Seiji Hayashi, MD, MPH, FAAFP Chief Medical Officer U.S. Department of Health and Human Services

1. Integrating Behavioral Health into Health CentersThe Role of the Medical Home in the Treatment of AddictionNovember 4, 2011 Seiji Hayashi, MD, MPH, FAAFP Chief Medical Officer U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care AMERSA National Conference

2. 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

3. What is a “Health Center”? • Located in medically underserved area or serve a medically underserved population • Governed by a community board • Providecomprehensive primary health care • Primary & Preventive Care • Enabling Services • Provide services available to all with fees adjusted based on ability to pay. • Meet otherperformance and accountability requirements regarding administrative, clinical, and financial operations • Synonyms: Federally Qualified Health Centers (FQHC), Community Health Centers, Section 330 Health Centers

4. Health Center ProgramNational Presence – July 2011

5. Health Center Program Overview Calendar Year 2010 • 19.5 Million Patients • 93% Below 200% poverty • 38% Uninsured • 62% Racial/Ethnic Minorities • 1,052,000 Homeless Individuals • 863,000 Migrant/Seasonal Farmworkers • 173,000 Residents of Public Housing 77 Million Patient Visits • 1,124 Grantees • 8,100+ Service Sites • Over 131,000 Staff • 9,592 Physicians • 6,362 NPs, PA, & CNMs 5 Source: Uniform Data System, 2010, Service Sites: HRSA Electronic Handbooks Scope Repository 12/31/2010

6. Health Center Program Overview National Impact Source: Health Center Data:Uniform Data System, 2010. National Data: U.S. Census Bureau, 2010 Current Population Reports and Current Population Survey. 6

7. Health Center Program Growth: National Impact 2008-2010

8. Total Staff 131,660 Physicians 9,592 Family/General P. 4,876 Internal Med 1,595 Pediatrics 1,903 Ob/Gyn 931 Other MD/DO 287 Nurse Practitioners 3,808 Physician Assistants 2,034 Certified Nurse Midwives 520 Nurses 11,365 Other Med 16,511 Lab/X-ray 2,713 Dental 9,452 Dentists 2,882 Hygienists 1,144 Assistants 5,426 Mental Health 4,241 Psychiatrists 395 Clinical Psychologists 360 Clinical Social Workers 1,264 Other Licensed MH 958 Other MH 1,264 Substance Abuse 854 Pharmacy 2,756 Vision 242 Ophthalmologists 30 Optometrists 115 Other Vision Care Staff 97 Other Professional 839 Program Enabling Services 12,128 (Case Managers, Education, Outreach, Transport, etc.) Other Program/Services 3,997 Patient Support Staff 22,842 Management and Support Staff 13,367 Fiscal and Billing Staff 9,025 IT Staff 1,979 Facility Staff 3,395 Health Center Program WorkforceCalendar Year 2010 Source:Uniform Data System, 2010 Data

9. Primary Health CareOur Focus

10. BPHC QI Strategy • Develop and enhance access points • Transform HC care delivery system • PCM/HH- Recog/Accred, Pilots/Demos • HIT MU- HCCN, ONC-REC, Beacon • Service Integration: BH, OH, etc. • Recruit, develop, retain skilled workforce • Integrate Health Centers into local health systems • Specialists, ER, Hospitals • ACOs, Public Health • Align policies and programs • Federal, State, local • Private/Public (e.g. NQF measures)

11. Medical Homes “A medical home is not simply a place but a model of primary care that delivers care that is: • Patient-centered • Comprehensive • Coordinated • Accessible • Continuously improved through a systems-based approach to quality and safety” (AHRQ, www.pcmh.ahrq.gov)

12. Example of PCMH Enhance Access and Continuity Identify and Manage Patient Populations Plan and Manage Care Provide Self-Care and Community Support Track and Coordinate Care Measure and Improve Performance NCQA PCMH Recognition Criteria

13. HRSA Supported TA & Training

14. HRSA Supported TA & Training

15. Summary • The need is tremendous, especially for the communities we serve. • There is not enough of us, and we can’t do it alone; • Partner and collaborate • Recruit, train, and retain • We must be patient-centered • Work in teams to integrate • Address the social determinants

16. A. Seiji Hayashi, MD, MPH, FAAFP Chief Medical Officer U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care 5600 Fishers Lane Rm. 17-105 Rockville, MD 20857 Shayashi@HRSA.gov http://bphc.hrsa.gov Thank You!