Health Care Reform

1. Health Care Reform • Our State: Problems and Perceptions • State Medicaid: Issues and Direction • A Case for Federal Reform • Community Health Centers

2. NICHOLAS MC- CUMBER- CRACKEN LAND 1 MUA/P and HPSA Designations Shortage Designation Legend Medically Underserved Area or Population (MUA/P) Health Professional Shortage Area (HPSA) Both MUA/P and HPSA KENTON BOONE CAMPBELL BRACKEN PENDLETON GREENUP GALLATIN GRANT MASON LEWIS WOOD- CARROL ROBERTSON Boyd TRIMBLE OWEN HARRISON FLEMING CARTER HENRY OLDHAM ROWAN BATH SCOTT ELLIOT BOURBON FRANKLIN LAWRENCE SHELBY MONTGOMER JEFFERSON FAYETTE MENIFEE JOHNSON CLARK FORD MORGAN MARTIN SPENCER ANDERSON FORD POWELL JESSAMINE MAGOFFIN BULLITT WOLFE FLOYD MEADE MERCER MADISON NELSON ESTILL WASHINGTON LEE GARRARD BREATHITT PIKE BRECKINRIDGE HANCOCK HARDIN BOYLE HENDERSON JACKSON OWSLEY KNOTT MARION DAVIESS LARUE LINCOLN PERRY ROCKCASTLE WEBSTER UNION MCLEAN GRAYSON TAYLOR LETCHER HART CASEY CLAY OHIO Leslie LAUREL GREEN CRITTENDEN PULASKI EDMONSON HOPKINS HARLAN MUHLENBERG BUTLER ADAIR METCALFE KNOX LIVINGSTON RUSSELL CALDWELL BARREN BELL WARREN WHITLEY LYON WAYNE CHRISTIAN LYON CUMBER- LAND BALLARD ALLEN MCCREARY LOGAN MONROE CLINTON TODD SIMPSON TRIGG CARLISLE MARSHALL GRAVES HICKMAN CALLOWAY FULTON Designations as of March 2009

8. Cunningham, Peter J., and Laurie E. Felland, Falling Behind: Americans’ Access to Medical Care Deteriorates, 2003-2007, Tracking Report No. 19, Center for Studying Health System Change, Washington, D.C. (June 2008).

9. What Do People Say?

14. STATE OF THE STATEMedicaid growth and cost is unsustainable.New leadership gets it! They understand the Big Picture and see how the parts fit together.Trying to move Medicaid from an entitlement program to a program that will improve the health of a population.Using Stimulus, HITECH and MTG funding to move changes in Medicaid and the health of the StateFocus on Medical Home and outcomes

15. THE CASE FOR REFORM AT THE FEDERAL LEVELACCESS⎯MILLIONS OF AMERICANS LACK COVERAGECOST⎯ GROWTH IN HEALTH CARE SPENDING IS UNSUSTAINABLE FOR FAMILIES, BUSINESSES, AND THE FEDERAL GOVERNMENTQUALITY⎯ POOR RETURN ON OUR HUGE INVESTMENT

16. PROBLEMSThere is no health care system. It is a business enterprise.We have a series of silos.Accountability is limited. It has about the same controls as Wall Street.

17. SOCIETIAL DECISIONAs a society we have decided that education is a right. We have not made a decision whether health care is a right or a privilege.LESSONS LEARNED AND UNLEARNEDWhat we are learning as a society is that education is a key to our economic success. What we have not learned is that a well educated and healthy workforce is the true key to our future.

