Bureau of Primary Health Care Update

Vanessa Shaw, MPH, MAChief, Central Valley Branch, Southwest DivisionU.S. Department of Health and Human ServicesHealth Resources and Services AdministrationBureau of Primary Health Care

New Mexico Primary Care Association2011 Annual Meeting and Conference

June 16, 2011

National Overview• Health Center Program Performance • Primary Health Care Focus

New Mexico • Impact• Funding

Primary Health Care Updates• Organizational Structure • Policy• Funding• Quality and Data

Additional HHS and HRSA ResourcesHRSA Priorities

Today’s Presentation

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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

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Health Center Program Overview

Calendar Year 2009

73.8 Million Patient Visits 1,131 Grantees – half rural 7,900+ Service Sites

Over 123,000 Staff 9,100+ Physicians 5,700+ NPs, PA, & CNMs

Source: Uniform Data System, 2009, Service Sites: HRSA Electronic Handbooks Scope Repository 12/31/2009

18.8 Million Patients 92% At or Below 200% Poverty 38% Uninsured 63% Racial/Ethnic Minorities Over 1 Million Homeless Individuals 865,000  Migrant/Seasonal Farmworkers 165,000  Residents of Public Housing

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Health Center Program National Presence

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Health Center Program Overview

National Impact

Source: Health Center Data: Uniform Data System, 2009. National Data: U.S. Census Bureau, 2009 Current Population Reports and Current Population Survey.

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Health Center Performance Calendar Year 2009

Among Health Center Patients:

• 67.3% entered prenatal care in the first trimester• Rate of low birth weight babies (7.3%) continues to be

lower than national estimates (8.2%)• 68.8% of children received all recommended immunizations

by 2nd birthday• 63.1% Hypertensive Patients with Blood Pressure<= 140/90• 70.7% Diabetic Patients with HbA1c <= 9• $600 Total Cost per Patient • $131 per Medical Visit

For more information: http://www.bphc.hrsa.gov/policiesregulations/performancemeasures/index.html

Source: Uniform Data System, 2009 7

o Over 80% reported the overall quality of services received at the health center were “excellent” or “very good.”

o Over 80% reported that they were “very likely” to refer friends and relatives to the health center.

o Over 75% reported the main reason for “going to the health center for healthcare instead of someplace else” was because it was convenient (28%), affordable (25%), and provided quality healthcare (22%).

Health Center Performance2009 Health Center Patient

Survey

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Primary Health CareMeasures of Success

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Primary Health CareDrivers of Success

• Technical Assistance and Support

• Grantee - Project Officer Relationship

• Application Guidance and Electronic Support

• Management and Administrative Support

• Decision Support and Work Environment

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New Mexico State Health Centers

Calendar Year 2009New Mexico State Health Center

GranteesIn 2009, 15 Health Centers

Served 274,397 patients:

• 37.45% were uninsured

• 89.03% were at or below 200% of poverty

• 57.06% Female• 58.90% nationally

• 27.51% Children < age 18• 32.78% nationally

• 10.92% Seniors age 65+ • 6.89% nationally

• Served by (FTEs): – 122.96 Physicians

– 95.27 Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives

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Map and Data to be inserted

Source: Uniform Data System, 2009

New Mexico State Health CentersCalendar Year 2009

PERFORMANCEAmong New Mexico State Health

CenterPatients:• 65.08% entered prenatal care in the

1st trimester• Rate of low birth rate: 5.79%• 70.24% of children have received all

recommended immunizations by second birthday

• 77.54% Diabetic Patients with HbA1c <= 9

• 68.75% Hypertensive Patients with Blood Pressure <= 140/90

• $621.73 Cost per Patient; $153.43 per Visit

FUNDING• $37.99 M base

operational grants (FY ‘09)

• $19 M in ARRA grants• $4.96 M – Increased Demand

for Services• $12.82 M – Capital

Improvement Projects• $1.22 M - Facilities Investment

Program• 45,533 additional patients

served via ARRA• 29,319 additional uninsured

patients served via ARRA

12Source: Uniform Data System, 2009 and HRSA Health Center Quarterly Report, March 31, 2011.

