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The Health Center Program
Judith Steinberg, MD, MPHChief Medical OfficerBureau of Primary Health Care (BPHC)Health Resources and Services Administration (HRSA)
MassLeague of Community Health CentersCommunity Health Institute, 2017
May 3, 2017
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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Key Strategies
Increase access to primary health
care services
Modernize primary care infrastructure and systems
Improve health outcomes
Promote performance-
driven, innovative
organizations
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Increase Impact of Health Center Program
Increase AccessNational Impact
Source: Uniform Data System, 2015. National Data: U.S. Census Bureau, 2015 Population Estimates
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Increase AccessNational Impact
Source: Uniform Data System, 2015. National Data: U.S. Census Bureau, 2015 Population Estimates
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Increase AccessProgram Growth
Source: Uniform Data System, 2008-2015. HRSA Electronic Handbooks, 2008-2015.
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17
18
19
20
21
22
23
24
25
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Mill
ion
s
Patients
2008 2010 2013 2015Growth from 2008-2015
(% Increase)
Patients 17,122,535 19,469,467 21,726,965 24,295,9467,173,411 (41.9%)
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Increase AccessProgram Growth
7
1000
1050
1100
1150
1200
1250
1300
1350
1400
1450
1500Grantees
2008 2010 2013 2015Growth from 2008-2015
(% Increase)
Grantees 1,080 1,124 1,202 1,375295
(27.3%)
Source: Uniform Data System, 2008-2015. HRSA Electronic Handbooks, 2008-2015.
Modernize and Improve Primary Care Delivery
EHR Adoption
No EHR2% Some
Sites6%
All Sites
92%
2015
Patient Centered Medical Home
Source: Uniform Data System, 2010 and 2015. AIU = Adoption, Implementation, Upgrade.
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Over 1,020 (74%) of health centers are participating in Health Center
Controlled Networks
No PCMH
Recognition
32%
PCMH
Recognized
68%
2016
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Improve Health Outcomes and Reduce Health Disparities
Perinatal Measures
8.0%17.6%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
9.0%
10.0%
NationalEstimates
UDS 2015
Low Birth Weight Babies
71.0%273.0%
60.0%
65.0%
70.0%
75.0%
80.0%
NationalEstimates
UDS 2015
Patients Entering Prenatal Care in the First Trimester
Source: 1National Vital Statistics Report. Birth: Final Data for 2014. Vol. 64, No 12, December 23, 2015.2National Vital Statistics Report. Expanded Data from the New Birth Certificate, 2008. Vol. 59, No.7, July 27, 2011.
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Improve Health Outcomes and Reduce Health Disparities
Chronic Disease Management
53.0%1
63.8%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
National Average UDS 2015
Adults with Hypertension whose Blood Pressure is Under Control
54.4%2
70.2%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
National Average UDS 2015
Diabetic Patients whose Diabetes is Under Control
Source:1NCHS Data Brief. Hypertension Prevalence and Control Among Adults. No. 220, November 2015.2National Committee on Quality Assurance. The State of Health Care Quality 2014.
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Improve Health Outcomes and Reduce Health Disparities
Preventive Services
68.4%1
71.6%2
77.5%
62.0%
64.0%
66.0%
68.0%
70.0%
72.0%
74.0%
76.0%
78.0%
80.0%
HP2020 Baseline National Average UDS 2015
Percentage of Children Ages 19-35 Months who Receive Immunizations
Source:1National Immunization Survey (NIS), CDC/NCIRD and CDC/NCHS, 2012.2National Immunization Survey (NIS), CDC/NCIRD and CDC/NCHS, 2014.
