Nation’s Health Center Program

1. Community Health Integrated PartnershipMaryland Community Health Resources Commission April 23, 2007Maryland’s Community Health Center Quality Improvement Initiative

2. Nation’s Health Center Program • Created in 1965 as part of the “War on Poverty” • Goal to provide primary care services to the un/underinsured via the Health Centers Consolidated Care Act of 1996 • Consolidated Health Center Program includes: • Federally Qualified Health Centers • Migrant Health Centers • Health Care for the Homeless • Public Housing Primary Care Programs

3. Nation’s Health Center Program • Annually serve 14 million unduplicated patients and provide 55+ million patient encounters • >91% of health center patients are at/below 200% of poverty • 52% of health centers are located in rural areas and 48% are in urban and suburban areas • Center size ranges from 4,000 - 19,000 patients • Health centers serve diverse populations: • 37% white, 36 % Hispanic/Latino, 24 % African-American, 3% Asian Pacific Islander and >1% American Indian/Alaskan Native • 45% of health center patients are newborn to age 24, 48% 25 – 64, and 7% are age 65 and up

4. Maryland’s Health Center Program • Sixteen health centers located throughout the state • Thirteen federally qualified health centers • One Health Care for the Homeless • Two federally qualified look-alike health centers • Within these sixteen health centers • Three health centers are also Migrant Health Centers • Three health centers operate 26 school based health centers • Three health centers provide HIV/AIDS services through the federal Ryan White Program • Health centers are highly regulated primary care facilities • Must meet DHMH guidelines for Freestanding Clinics • Undergo a periodic review by federal Office of Performance Review • Re-accredited every three years by JCAHO

5. Maryland’s Health Center Program • 80% of the health centers’ 173,089 patients are uninsured or covered by public “insurance” program • 30% are uninsured • 40% are Medicaid beneficiaries • 1% are covered by other public programs • 9% are Medicare beneficiaries • 20% are covered by private insurance • MD health center patients are as diverse as the nation’s • 59% are African American • 33% are white • 7% are Hispanic/Latino • 1% are Asian/Pacific Islanders • <1% American Indian

6. Maryland’s Health Center Program • Health centers contribute to Maryland’s health care environment • Health centers contribute $37.7 million annually to health care system • Improve access through site & service expansion in medically underserved areas • Provide health care regardless of an ability to pay • Provide high quality, comprehensive primary care • Expanded “primary care” services to include pre-natal care & delivery services, behavioral health, and oral health • Proactively work to reduce disparities in health care delivery • Health center clinical providers are either board certified or licensed in their respective discipline & health centers are JCAHO accredited • Provide case management for chronically ill facilitative services such as translation, transportation, eligibility for publicly-funded health and social programs

7. CHIP - Health Center Controlled Network • Non-profit (501c3) membership organization of eight federally qualified health centers • Designated (HRSA) as a health centered controlled network • 100% owned and governed by FQHCs (51% minimum requirement) • Governed by 8 member board of health center CEOs • Provide operational support and technology services to member health centers • Clinical quality & operational performance improvement initiatives • Technology access & enhancement • Establish partnership & collaborations to strengthen community health system • Three health centers in rural areas – five in urban/suburban areas • 67 sites - serve 132,716 patients annually – provide 515, 169 encounters

8. Need to Improve Health Outcomes • Maryland’s population tends to have higher rates of disease especially among those “lifestyle” diseases such as diabetes, heart disease and hypertension that could be managed through access to routine primary and preventive care including chronic disease management programs Maryland United States • Cardiovascular Diseases 251 248.6 • Malignant Neoplasms 204.8 195.5 • Cerebrovascular Diseases 60.0 58.4 • Influenza and Pneumonia 22.4 22.8 • Diabetes 30 25.2 •   Rates are age-adjusted per 100,000 population • Source: Maryland Vital Statistics Annual Report 2002