Organizational StructurePolicy • Recent Program Policies• Anticipated Program Policies

Funding • American Recovery and Reinvestment Act • Affordable Care Act • Fiscal Year 2011 Funding and FY 2012 President’s Budget

Quality and Data • Medical/Health Home Initiative• FTCA and Patient Safety/Risk Management• UDS

Additional HHS and HRSA ResourcesHRSA and BPHC Priorities

Primary Health Care Updates

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Organizational Structure Updates

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Bureau of Primary Health Care

New Structure Purpose and Goals

• Build on current structure but prepare for program growth

• Promote integration of BPHC’s service delivery programs

• Improve coordination of internal and external technical assistance and training activities

• Provide increased administrative service and support for grantees and staff

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Bureau of Primary Health Care New Organizational Structure

OFFICE OF THE ASSOCIATE ADMINISTRATOR

Southwest Division

Division of National Hansen’s Disease Program

Northeast Division

North Central Division

Central Southeast Division

Office of Administrative Management

Office of Training &Technical

Assistance Coordination

Office of Policy and Program

DevelopmentOffice of

Quality and Data

Office of Special

Population Health

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New Organizational Structure:

Primary Health Care Divisions

• Transition from Three to Four Divisions

• Project Officers for:– Health Centers– State/Regional Primary Care Associations– FQHC Look-Alikes

• Technical Assistance and Support

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New Organizational Structure:

Primary Health Care Divisions

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Southwest Division Regions: 6 and 9

Division Director: Angela PowellOperations Director: Cynthia Phillips

• Five Branches:– Central Southwest Branch: Texas– Central Valley Branch: Arizona, Central

California and New Mexico– East Southwest Branch: Arkansas,

Louisiana and Oklahoma – North Pacific Branch: Nevada and

Northern California– South Pacific Branch: Southern

California, Hawaii and the Pacific Islands19

Policy Updates

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Recently Released Policies

• Process for Becoming Eligible for Medicare Reimbursement under the FQHC Benefit

• Health Center Collaboration• FINAL Federal Tort Claims Act (FTCA) Health Center

Policy Manual• HRSA Patient-Centered Medical/Health Home Initiative • HIV Testing in Health-Care Settings• Free Clinics Federal Tort Claims Act (FTCA) Program

Policy Guide

To Access these and other policies, visit:http://www.bphc.hrsa.gov/policiesregulations/policies/index.html

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2011 Anticipated Policy Topics

• FINAL Requirements for Medical Malpractice Coverage for Free Clinics (Spring 2011)

• FINAL Governance (Spring 2011)

• DRAFT Change in Scope for Non-Traditional Facilities (Spring 2011)

• DRAFT Sliding Fee Discount Program (Summer 2011)

• DRAFT Sub-Recipients/Sub-Contracts (Fall 2011)

• DRAFT Quality Improvement/Assurance (Fall 2011)

Final and draft policies open for comments will be posted at:

http://www.bphc.hrsa.gov/policiesregulations/policies/index.html

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Funding Updates

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American Recovery and Reinvestment Act Health Center

Awards to Date

• Awarded $156 million to support 127 New Access Point (NAP) grants.

• Awarded $342 million to support almost 1,130 grants for Increased Demand for Services (IDS).

• Awarded $853 million to support over 1,120 grants for Capital Improvement Program (CIP).

• Awarded $520 million to support 86 grants under the Facility Investment Program (FIP).

• Awarded $121 million for 99 grants to expand Health Information Technology (HIT).

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American Recovery and Reinvestment Act Health Center

Program Outcomes

• What have we accomplished so far? o 4.3 million patients servedo More than 2.4 million uninsured patients served

• What’s next? o 1,600+ New or Improved Health Center Siteso 650+ Health Centers with new equipment or

health information technology systemso 380+ Health Centers with new/enhanced

certified EHRs

25Source: HRSA Health Center Quarterly Report March 31, 2011

Affordable Care Act:Support for Health Centers

• The Affordable Care Act provides $11 billion in funding over the next 5 years for the operation, expansion, and construction of health centers throughout the Nation.