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Colorectal Cancer (CRC) Screening: 80% by 2018 Public Health Campaign
CRC Screening by PCMH National Partnerships
• National Colorectal Cancer Roundtable TA resources
1. EHR Best Practice Workflow and Documentation Guide
2. 80% by 2018 Communications Guidebook to reach the unscreened
3. American Cancer Society CRC Health Center Learning Collaborative in New England and West Virginia
38.7%
32.4%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
CRC ScreeningRates
PCMH
No PCMH
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Promote Innovative Organizations
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Integrate with Primary Care:
Focus Area FundingOpportunity
Awards Amount
BehavioralHealth
Mental Health Service
Expansion
433 $105.8 M
Substance Use
Substance Abuse Service
Expansion
271 $94 M
Oral Health Oral Health Service
Expansion
420 $155.9 M
HIV/Public Health
Partnerships for Care
22 $30 M
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Successes:
• Hiring BH staff
• Staff training/education
• Policies/procedures
• Huddles for team based care
• Integrating EHR
• Expanding into addiction services
Challenges:
• Recruitment/retention BHCs
• Lack of desired competencies for BHI
• Lack of bilingual staff
• Partnering with professional schools
• Mental health stigma
• Lack of resources re: autism
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Behavioral Health Integration
RESOURCE: The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS)Health Center Depression Screening Innovation CommunityMonthly roundtable discussionsResources, webinars, direct TA
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Substance Abuse Service Expansion (SASE)
• Progress at 9 months: • 92% have at least one provider with Drug Addiction Treatment Act
(DATA) Waiver
• 50% have increased the number of providers with DATA Waiver
• 67% increase in DATA Waivers
• 15,000 patients received MAT
• Resources:• Opioid Addiction Treatment ECHO
• Substance Abuse Warmlines
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Facilitators• Language interpretation
• SBIRT integrated in EHR
• Shared medical appointments for transitional age youth
• Support groups for young adults
• Use of telemedicine
Challenges• Recruitment/retention
• DATA waiver training not widely available for NPs and PAs
• State regulatory restrictions on MAT
• Coordinating and managing workflow for MAT
• Coordinating with internal and external partners
• Confidentiality and release of records from external treatment facilities
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Substance Abuse Service Expansion
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Behavioral Health and Substance Abuse Services Integration
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0
500,000
1,000,000
1,500,000
2,000,000
2007 2008 2009 2010 2011 2012 2013 2014 2015
Nu
mb
er o
f Pa
tien
ts
Years
Health Center Mental Health and Substance Use Patients 2007-2015 (UDS)
• Mental health patients increased by 19% from 2014 to 2015
• Mental health personnel increased by 22% from 2014 (6,372 FTEs) to 2015 (7,780 FTEs)
• Depression screenings and follow up for patients increased by nearly 12%from 2014 (38.8%) to 2015 (50.6%)
38.8%
50.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
2014 2015
DepressionScreening
Oral Health Integration
Investments to Increase Access to Oral Health:
• Oral Health Services Expansion (OHSE) • $156 Million supporting 420 Health Centers
• 1,600 new dentists, dental hygienists, assistants, technicians to serve nearly 785,000 new patients
• Increase access to oral health care services and improve oral health outcomes
• Oral Health T/TA National Cooperative Agreement (NCA)• National Network for Oral Health Access (NNOHA)
• T/TA for health centers to provide new high quality oral health services, enhance quality of oral health services, report on oral health care quality
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Oral Health Integration
• 90% health centers provide preventive dental services either directly or via contract
• In 2015, 13.2M dental visits were provided with an increase of 42% since 2010
• 5.2M dental patients were served in 2015 with an increase of 38% since 2010
• 4,108 dentists and 1,921dental hygienists work at health centers
• HRSA UDS Dental Sealant Measure in 2015, achieved 42.4%, exceeding HP2020 goal of 28.1%
Source: HRSA Uniform Data System (UDS)
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0
2
4
6
8
10
12
14
2010 2011 2012 2013 2014 2015
Mill
ion
Health Center Dental Patients and Visits from 2010-2015
# of Patients
# of Visits
UDS 2015 Dental Sealants Measure
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Numerator 121,312
Denominator 285,799
% 42.5%
25.5
42.5
0
5
10
15
20
25
30
35
40
45
HP2020 Baseline UDS 2015
Dental Sealants Measure, %
HP2020 Goal – 28.1
Percentage of children, age 6-9 years of age, at moderate to high caries risk, who received a dental sealant on a first permanent molar during the measurement period.
