Safety Net Providers and Safety Net Providers and Health Care Health Care

TransportationTransportation

Presented byPresented by

Oklahoma Primary Care AssociationOklahoma Primary Care AssociationHRSA/BPHC State LiaisonHRSA/BPHC State Liaison

Human Nature & Health Human Nature & Health CareCare

Health care is put on ‘back burner’ Health care is put on ‘back burner’ until neededuntil needed

Can’t schedule earaches, sore throats, Can’t schedule earaches, sore throats, etc.etc.

Risky behavior (e.g., smoking, Risky behavior (e.g., smoking, overeating) is hard to reverseovereating) is hard to reverse

Health care provision is one of first Health care provision is one of first items to get cut from personal budgetsitems to get cut from personal budgets

Oklahoma Primary Care AssociationOklahoma Primary Care Association

Oklahoma Primary Care AssociationOklahoma Primary Care Association

America’s Health Structure America’s Health Structure 20082008

Tertiary Care

Secondary Care

Primary Care

Oklahoma Primary Care AssociationOklahoma Primary Care Association

Where We Want to BeWhere We Want to Be

Tertiary Care

Secondary Care

Primary Care =PREVENTIVE

HEALTH!

Oklahoma Primary Care AssociationOklahoma Primary Care Association

Who is OPCA?Who is OPCA? Funded by Health Resources and Services Funded by Health Resources and Services

Administration (HRSA)/Bureau of Primary Administration (HRSA)/Bureau of Primary Health Care (BPHC) to assist community Health Care (BPHC) to assist community health centers (CHCs) and create a health centers (CHCs) and create a regional and state presenceregional and state presence

OPCA has hybrid membership – OPCA has hybrid membership – community health centers (CHCs), other community health centers (CHCs), other safety net providers and health advocatessafety net providers and health advocates

Mission: Mission: Strengthening access for community-Strengthening access for community-based health care through advocacy, based health care through advocacy, education, and technical assistanceeducation, and technical assistance

Oklahoma Primary Care AssociationOklahoma Primary Care Association

What are CHCs/FQHCs?What are CHCs/FQHCs?

Community Health Centers (CHCs), initially Community Health Centers (CHCs), initially referred to as “Neighborhood Health Centers,” referred to as “Neighborhood Health Centers,”

are an outgrowth of President Lyndon B. Johnson’sare an outgrowth of President Lyndon B. Johnson’sGreat Society Program,Great Society Program, in 1966. in 1966.

CHCs, receiving grant funds under Section 330 of CHCs, receiving grant funds under Section 330 of thethe

Public Health Service Act are federally mandated to Public Health Service Act are federally mandated to provide access based on affordable sliding fees for provide access based on affordable sliding fees for

anyone seeking primary health care.anyone seeking primary health care.

Note: FQHC – a deemed reimbursement status for Note: FQHC – a deemed reimbursement status for 330-funded CHCs330-funded CHCs due to greater amount of due to greater amount of mandatory uninsured servicesmandatory uninsured services

Oklahoma Primary Care AssociationOklahoma Primary Care Association

Oklahoma CHC Presence Oklahoma CHC Presence Prior to 2001Prior to 2001

Six CHC SitesSix CHC Sites

- 4 CHC grantees- 4 CHC grantees

- 2 Homeless - 2 Homeless SitesSites

CHC Grantee

Homeless Center

2008 Oklahoma CHC 2008 Oklahoma CHC PresencePresence

Over $9.5 million in CHC funds to OK since the inception of President Bush’s

Initiative!