18. Community Health Centers in Kentucky

19. Innovative Approaches in Healthcare • Technology • National Quality Initiative

20. NICHOLAS MC- CUMBER- CRACKEN LAND 1 Section 330 Health Center Sites by County with MUA/P and HPSA Designations Health Center Legend New Section 330 Health Center sites funded by the ARRA Stimulus Package Section 330 Health Center Sites by County (Number of sites in the County is indicated in circle) Shortage Designation Legend Medically Underserved Area or Population (MUA/P) Health Professional Shortage Area (HPSA) Both MUA/P and HPSA KENTON 3 BOONE CAMPBELL 6 GALLATIN BRACKEN PENDLETON 1 1 GREENUP GRANT MASON LEWIS WOOD- CARROL 2 12 Boyd TRIMBLE OWEN HARRISON FLEMING CARTER 1 HENRY OLDHAM ROWAN BATH SCOTT ELLIOT BOURBON FRANKLIN LAWRENCE SHELBY MONTGOMER JEFFERSON FAYETTE 10 MENIFEE JOHNSON CLARK FORD 8 MORGAN MARTIN SPENCER ANDERSON 1 POWELL JESSAMINE MAGOFFIN BULLITT WOLFE FLOYD MEADE 1 MERCER MADISON NELSON ESTILL WASHINGTON LEE GARRARD 1 BREATHITT 2 PIKE BRECKINRIDGE HANCOCK 3 1 1 HARDIN BOYLE HENDERSON JACKSON OWSLEY KNOTT MARION DAVIESS LARUE LINCOLN 1 PERRY ROCKCASTLE 1 6 WEBSTER UNION MCLEAN GRAYSON TAYLOR LETCHER HART CASEY CLAY OHIO 1 1 Leslie LAUREL GREEN CRITTENDEN PULASKI 2 EDMONSON HOPKINS HARLAN MUHLENBERG BUTLER ADAIR 1 METCALFE 1 KNOX LIVINGSTON 2 1 RUSSELL 1 1 CALDWELL 2 BARREN BELL WARREN 1 WHITLEY LYON WAYNE CHRISTIAN LYON CUMBER- LAND 1 BALLARD ALLEN MCCREARY LOGAN MONROE CLINTON TODD SIMPSON TRIGG CARLISLE MARSHALL GRAVES HICKMAN CALLOWAY FULTON 2008: 19 grantees with 76 sites in 30 counties As of March 2009: 20 grantees with 83 sites in 37 counties (The additional sites will be open by July 2009)

21. What is a Health Center? • For more than 40 years, HRSA-supported Health Centers have provided comprehensive, culturally competent, quality primary health care services to medically underserved communities and vulnerable populations. • Health centers are community-based and patient-driven organizations that serve populations with limited access to health care. These include low income populations, the uninsured, those with limited English proficiency, migrant and seasonal farm workers, individuals and families experiencing homelessness, and those living in public housing.

22. Health Center Program Fundamentals • Located in or serve a high need community (designated Medically Underserved Area or Population). • Governed by a community board composed of a majority (51% or more) of health center patients who represent the population served. • Providecomprehensive primary health care services as well as supportive services (education, translation and transportation, etc.) that promote access to health care. • Provide services available to all with fees adjusted based on ability to pay. • Meet otherperformance and accountability requirements regarding administrative, clinical, and financial operations.

25. Technology Teleradiology Hospital Portals Insurance Internet Family Med., Pharmacy PrimaryPlus Flemingsburg PrimaryPlus Tollesboro Family Medicine Other Data Sources T-1 Voice Data TeleHealth T-1 T-1 Voice Data TeleHealth PrimaryPlus Maysville T-1 Voice Data TeleHealth OB/GYN, Family Medicine, Pharmacy T-1 Voice Data TeleHealth Family Med., Women’s Health, Dental, PT and Fitness Center and Pharmacy PrimaryPlus Vanceburg PrimaryPlus Bracken Family Medicine T-1 Voice Data TeleHealth T-1 Video Only Comprehend PrimaryPlus Robertson County University of Louisville University of Kentucky Other

26. Community Programs LIFE STILL ENHANCEMENT ACTIVITY PROGRAM LEAP A PERSONAL AND COMMUMITY WELLNESS APPROACH

27. National Quality Initiative Health Disparities Collaborative THE EXPERIENCE IN CHCs IN KENTUCKY

32. HOW IS DATA BEING USED TO IMPR0VE CARE IN CHCs

33. An example is provided by the analysis we performed in linking data on diabetics from Big Sandy’s information system with Medicaid claims data. We accomplished this with the assistance of Artemetrx. We had observed, as stated earlier, that Big Sandy clinicians prescribe 80% of their diabetic patients renal-protective agents. In looking at the Medicaid claims data, however, we find that a full 29% of those patients prescribed such medications never get them filled at a pharmacy. Further analysis of claims data reveals that only 39% of patients prescribed these medications are compliant with the medication at least 75% of the time. With access to this type of information, Big Sandy would be in a position to greatly enhance its already leading edge care management programs.