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Primary Care HIV Integration
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Partnerships for Care (P4C) Health Centers have:
• Improved HIV testing and care capacity
• Established multidisciplinary HIV care teams
• Enhanced EHR and trained HIV care teams
• Developed partnerships with local and state entities
for enabling services and linkage/ re-engagement in
care
1.3 million patients tested for HIV
155,000 HIV patients served at over 630,600 visits
74.7% of HIV patients linked to care
In 2015, HRSA-funded health centers continued working to increase access and improve health outcomes for patients living with HIV
4 State Health Departments in FL, MA, MD, NY
22 Health Centers across the 4 states
One Training and Technical Assistance Contractor
Federal Partners across Department of Health and Human Services
PrEP Service Delivery by Health Centers
• Developed and disseminated HIV PrEP Health Center Technical Assistance Resource
• BPHC supports adopting PrEP into clinical practice for at risk patients as part of routine primary care
• Health Center Program/ Section 330 funding can be used for PrEP, including medication and health center visits for follow-up and related services
• Offered services must be provided in accordance with applicable clinical guidelines regardless of insurance status and/or ability to pay
• Working with partners to support PrEP training and technical assistance
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Public Health and Primary Care Integration
• Emergent public health issues, examples:• Zika virus infection
• Opioid epidemic
• Social Determinants of Health Academy
• Partnership for Care
Health Centers Respond to their Community
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Health Center Workforce
• Health Center Workforce Workgroup
• National Cooperative Agreements:• CHC Inc
• Association of Clinicians for the Underserved
• Collaborations with Bureau of Health Workforce, Federal Office of Rural Health Policy
• FTCA coverage for health center volunteer health professionals
• Telehealth
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Preparing for New Payment and Delivery Models
• Demonstrate impact:• Access
• Quality of care
• Cost-effectiveness
• Population management
• Getting there:• QI, performance management
• Optimization of HIT/HIE
• Expertise with most complex populations
• Care integration
• Addressing social determinants of health
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BPHC Key Strategies Prepare Health Centers
Health Center Controlled Network Accomplishments
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83.8 81.9
63.2
54.7
74.0
28.8
99.0 98.8
73.468.1
97.3
81.2
0
20
40
60
80
100
ONC certifiedEHRs
EPs usingEHRs
EPs attestingto MU
EPs receivingMU payments
HCs meetingat least oneHP2020 goal
HCs withPCMH
recognitionstatus
HCCN Baseline YR 3 Closeout
%
Source: FO HRSA-13-237, HCCN awardees, final report
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Health Information Exchange and Patient Engagement
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57.7
68.0
75.7
86.4
51.3
59.3 57.3
67.3
0
20
40
60
80
100
2014 2015 2014 2015
Health Info Exchange Patient Engagement using HIT
HCCN No Network
%
Source: UDS 2014 and UDS 2015
Looking Ahead
• Priority areas• Opioid epidemic/substance abuse treatment services• Mental health• Childhood Obesity
HRSA/BPHC • Care integration/Social determinants of health• Coordinated strategy to improve diabetes control• Intimate partner violence strategy• UDS Modernization• New Compliance Manual, Change in Scope, Operational
Site Visits• Enhance bi-directional communication with health
center clinicians
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Role of State, Regional, and National Partners
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Local
Regional
Federal
State
Health Centers
PCAs HCCNs
NCAs
BPHC and Federal Partners
Health Center Program Resources
BPHC Helpline: www.hrsa.gov/about/contact/bphc EHB questions/issues FTCA inquiries
BPHC Project Officer: Address specific questions about your health center’s grant or look-alike
designation
National Cooperative Agreements & Primary Care Associations: bphc.hrsa.gov/qualityimprovement/strategicpartnerships
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Website: www.bphc.hrsa.gov Includes many Technical Assistance (TA)
resources
Weekly E-Newsletter: Primary Health Care Digest Sign up online to receive up-to-date
information
5/2/2017
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Thank You!
Judith Steinberg, MD, MPH
Bureau of Primary Health Care (BPHC)
Health Resources and Services Administration (HRSA)
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301 594 4110
www.bphc.hrsa.gov
facebook.com/HHS.HRSA@HRSAgov