9. CHIP Quality Improvement Initiatives • 1999 – CHIP commits resources to improve health care delivery • Health Disparities Collaborative (HDC) • Trained staff on chronic disease management (Care Model) • Identified “populations of focus” & captured data to measure improvement in patient health outcomes • JCAHO accreditation • Facilitated each health centers’ initial accreditation/reaccreditation • Patient satisfaction surveys • Developed bi-lingual surveys & administered semi-annually • Performance improvement • Using staff feedback & patient survey results undertook process improvement projects • Began using tools such as “Balanced Scorecard” to measure and report results

10. CHIP’s Quality Improvement Initiatives • 2000 - Health centers recognized the need for better tools to support improvement efforts • Current improvement efforts required dual data entry & relied on manual data collection for evaluation • Current systems had limited management reporting capability • Health centers were using multiple systems that did not “talk” to each other to manage business operations • CHIP Board made strategic decision to acquire more robust technology that better met needs & deploy in a single platform, integrated, centrally managed environment

11. CHIP’s Quality Improvement Initiatives • 2000 launched Technology Improvement Project • Phase I – 2001 – 2003 – implemented new practice management system • Standardized business rules across health centers • Central IT management ensures application integrity & performance • HIPAA compliant • Reporting capability allows centers to benchmark performance on variety of dimensions & measure performance improvement • Phase II – electronic patient record system (EPRS) • 2006 – developed system specifications & requirements, issued RFP, evaluated multiple EPRS, selected vendor & began pre-implementation process • 2006 – 2007 – working to identify funding for EPRS installation in 8 health centers • Public sources - HRSA, Community Health Resources Commission • Private sources – foundations, insurers, corporations • Health centers

12. CHIP’s Quality Improvement Initiatives • 2000 launched Technology Improvement Project (continued) • Phase III – 2008 & beyond - Health Center RHIO • Establish interoperable linkages • Hospitals - particularly emergency departments • Community partners – other service providers to which we refer/receive patients • Reporting agencies • Funding agencies • Research organizations • Other RHIOs – regional health information organizations

13. CHIP’s Quality Improvement Initiatives • BUT – its not about the technology – its about QUALITY • Strategic goals are to: • Improve the quality of the health care we deliver • Reduce disparities in the access to & deliver of health care • Improve patient safety • Decrease medical & prescription drug errors • Increase efficiency of our delivery systems

14. CHIP’s Quality Improvement Initiatives • EPRS is the tool that will enable CHIP & health centers to: • Identify areas for delivery system improvement & measure the results of performance improvement initiatives • Identify variances, by race, ethnicity, age, gender in health care access/ delivery & measure our efforts to close those gaps • Ensuring patient safety by having 24/7/365 access to patients’ records, from any location, to ensure that clinical decisions are based on real time, accurate information • Reducing the opportunity for medical/drug errors by giving providers access to a real time, comprehensive, organized system that clearly documents patients’ health history vs. a cumbersome, complex paper medical record • Improving patient care & compliance by having tools/reminders that alert providers when diagnostic tests, immunizations, follow up visits, script refills, etc. are due • Improving delivery system efficiency by replacing paper patient records, avoiding duplication, providing tools for proactive patient management, reducing emergency department visits, etc.

15. Next Steps • Readiness • Completed planning phase & vendor selection - advanced to pre-implementation phase • Benefited from one CHIP health center being operational on an EPRS for 3 years – used as a “learning lab” throughout planning and pre-implementation process – as well as HRSA pilot sites & technical assistance • CHIP has developed a sustainability plan to support the on-going operation of the EPRS • Used existing practice management system support financial model in place since 2001 • Health centers have made commitments & are prepared to proceed to implementation • Finalizing vendor contract terms • Continuing pre-implementation activities • Working to secure funding - $2.3 million/8 health centers/69 sites

16. Contact Information Salliann Alborn, Chief Executive Officer Community Health Integrated Partnership, Inc. 804 Landmark Drive, Suite 128 Glen Burnie, Maryland 21061 Telephone – 410-761-8100 X202 Facsimile – 410-761-5835 salborn@mdhealth.net