• $9.5 billion is targeted to: – Support ongoing health center operations.– Create new health center sites in medically

underserved areas.– Expand preventive and primary health care services,

including oral health, behavioral health, pharmacy, and/or enabling services, at existing health center sites.

• $1.5 billion will support major construction and renovation projects at community health centers nationwide.

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Affordable Care Act: Other Key Health Center

Provisions

o National Health Service Corps and Workforce Programs

o Teaching Health Centers

o School-Based Health Centers

o Negotiated Rulemaking for Shortage Designation

o Community-Based Collaborative Care Networks

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Fiscal Year 2011 Funding

The appropriation for the Health Center Program in Fiscal Year (FY) 2011 is $1.585 billion which is a $600 million reduction from FY 2010.

When combined with the Affordable Care Act funding, the overall amount available for health centers in FY 2011 is approximately $400 million above the 2010 fiscal year funding level.

Includes continued support for the 127 health center sites and more than 1,100 Increased Demand for Services grants initially established through the Recovery Act.

The U.S. Department of Health and Human Services (HHS) reviewed its operating plan and has made adjustments.

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Fiscal Year 2012 President’s Budget

$3.3 billion for Health Centers, including $96 million for FTCA coverage

$50 million for School-Based Health Center Capital grants

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Quality and Data Updates

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Patient Centered Medical/Health Home (PCMHH)

Initiative• Encourages and supports health centers to transform their

practices and participate in the PCMHH recognition process to:– improve the quality of care and outcomes for health center populations;– increase access; and – provide care in a cost effective manner.

• HRSA/BPHC will cover recognition process fees and provide technical assistance resources for practice transformation.

• Participation is strongly encouraged and provides an opportunity for health centers to achieve PCMH recognition.

For further information on the PCMHH Initiative:• PCMHH Initiative PAL:

http://www.bphc.hrsa.gov/policiesregulations/policies/pal201101.html • BPHC Helpline: bphchelpline@hrsa.gov or 1-877-974-BPHC

(2742)• PCMHH email: PCMHHinitiative@hrsa.gov

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FTCA Program Updates

• FTCA Consolidated Policy Manualo Primary source for information on FTCA grantees and

related stakeholderso Consolidates, clarifies and synthesizes existing FTCA

policy documents and statutory languageo Available at:

http://bphc.hrsa.gov/policiesregulations/policies/pin201101.html

• Application Review/Deeming in EHBo 2011 Requirements for FTCA Deeming available in PAL

2010-06: http://www.bphc.hrsa.gov/policiesregulations/policies/pal201006.html

o For TA on submitting FTCA Applications in EHB contact:

Email: BPHCHelpline@hrsa.gov Phone: 1-877-974-2742

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ECRI risk management and patient safety resources are available to Health Center Program grantees and Free Clinics at no cost.  Resources include:

• Risk management courses• Continuing medical education (CME) credits at no cost to

health care providers• Links to archived audio-conferences/webinars to

supplement evidence-based risk management training• Guidance articles, self-assessment tools, ready-made

training materials on patient safety, quality and risk management for the health center and free clinic setting

• Risk & Safety E-news

Visit: www.ecri.org/clinical_RM_program. 

Risk Management and Patient Safety Web

Resources

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2011 UDS Reporting

New/revised 2011 clinical measures approved January 3, 2011.

New Measures: 1. Weight Assessment and Counseling for Children and

Adolescents2. Adult Weight Screening and Follow-up3. Tobacco Use Assessment and Cessation Counseling 4. Asthma – Pharmacological therapy

Revised Measures:1. Diabetes HbA1c Control2. Childhood Immunizations 2 years

Review PAL 2010-12 for additional details:

http://www.bphc.hrsa.gov/policiesregulations/policies/pdfs/pal201012.pdf

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UDS Website: http://www.hrsa.gov/data-statistics/health-center-data/index.html.

o Data analysis toolso Data download functionality

• UDS Grantee/State/National Summaries• Health Center Trend Reports• State and National Roll-up Reports• Reporting and Training Resources

UDS Mapper: www.udsmapper.org• HRSA has developed a mapping and support tool driven

primarily from data within the Uniform Data System (UDS)• Webinar trainings on using Mapper functionality available:

http://www.udsmapper.org/webinars.cfm

UDS Web Tools

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Additional HHS and HRSA Resources

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New HHS-supported public-private partnership that will help improve the quality, safety and affordability of health care for all Americans. 