CHC Grantee

Homeless Center

Expansion/Satellite

Oklahoma Primary Care Association

Oklahoma Primary Care AssociationOklahoma Primary Care Association

Core Elements of CHCsCore Elements of CHCsOvercoming Health Care Access BarriersOvercoming Health Care Access Barriers

Federal Resources be targeted to communities Federal Resources be targeted to communities with highest need – must serve an MUAwith highest need – must serve an MUA

Health services are available to all people Health services are available to all people regardless of regardless of abilityability to pay (sliding fee scale) to pay (sliding fee scale)

Provide comprehensive primary care enabling Provide comprehensive primary care enabling services (transportation, translation) and services (transportation, translation) and health educationhealth education

Health centers must be directed by a Health centers must be directed by a governing board of which 51% are patients of governing board of which 51% are patients of the health centerthe health center

Must meet performance & accountability Must meet performance & accountability requirementsrequirements

Oklahoma Primary Care AssociationOklahoma Primary Care Association

Who Do Oklahoma CHCs Who Do Oklahoma CHCs Serve?Serve?

By Income Level, 2006By Income Level, 2006

100% FPL and Below75.6%

101-150% 16.4%151-200%

4.0%

Over 200% 4.0%

Source: BPHC, HRSA, DHHS, 2006 Uniform Data System

Of Health Center Patients in America…

•Half reside in rural areas

•One in five low income children are served

•Over 70% have family incomes at or below poverty ($17,600 annual income for family of three – 2008 FPL)

Oklahoma Primary Care AssociationOklahoma Primary Care Association

Who Do Oklahoma CHCs Who Do Oklahoma CHCs Serve?Serve?

By Insurance Status, 2006By Insurance Status, 2006

Uninsured50.7%

Medicaid/SCHIP26.3%

Medicare11.8%

Private11.2%

Source: BPHC, HRSA, DHHS, 2006 Uniform Data System

2006 Oklahoma Health 2006 Oklahoma Health Center Population by AgeCenter Population by Age

Oklahoma Primary Care AssociationOklahoma Primary Care Association

Oklahoma Primary Care AssociationOklahoma Primary Care Association

Examples of Health Center Examples of Health Center ServicesServices

Primary Care – All AgesPrimary Care – All Ages Well ChildWell Child Well BabyWell Baby Lab, X-RayLab, X-Ray Oral HealthOral Health Mental Health/Mental Health/

Substance AbuseSubstance Abuse Pre- and Postnatal Pre- and Postnatal

CareCare Family PlanningFamily Planning PharmacyPharmacy ImmunizationsImmunizations

TranslationTranslation PreventionPrevention OutreachOutreach Home HealthHome Health Child CareChild Care Social ServicesSocial Services ReferralReferral Patient EducationPatient Education School-Based School-Based

ServicesServices Homeless Health Homeless Health

CareCare TransportationTransportation

Transportation Barriers for Transportation Barriers for Low-Income & Elderly Low-Income & Elderly

PatientsPatients Inability to afford personal Inability to afford personal

transportationtransportation- initial cost of car- initial cost of car- fuel costs and maintenance- fuel costs and maintenance

Unable to drive due to…Unable to drive due to…- vision impairment and other health - vision impairment and other health conditionsconditions- medications that prohibit driving- medications that prohibit driving

Absence of an ‘on call’ driverAbsence of an ‘on call’ driverOklahoma Primary Care AssociationOklahoma Primary Care Association

Transportation Barriers Transportation Barriers Cause…Cause…

Delay in care Delay in care - more serious illness- more serious illness- reduced quality of life - reduced quality of life - increased cost of care- increased cost of care

Inability to secure medication, social Inability to secure medication, social services, etc.services, etc.

Use of ER for non-emergent problemsUse of ER for non-emergent problems Increased medical costs for everyoneIncreased medical costs for everyone

Oklahoma Primary Care AssociationOklahoma Primary Care Association

Oklahoma Primary Care AssociationOklahoma Primary Care Association

The Driving Forces Behind The Driving Forces Behind Health Care PolicyHealth Care Policy

1.1. Cost, Cost, CostCost, Cost, Cost

2.2. Wide Variation in Health Wide Variation in Health Care DeliveryCare Delivery

3.3. Public OutcryPublic Outcry

Oklahoma Primary Care AssociationOklahoma Primary Care Association

1. 1. America’s Health Care America’s Health Care CostsCosts

Health care costs in America exceed $2 Health care costs in America exceed $2 trillion now expected to double within next trillion now expected to double within next decadedecade

