Innovative Community-Based Approaches to Program and Policy Development Aimed at Reducing Disparities in Primary Care

1. Innovative Community-Based Approaches to Program and Policy Development Aimed at Reducing Disparities in Primary Care Sam S. Shekar, M.D., M.P.H. Associate Administrator for Primary Health Care and Assistant U.S. Surgeon General American Public Health Association (APHA) 131st Annual Meeting and Exposition November 15 - 19, 2003

2. Health centers that receive a federal grant are called Federally Qualified Health Centers (FQHCs) HRSA provides federal grant funding to health centers to deliver primary and preventive care Authorized under 2002 Amendments of the Health Centers Consolidated Care Act of 1996, section 330 of the Public Health Service Act Consolidated health centers include: Community Health Centers Migrant Health Centers Health Care for the Homeless Programs Public Housing Primary Care Programs School-Based Health Centers FQHCs and Health Centers

3. $6M annual budget 50,000 encounters/year 14,000 patients/year Services: General primary care Preventive screenings Chronic disease management Enabling services Source: BPHC, 2002 Uniform Data System (UDS) 30 clinicians/clinical professionals 10 enabling staff 40 administrative staff Typical Health Center

4. 12.8 % 4 and under – 14.3 5-12 years – 20.2 13-24 years – 45.6 25-64 years – 7.0 65 and over – Presidential Initiative Calendar Year (CY) 2002 • 11.3 Million served • 44.7 Million patient encounters • >3,400 service sites • 88.1% below 200% poverty • 38.9% uninsured • 63.9% racial/ethnic minority • Serve all ages Source: Uniform Data System, CY 02, June 2003

5. Health Centers:Sources of Funding(FY 2002 est) Source: BPHC, 2002 UDS

6. Health Centers and Medicaid • Relationship: • -- 1/3 of Health Center Patients • -- 1/3 of Health Center Total Revenue • -- 2/3 of Health Center Patient Revenue • Result: Decreased Avoidable Hospitalizations – Health Center Medicaid patients are 22% less likely to be hospitalized for potentially avoidable conditions than those obtaining care elsewhere. • Falik et al. Medical Care Vol. 39, No 6; 2001. • Health Center Medicaid patients are 11% less likely to be hospitalized for potentially avoidable conditions than those with a usual source of care who obtained care elsewhere.Ambulatory Care Sensitive Conditions (ACSC) II Study to be published. • Lower Health Care Costs –Cost of treating Health Center Medicaid patients is 30-34% less than cost for those receiving care elsewhere; 26-40% lower for Rx; 35% lower for diabetics; 20% lower for asthmatics.Center for Health Policy Studies. Final Report; November 1994.

7. President’s Initiative to Expand Health Centers By 2006: • 1,200 new or expanded health centers • 6 million additional people

8. Access to Care: Uninsured Health Center Patients Face Fewer Primary Care Access Barriers than Uninsured Overall Source: Carlson et al. Primary Care of Patients without Insurance by Community Health Centers (CHCs). Journal of Ambulatory Care Management (JACM). 2001. *p<.001

9. HRSA Health Disparities Collaboratives A national effort to improve health outcomes for all medically underserved people • • Care Management Collaboratives • Diabetes, Cancer, Cardiovascular, • Asthma, Depression, HIV/AIDS • Prevention Collaboratives • Diabetes • Healthy weight, tobacco use, blood pressure, cholesterol, immunizations, lead screening, oral health • Finance Redesign Pilot • Perinatal Risk Management – Planned

10. HRSA Health Disparities Collaboratives The Care Model includes six essential elements for improving the care of people with chronic illness: • Patient self-management • Evidence based decision support • Clinical information system to monitor clinical outcomes • Delivery system designed for patient and family goals • Organization of health care for quality • Community partnerships

11. Health Center Patients With Diabetes Are Twice As Likely To Have Their Glycohemoglobin Tested on Schedule 50 43% 40 30 20% Health Center Patients 20 National Norm 10 0 Source: MDS Associates, Evaluation of the effectiveness and Impact of Community Health Centers, based on the National Health Interview Survey, 1999

12. Collaborative Success “With federally funded health centers having fully embraced the (Health Disparities Collaborative) model…this has become arguably the largest, most important health care quality improvement initiative in the country. It’s exactly what the health care system needs right now - a demonstration that it is possible both to improve care dramatically and even reduce health care costs.” Tracy Orleans, Ph.D., senior scientist at the Robert Wood Johnson Foundation Advances Online, Robert Wood Johnson Foundation Newsletter, October 2002

13. Healthy Communities Access Program (HCAP) Newly Established Legislative Authorization (340 Public Health Service (PHS) Act New Direction Stronger Emphasis on Health Care for Underserved Strengthens Vertical Integration Improves Chronic Care Coordination Builds Information Technology Systems Assists Infrastructure Development Healthy Community Access Program – FY 2003 35 new HCAP communities in 20 states received awards in FY 2003 129 HCAP communities received continuing funds. Currently, HRSA has a total of 164 HCAP grantees in 43 states HCAP Partnerships

14. Public Health Center Entities • Public Health Center Entities • Under section 330(l)(2)(A), the Secretary may allocate up to 5% of its section 330 dollars to public centers or entities that do not independently meet governing board requirements. • In 2002, 39 public entities currently received $41 million of community and migrant health center funds. • Public Health Entity Examples • Multnomah County Public Health Department – Portland, Oregon • Will County Community Health Center – Joliet, Illinois • City of Austin Primary Care Department – Austin, Texas • Lexington-Fayette County Health Dept. – Lexington, Kentucky • Denver Health and Hospitals – Denver, Colorado • Palm Beach County Health Dept. – West Palm Beach, Florida