Goals:• Keep patients from getting injured or sicker.• Help patients heal without complication.

Partners include:• Hospitals and national organizations representing

physicians and nurses; • Patient and consumer organizations; and• Employers, unions, health plans and States.

For more information visit: www.HealthCare.gov/center/programs/partnership

Partnership for Patients: Better Care, Lower Costs

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Technical Assistance (TA) Resources

• National and state-based support for training and technical assistance:oPrimary Care AssociationsoPrimary Care OfficesoNational Cooperative Agreements

• Federal TA Support:• Project Officer• TA Calls/Trainings• Onsite Consultant Support• BPHC TA Website

For more information visit the NEW BPHC TA Website: http://www.bphc.hrsa.gov/technicalassistance/index.html

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Competing and Non-Competing Continuation

Technical Assistance

• Budget Period Progress Report (BPR) Technical Assistance:

http://www.bphc.hrsa.gov/policiesregulations/continuation/index.html

• Service Area Competition (SAC) Technical Assistance:

http://www.hrsa.gov/grants/apply/assistance/sac/

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Bureau of Primary Health Care

Help Line

Single point of contact to assist grantees and stakeholders with information in the following areas:

• BHCMIS – System in EHB (Electronic Handbook) • Health Center Quarterly Reporting (HCQR)/ARRA 1512 • Reporting Uniform Data System (UDS) • Federal Torts Claims Act (FTCA) for Health Centers and

Free Clinics

Phone: 1-877-974-BPHC (2742) Email: bphchelpline@hrsa.gov.

Available Monday to Friday (excluding Federal holidays), from 8:30 AM – 5:30 PM (ET), with extra hours available

during high volume periods.

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HRSA’s Electronic Handbooks (EHBs)

• Grantees must electronically submit requests to change grant-related information (Prior Approval requests) and post award submissions (Conditions and Reporting Requirements) to HRSA through the EHBso HRSA will review and approve/disapprove requests through EHBs o Automated notifications will facilitate review and approval processes

• All members of the grantee organization who are responsible for submitting prior approval requests or other post award submissions must register in the HRSA EHBso Go to https://grants.hrsa.gov/webexternal/login.aspo If you have registered before, you do not have to register again. o Contact the HRSA Call Center if you do not remember your username or password

Phone: 877-Go4-HRSA/877-464-4772;301-998-7373 (9:00 AM to 5:30 PM ET M-F)

HRSA Electronic Handbooks URL: https://grants.hrsa.gov/webexternal/home.asp

Email: callcenter@hrsa.gov

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HRSA Priorities

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FY 2011 HRSA Strategic Priorities

• Improve Access to Quality Health Care and Services– Community/new site development– Expansion planning– Patient-centered medical/health home

development

• Strengthen the Health Workforce– Workforce recruitment and retention– Meaningful use adoption

• Build Healthy Communities and Improve Health Equity

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Health Center Program Overview

Calendar Year 2016

Million Patient Visits Grantees – rural Service Sites

Over Staff Physicians NPs, PA, & CNMs

Source: Uniform Data System, 2016

Million Patients % At or Below 200% Poverty % Uninsured % Racial/Ethnic Minorities Homeless Individuals  Migrant/Seasonal Farmworkers  Residents of Public Housing

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Thank You!

Questions?

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Vanessa Shaw, MPH, MAChief, Central Valley Branch, Southwest DivisionU.S. Department of Health and Human ServicesHealth Resources and Services Administration

Bureau of Primary Health Care 5600 Fishers Lane Rm. 16C-26

Rockville, MD 20857Telephone: 301.594.4282Email: vshaw@hrsa.gov

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