers Excel at Reducing Health Disparities Decline in Hispanic/White Disparity for Early Prenatal Care Based on Proportion of States’ Low-Income Population Served by CHCs Decline in Black/White Disparity for Overall Mortality Per 100,000 Based on Proportion of States’ Low-Income Population Served by CHCs Pct. Served by CHCs Source: Shin, P., Jones, K. and Rosenbaum, S. Reducing Racial and Ethnic Health Disparities: Estimating the Impact of High Health Center Penetration in Low-Income Communities. GWU CHSRP. September 2003

9. Clinical Quality: Where We Are Today Up-To-Date Pap Tests by Race: Health Center Women Exceed National Health Interview Survey Comparison Group and Healthy People 2000 Objectives

10. Clinical Quality: Where We Are Today CollaborativeResults • Over 250,000 health center patients in a registry; over 150,000 patients have a self-management goal • Over 50% of patients in the Diabetes collaborative have had at least two HbA1c tests per year 90% of patients with hypertension have had at least two blood pressure exams per year • 50% of patients with hypertension have a blood pressure reading of less than 140/90 - the national average is 20% • 90% of patients with severe asthma are on the proper medication

11. Clinical Quality: Where We are Going NACHC can play several vital roles for health centers in the evolving “quality dialogue”, including: • Influence health center leaders at every turn to make quality and safety a strategic and operational emphasis at their centers, making it part of the organizational culture, and reinforcing it as their fiduciary responsibility to their communities. • Provide sources and technical assistance for health centers and networks on best practices, models, and strategies that work. • Identify lead performers (internally and externally) and develop ways to link health centers to work with them. • Support health centers by being the source of information they need to know and can trust and more importantly prevent ‘information overload’ by keeping it simple, aligned, consistent, and uniform.

12. Vision for the Future of Health Centers • Grow health centers to become the health care home for all 51 million un-served Americans • Share, and disseminate data on health center results in performance and quality improvement, both in terms of statistical analysis and third party evaluations of health center performance, to bolster case for continued support and expansion of health centers • Reform health professions programsto promote Primary Care careers, diversity, and service in underserved areas via health centers

13. Vision for the Future of Health Centers • Preserve the Medicaid guarantee of coveragefor low-income, elderly & disabled Americans • Wire every health centerfor complete health information technology • Lead the wayto a high-performing health system as indicated by a set of clinical primary care performance measurements • Play a central role in emergency preparedness, at the local, state and national levels