The U.S. is the worldwide leader in costsThe U.S. is the worldwide leader in costs In FY2006, Medicaid and Medicare In FY2006, Medicaid and Medicare

expenditures totaled $600 billion expenditures totaled $600 billion By 2030, 50% of all federal dollars are By 2030, 50% of all federal dollars are

projected to be spent on Medicaid and projected to be spent on Medicaid and Medicare – given the current trendMedicare – given the current trend

Spending is unevenly distributed with a Spending is unevenly distributed with a reimbursement system that encourages reimbursement system that encourages ‘churning’ – 43% of ‘top 5% population in ‘churning’ – 43% of ‘top 5% population in expenditures’ is 65 years or olderexpenditures’ is 65 years or older

Oklahoma Primary Care AssociationOklahoma Primary Care Association

Health Care Costs &Health Care Costs &The Aging of AmericaThe Aging of America

Medicare populationMedicare population1960 – 16.6 million1960 – 16.6 million2050 – 78.9 million (projected)2050 – 78.9 million (projected)

While Medicare costs escalate, Social Security While Medicare costs escalate, Social Security funding mechanisms are beginning to flat linefunding mechanisms are beginning to flat line

The intersection where Medicare costs exceed The intersection where Medicare costs exceed the Social Security funding mechanism is the Social Security funding mechanism is expected just before the year 2025expected just before the year 2025

In SFY2006, 19.17% of Oklahoma Medicaid In SFY2006, 19.17% of Oklahoma Medicaid Enrollees were Aged, Blind & Disabled (ABD); Enrollees were Aged, Blind & Disabled (ABD); 59.30% of Total Expenditures were for ABD59.30% of Total Expenditures were for ABD

Transportation Issues Transportation Issues Facing Safety Net ProvidersFacing Safety Net Providers

Schedule difficulties result in ‘no shows’Schedule difficulties result in ‘no shows’ Lack of culturally-sensitive servicesLack of culturally-sensitive services Insurance rarely pays for transportationInsurance rarely pays for transportation Rural areas have no or limited public Rural areas have no or limited public

transportation options with many transportation options with many patients residing more than 30 miles patients residing more than 30 miles away from health centeraway from health center

Logistically difficult to schedule a ‘van Logistically difficult to schedule a ‘van load’ of patientsload’ of patients

Oklahoma Primary Care AssociationOklahoma Primary Care Association

What Safety Net Providers What Safety Net Providers Do to Enable Transportation Do to Enable Transportation

Offer transportation service – limited by Offer transportation service – limited by budget constraints, manpower, etc.budget constraints, manpower, etc.

Use SoonerRide when possible (3-day Use SoonerRide when possible (3-day process)process)

Connect with local community action Connect with local community action agencies for transportation solutionsagencies for transportation solutions

Offer vouchers and bus tokens to patients Offer vouchers and bus tokens to patients Develop health center sites near public Develop health center sites near public

transportation lines transportation lines Oklahoma Primary Care AssociationOklahoma Primary Care Association

What Safety Net Providers What Safety Net Providers Would Like to SeeWould Like to See

Statewide transit plan for OKStatewide transit plan for OK Dedicated funding for non-urgent Dedicated funding for non-urgent

health care transportationhealth care transportation Culturally sensitive services for all Culturally sensitive services for all

peoplepeople Increased dependability of SoonerRideIncreased dependability of SoonerRide

Oklahoma Primary Care AssociationOklahoma Primary Care Association

Oklahoma Primary Care AssociationOklahoma Primary Care Association

Questions?Questions?For further information, contact

Judy Grant, Director of Community DevelopmentOklahoma Primary Care Association

4300 N. Lincoln Blvd., Ste. 203Oklahoma City, OK 73105

(405) 424-2282Fax (405) 424-1111